Crystal Caring

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 changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. We identified a breach of the legal regulation in relation to safeguarding people from abuse and improper treatment.

This service scored 59 (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 did not always have a proactive and positive culture of safety based on openness and honesty. They did not always listen to concerns about safety and did not investigate or report safety events. Lessons were not always learnt to continually identify and embed good practice. For example, there was an incident recorded where a person had reported they sustained a minor injury whilst being supported by staff to use a piece of equipment. There was no evidence the provider had taken any action to investigate how this occurred, or any actions taken as a result to reduce the risk of this happening again. Additionally, a staff member had raised a concern about a person experiencing regular falls, but there was no recorded evidence of any actions taken in response to this to reduce the risk of re-occurrence. However, people and relatives did not raise any concerns about how lessons were learned following incidents. The manager provided an example of how they had previously learnt from an incident and told us, “We all want to do good."

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. The provider had processes in place to support the safe transitions into other services, which included information about people’s needs, likes and dislikes, and any other important information. This also included a separate document containing any clinical records. There was an admissions and discharge policy in place regarding transfers to and from hospital which was appropriate for the service.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately. We identified multiple recorded incidents which had not been appropriately addressed. For example, staff had recorded they had observed a person had head injuries on three separate occasions. There was no recorded evidence to show the provider had involved or supported the person to fully safeguard themselves, including seeking an appropriate level of medical treatment. Additionally, we found staff had recorded they had observed bruising for another person. The manager explained this was a result of the person’s lifestyle, however, there was no clear process in place or actions recorded to ensure this person was safeguarded from abuse. However, people told us they felt safe. Staff had completed training in safeguarding and understood the signs of abuse to look out for.

The provider did not always work well with people to understand and manage risks. People had information in their care plans about how to manage risks, however there were some risk assessments which were not in place, for example for those at the risk of choking and pressure injuries. This meant these risks could not be formally reviewed to ensure they were accurate and up to date. We raised this with the manager during our onsite visit and the manager addressed this on the same day. We identified incidents where appropriate action had not always been taken, including involving people to manage any risks. However, people and relatives did not raise any concerns about the way people’s risks were managed. Staff told us they had enough information to manage risks safely.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. People had risk assessments in place to support the management of risks within their environment, such as living alone, the use of equipment and adverse weather conditions. People told us the provider supported them to obtain any equipment they may need through the local authority. There was a health and safety policy in place which was relevant to the service and was being followed, for example by ensuring health and safety risk assessments were in place and ensuring staff had been trained in topics relating to health and safety. The manager told us fire safety checks for the office were completed annually by the building manager and also explained a health and safety inspection takes place every year by an external company to ensure compliance.

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 told us they received regular support from leaders. One staff member told us, “Crystal Caring Limited is a very supportive company that I will recommend to anyone at any time”. Staff were recruited safely, however, we identified some gaps in a staff member’s employment history had not been fully explored. Following this feedback, the manager addressed this. People and their relatives spoke positively about staff. People and their relatives told us that staff were sometimes late but understood the reasons for this and told us they were usually informed if this was going to happen. Staff had received a training relevant to their role. One staff member told us, “Crystal Caring use one of the best health care training platforms in the UK, both online and face to face, they provided all materials and support for training”.

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. People told us staff used personal protective equipment (PPE) when providing care and support. Staff were able to tell us about appropriate infection control practices and had completed online training in infection control. There was an infection control policy and procedures in place.

The provider did not always make sure that medicines were managed safely. Medicine Administration Records (MARs) showed some medicines had not been signed for in line with the prescribing instructions. There was no evidence to indicate people had missed any medicine doses, and was most likely a recording error. In addition, the provider’s audits had not always identified these and there were no recorded actions to improve practice. The provider’s audits also stated some medicines used to treat infections had been applied as a ‘when required’ (PRN) medicine which was not in line with the prescribing instructions. There was no evidence this had been followed up with staff to ensure medicines were being managed safely and to protect people from harm. We raised this with the manager who told us they have now implemented a new auditing system to allow better oversight. However, people had PRN protocols in place where appropriate. There were risk assessments in place for medicines which required these, such as blood thinning medicines. People and their relatives’ felt medicines were managed safely. Staff had received training in medicines including an observation from leaders to check competency.