Cooksons Court

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 84 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a strong proactive and positive culture of safety, based on openness and complete honesty. Staff actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice

The managerial team fostered a culture of learning; they regularly reviewed accidents and incidents to check for any themes or trends. All incidents were investigated fully, and staff were updated on findings and improvements that could be made to keep people safe. There was a robust system in place for reporting all incidents and staff told us they had no concerns reporting safety events. Examples of how learning had a positive impact for people was shared with us. During the summer months it was noted by the provider that there was an increase in urine infections. To address this an increase in water stations were put in place across the home. Where bedrooms were further away from a kitchenette. Staff had additional training to raise awareness about the risks of dehydration through the NHS. A shared learning system is in place so learning can be shared across other homes. The provider also added more information on their care planning system to assist staff to understand more about mobility and how best to support someone with mobility needs. Learning is part of their everyday practice and is used to high light issues and improve the service for people.

The provider always worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care, including when people moved between different services.

The provider shared some examples of how they managed referrals into the home. There was clear guidance and policies in place. In one case a person was referred with very specialist support needs, initially the provider could not meet those needs, however, following discussion the provider worked closely with the hospital team to create a safe pathway. The hospital agreed to continue caring for the person until the team had completed the specialist clinical training required. Once the training and competency had been completed and the service was confident, they could safely meet their needs, they were admitted to the home. As a result, the family were very grateful for the lengths the home went to that and another relative was also admitted to the home. There was a significant positive impact on the family as a unit.

Due to this success the home is now working with another hospital to obtain further training for staff to be able to offer this additional procedure to other people if required.

Care plans reviewed showed the provider worked closely with a range of health care professionals. Care records were regularly reviewed and updated with any changes. When people needed to go into hospital or other care settings the provider was able to pass on information accurately and efficiently. This meant that people could be confident their care needs could be met in a different care setting if required.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. Everyone we spoke with told us they felt safe. Staff told us how to safeguard and protect people from risk of harm or abuse. The provider understood the importance of raising any concerns about safeguarding with the local authority when needed. There was a clear process in place to ensure people were protected from harm or abuse.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In [care homes/hospitals], this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service.

We found where people needed to be deprived of their liberty to keep them safe, the provider ensured a Deprivation of liberty Safeguard (DoLS) authorisation was applied for through the relevant local authority. All legal applications had been made in accordance with DoLS, this meant people’s rights were fully respected.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.Care records reviewed showed that risks identified were mitigated, for example, people at risks of falls, had sensor and crash mats in their bedrooms. Although the provider had guidance in care plans for staff to follow. We found some of the guidance for catheter care was not available in each care plan. However, the provider informed us that there was extensive guidance in their policy documents which staff had full access to and used on a regular basis. Following our feedback on day 1 the provider did update catheter care plans which were more personalised.

People and relatives told us they were involved in their care plans and reviews. Risks identified were mitigated by the provider and control measures were in place. For example, equipment such as crash mats and sensor mats were used to keep people at risk of falls safe, alerting staff to their movements so they could respond quickly.

People and relatives told us they felt safe, one relative said, “My [relative] has been there years, and I have never had to worry about her safety.” And another relative said, “I feel sure they are safe, when they were at home with 4 lots of carers they had numerous falls sometimes 5 times a week and they have not had one here.” The provider shared some examples of how people take positive risks which enables them to remain independent. For example, people can access the community independently once a risk assessment has been completed and it is safe to do so. Other people may use the garden and take actions were needed to ensure they are safe. The provider encouraged people to take positive safe risks as appropriate.

The provider was fully aware of all potential risks in the care environment and controlled them well. They made sure equipment, facilities and technology supported the delivery of safe care. During our visit we observed the care home environment to be safe and free from hazards. The home was spotless clean and well maintained. All equipment was well maintained, clean stored securely and used correctly. The home had adaptations to enable people to move around free from obstructions. The premises was purpose built which helped to meet people’s needs. There were effective fire safety procedures in place to keep people safe. Health and safety audits of the environment were completed on a regular basis. Concerns were addressed swiftly when identified. People and relatives told us the home was safe, clean and comfortable.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. Staff were vetted prior to taking up their role. For example, references were obtained from previous employers and criminal background checks were carried out. Staff had training in a range of subject areas, this meant they could carry out their roles effectively. The managerial team also supported staff training informally for example, holding sessions on end-of-life care. People could be confident they were supported by well-trained competent staff. During our visit we observed there was enough qualified and experienced staff on duty to meet people’s needs. One relative told us, “They seem to have [enough staff], and at night she says they come quickly.” And another relative said, “Yes, I can’t say about night or weekends as I am not there, but [relative] says they come as soon as they know he needs them.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The home was clean and tidy. Staff used personal protective clothing when needed for example, gloves and aprons. This meant people were protected from the spread of infection. Cleaning schedules were in place and followed by staff. Regular health and safety audits included infection prevention and control, this meant all concerns could be addressed quickly. Relatives told us the home was clean, one person’s relative said, “[Relative] is very impressed with the cleanliness, about monthly they do a deep clean, raising the bed and cleaning it underneath”. Another person’s relative said, “[Relative] is very impressed with the cleanliness.”

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.People received their medicines safely in the way prescribed for them, and they were asked if they needed any ‘when required’ medicines. Some people looked after some of their own medicines after it had been assessed as safe for them to do this. There were suitable arrangements for ordering, storage and disposal, including for medicines needing cold storage and hose requiring extra security. Temperature monitoring was carried out to ensure medicines would be safe and effective. If medicines were prescribed to be taken ‘when required’ there were person- centred protocols or care plans in place to guide staff when these might be needed. Records were in place to show that risks were considered for people using higher-risk medicines such as anticoagulants, and flammable topical preparations. Staff had regular training and competency checks to make sure they gave medicines safely. Any errors or incidents were investigated and reported, so that systems could be put in place to prevent them recurring. Regular medicines audits took place which identified improvements that were needed, and actions were
recorded. Relatives told us that medicines were given to people if they were in pain for example, one relative said, “[Relative] is on regular pain killers, and they give her extra if needed.”