Viera Gray House

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 requires improvement. At this assessment the rating has changed to good. This meant people were now safe and protected from avoidable harm.

This service scored 69 (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 proactive and positive culture of safety, based on openness and honesty. Managers and staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

There was a learning culture and focus on safety at the service. Managers and staff understood the importance of reporting safety concerns and learning lessons when things went wrong. Systems were in place to support staff to report and record safety concerns and events when these arose. Managers investigated safety concerns and events and used the learning from these to support staff to continually improve their practice, reduce risk and keep people safe.

For example, managers and staff regularly met to discuss improvements at the service, and to people’s care and support. Incidents were collectively reviewed, and learning was shared through team meetings, handovers and supervision.

An external care professional gave us a good example of how the provider learnt lessons. They said, “There was a period last year (2024) where there were some medication errors. The managers worked well with the local authority through our safeguarding processes to promptly address these issues and make changes to reduce the risk of similar mistakes reoccurring. No medicine errors have occurred since.” Another external care professional added, “The provider is quick to identify when they have made a mistake and will take actions accordingly, and I feel that they are open and willing to learn from incidents.”

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.

People safely transitioned into the service. People’s needs, risks and preferences were assessed before they received a service. This was to ensure the provider could safely meet people’s needs. These were reflected in care plans which provided staff with guidance on meeting people’s needs. A relative told us, “Before my [family member] moved in she was initially assessed, which was very thorough and covered all areas. An external care professional added, “They [The provider] are now much better at taking more steps and precautions when assessing prospective new service users as part of the admissions process to ensure they can safely meet the person’s needs.”

The provider worked with people and external health and social care 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.

Managers and staff understood how to safeguard people. They knew how to recognise and report abuse and were able to articulate how they would spot signs if people were at risk of abuse or harm. A member of staff told us, “I would not hesitate to report any abuse or neglect I might see here straight away to the manager or senior staff in-charge.” People told us they felt safe living at the care home. One person said, “I do feel safe here.” A relative added, “I would feel confident that management and staff would deal with any issue of abuse or neglect.”

Managers worked proactively with the relevant external health and social agencies, when a concern was raised, and took appropriate action to safeguard people from further risk, when this was required. An external care professional told us, “There has been a decline is safeguarding activity. When we do have concerns, they are responsive and proactive. They always take timely action to report, investigate and learn lessons to mitigate safeguarding incidents happening again.”

The service was working within the principles of the Mental Capacity Act 2005 (MCA). Staff understood people’s capacity to make decisions about the care and support they received. Managers and staff had received up to date safeguarding, mental capacity and Deprivation of Liberty Safeguards (DoLS) training.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risk assessments were completed for people and updated regularly. However, we did find there were instances where staff were not always following recommendations. We saw a care plan which had specific care instructions that were not followed, for example the use of a crash mat and sensor was not observed to be in use as documented in the risk assessment. We observed this person sleeping in their room and the sensor and crash mat were not plugged in and placed under the bed.

We discussed this issue with managers and staff at the time of this inspection who acknowledged this was a failure and took immediate action to address the matter. We were assured that this was an oversight as crash mats and sensor mats were in place for other people.

This issue notwithstanding risk assessments had been carried out which covered peoples nutritional, mobility/falls and tissue viability needs, for example. Where people had been identified at being at high risk, management plans to reduce the risk were included in associated care plans. These included management plans with respect to supporting people likely to express distress.

We observed people could move freely around the care home and spent their time as they wished, with no unnecessary restrictions. Staff were aware of where people were and remained present and available in case people required their assistance. Typical feedback we received from relatives was positive regarding the management of risk and included, “The staff know what risks my relative presents which they manage professionally and sympathetically”, “I was very happy to see staff are fully aware of how my [family members] dementia is evolving and know how to meet those changing needs” and “Staff ensure my [family member] is checked hourly at night and has a crash mat near their bed to keep them safe if they fall as agreed in their care plan.”

Feedback we received from external care professionals was equally complimentary about how staff prevented and managed risk. For example, one said, “I feel the staff are well-versed in assessing and managing risk and often seek guidance from external care teams to help them keep our clients safe."

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 lived in an environment which was homely and comfortable. The provider had undertaken renovations in the home to enhance the living experience for our residents. This included taking steps to make the environment more ‘dementia friendly’, by using colour contrasting doors. Each bedroom consisted of an ensuite wet room, featuring an accessible walk-in shower.

People told us the care homes physical environment was safe and always kept clean. People told us the care home was a comfortable place to live. An external care professional said, “There’s a very welcoming environment at the care home which feels “homely”. I identified lots of positive environmental adaptations at the service which supported people living with dementia to safely navigate their home environment.”

The environment was kept free of obstacles and trip hazards which enabled people to move safely around the care home. Cleaning staff were a visible presence in the care home, maintaining the environment to a good standard of hygiene.

Regular checks were completed by the provider to maintain the safety of the care home’s physical environment. These included regular health and safety checks on the homes electrical, gas and water systems, and equipment used to support people, such as mobile hoists and wheelchairs. Regular fire drills and fire prevention checklists were also completed, including fire door, emergency lighting and firefighting equipment. A fire risk assessment had recently been completed in December 2024 and was satisfactory. Regular health and safety checks were also completed on the homes physical environment.

The provider did not always make sure staff received effective support, supervision and development. However, the provider did made sure there were enough qualified, skilled and experienced staff who worked together well to provide safe care that met people’s individual needs.

Staff did not always have enough ongoing opportunities to reflect on their working practices and to identify any further training, learning or support they might need. This was because staff had not had their overall work performance appraised for over 12 months contrary to recognised best care practice and the providers own staff appraisal procedures.

We discussed this issue with the registered manager at the time of our inspection. They were aware of this failure and had identified this issue using audits and developed a time specific action plan to address overdue staff appraisals by the end of May 2025.

This issue notwithstanding, staff did have regular individual and group meetings with their fellow peers and line managers. The provider operated safe recruitment practices and only fit and suitable staff were employed to work at the care home.Staffing levels matched the staff duty rota on the day of our site visit. Staff were visibly present throughout this assessment and were quick to respond to people’s questions and requests for support. For example, we saw several instances of staff responding promptly to people who had activated their call bell alarm. Staff were also vigilant when people were moving around the care home. People told us the care home was adequately staffed. One person said, “There is enough staff working here and they’re usually quick to come and help me whenever I call them.” A relative added, “Whenever I visit, staff are present and visible.”

Staff were well-trained to meet people’s individual needs, in line with their choices and preferences and encouraged to continually improve in their role. Staff received a mixture of e-learning and in-person practical and theoretical training, which was routinely refreshed as frequently as staff required it including, competency-based assessments.

We received only positive feedback from people about staff competencies. Typical comments included, “The staff seem well-trained and are always compassionate, patient and kind to my [family member]”, “I think the staff are absolutely brilliant at their jobs, so I can only assume they’ve been well-trained” and “When I trained the staff they were very engaged, clearly already had a lot of knowledge and were keen to learn more”. Staff were equally complimentary about the training they received. A member of staff said, “We have lots of ongoing training so are knowledge and skills always remain up to date and relevant.”

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 were supported to live in a clean, hygienic environment.

People lived in a clean, hygienic environment. The care home was clean and was free from offensive odours. An external care professional told us, “Based on observations when visiting the care home, it always appears to be clean and tidy.” Staff had received relevant infection control and food hygiene training, which meant they knew the processes to follow to minimise the risk and spread of infection. We observed domestic staff were visible throughout the care home on the day of this inspection conducting their cleaning duties. They maintained cleaning records to provide a clear audit trail of measures taken to reduce infection risks.

Staff had access to resources and equipment to help them reduce infection risks. People told us staff wore appropriate personal protective equipment [PPE] when they supported them with any personal care. We observed hand-gel stations were available throughout the care home, including the entrance and handwashing instructions were displayed in communal areas to encourage proper hygiene. The home had a food hygiene rating of 5 which indicated good food hygiene. The provider’s infection prevention and control policy was current and reflected national guidance.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Medicines systems were well-organised and safely managed. Medicines stocks, balances and records showed people consistently received their prescribed medicines as and when they should. People confirmed they received their medicines as they were prescribed. A relative told us, “The way they [staff] now manage my [family members] medicine has improved, as this wasn’t so safe in the past. “An external community medical professional added, “We found the staff to be always professional and their practice good when handling peoples prescribed medicines.” Medication Administration Records (MAR) were in date and signed by staff. Controlled medicines were audited and signed off by two staff members in line with good practice. Medicines were stored correctly in lockable cabinets and were in date and labelled correctly. Temperatures of medicines storage facilities were taken which helped to assure that medicines were stored in line with the recommended guidelines.

Care plans included detailed guidance for staff about how people needed and preferred their medicines to be administered. Staff received relevant training and their competency to continue managing medicines safely was routinely assessed. Staff were clear about their roles and responsibilities in relation to the safe management and administration of medicines, including controlled drugs, covert and ‘as required’ medicines. We observed staff administering medicines in a safe way. There were regular audits of medicines at the service. This included regular checks of staff’s practice to ensure they remained competent to administer and manage peoples prescribed medicines safely.