Christopher Grange Rhona 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 people were protected from abuse and avoidable harm. This is the first assessment for this newly registered service. This key question has been rated 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 people could be harmed. The provider was in breach of legal regulation in relation to people’s safe care and treatment.

This service scored 56 (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. There was a system in place to record and report accidents and incidents, however, no analysis of incidents had taken place. This meant there were missed opportunities to identify themes and trends to learn lessons and put measures in place to reduce the risk of harm. We raised this with the management team and were told systems had been introduced in the last couple of weeks, however, there was no evidence available to demonstrate this new system had been used to improve safety. We were assured appropriate actions had taken following incidents occurring, for example, records demonstrated medical assistance had been sought for people following falls. However, in some cases people’s care plans and risk assessments were not always updated in a timely manner.

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. Some people stayed at Christopher Grange Rhona House on a temporary basis. Important information about their care needs was assessed and the nursing team maintained close relationships with other health partners which ensured a positive experience for people. Records were in place to ensure people could safely transition out of the service should this be required in an emergency.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Systems were in place to protect people from the risk of abuse. Staff received training and understood the actions they must take if they felt someone was being harmed or abused. Staff told us they, ‘Would not hesitate’ to raise concerns and would escalate their concerns to external agencies if they felt any concerns were not being treated seriously. Generally, referrals were made to the local authority safeguarding team when abuse had been suspected, however, we identified this reporting had not occurred on a couple of occasions. The management team took immediate action to address this, and we were assured people had not been exposed to significant harm. We received positive feedback from family members who told us they felt people were safe and protected from the risk of abuse. Comments included, “[Name] has wonderful care from the care home. When I leave, I know [Name] is safe” and “You can’t beat the staff. I know [Name] is safe and no one will harm them.” When people were unable to consent to care, the local authority had been informed of any restrictions which had been put into place to keep people safe, and the appropriate legal authorisation had been obtained through the Deprivation of Liberty Safeguards (DoLS) framework. All authorised restrictions were accurately reflected in people’s care plans.

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. We identified some shortfalls in the accuracy of risk assessments and care plans. For example, one person was at risk of choking. Their care plan contained inconsistencies about the level of risk this posed to them. A person was at high risk of falls, but their care plan lacked detail to prompt staff how to fully mitigate this risk. This person had a piece of equipment in their bedroom to assist them when mobilising. We were told by staff it wasn’t used as the person chose not to use it however, the care plan directs staff to encourage its use. Another person experienced poor skin integrity which meant they were at risk of developing pressure sores. Guidance for staff to mitigate this risk through regular repositioning was confusing as the frequency of repositioning needed varied in different parts of their care plan. We identified some shortfalls with the level of detail of care plans to mitigate risk. For example, medicines records contained accurate information for nursing staff to follow when people needed support with diabetes or required nutrition or medicines via a percutaneous endoscopic gastrostomy tube route (PEG) however, the actual care plan lacked detail and needed a full review. We discussed these issues with the management team who told us they would take immediate steps to review and address these shortfalls. Although we identified several improvements were needed, staff spoken with knew people well and their individual care needs, including areas of risk and we generally observed safe working practices, such as moving and handling of people.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.Recent changes in staffing meant some of the routine checks on the environment were not all up to date. A new maintenance officer had recently been employed to support improvements in this area. Some aspects of the environment were potentially hazardous, and staff had not always recognised the risks these presented to people. For example, a couple of bedroom doors were propped open with chairs which was dangerous in the event of a fire. There was some remedial works needed such as replacement lighting in areas and a non-working toilet. These repairs had not been highlighted to the maintenance officer for repair. A person’s bedroom was full of trip hazards, and the person was identified to be at a high risk of falls. The volume on the call bell system in one area of the service was very low which meant staff were not always alerted promptly to peoples calls for assistance. We raised all these issues with the management team who took prompt action to address our concerns. Routine servicing records of the fire system, electrical system, gas boilers and equipment such as hoists and modified baths were up to date. Certificates were in place to demonstrate this.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs. Some family members told us people had to wait a long time for staff to respond to their needs. One family member described a recent situation when they couldn’t locate any staff to assist. They told us, “Staff are lovely. There is just not enough.” A person who lived in the home said, “Staff are very good. Sometimes they are a bit short, but they do their best.” We observed call bells were generally responded to in a timely manner and people received assistance which did not appear rushed; however, not all people could reach call bells if they were sat in communal areas. This meant they had to call out and wait if they needed assistance. We reviewed the staffing levels and concluded they were overall safe to meet people needs. However, we noted there was a reduced level of staff in the afternoon and evening. Most people required two staff to assist with their care needs which meant staff were not always immediately present to respond to people in the communal areas. Staff spoken with described how this created additional pressures which could impact on their ability to respond as promptly as they would like. We discussed all the feedback we had received and our observations with the provider. The provider told us they would review the staffing levels and were in the process of updating the existing call bell system which would include updated equipment for people to use to seek assistance. To maintain safe staffing levels the provider had been using agency workers. Staff and people who lived at the service told us this had caused inconsistencies in care and people had been assisted by staff who did not know them well. Staff spoken with told us the consistency of the agency staff provided had improved recently and confirmed agency staff received an induction to the service which included a summary of people and their care needs. Staff were recruited safely. Appropriate checks were in place to ensure staff were suitable for their role.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading. Some equipment needed replacement including some armchairs and fabric bed bumpers which showed signs of stains and rips. The environment was generally clean and tidy however, the small kitchen area was very tired and in need of a full refurbishment. Some bedrooms were fitted with old carpet which were difficult to keep clean and needed to be updated. There was ample stock of personal protective equipment (PPE) for staff to use, and we observed correct wearing of PPE, however, these were not always stored in a hygienic manner. Aspects of storage in the laundry area required attention as some items were observed to be resting on the floor. We raised all these issues with the management team who, along with the provider were proactive in addressing the immediate PPE storage concerns and told us of their plans to address some of the other areas. Although we identified some areas of improvement, we received positive feedback about cleanliness. A family member told us, “I can’t fault the cleaners, its kept nice and clean and they do the best they can.”

The provider did not always make sure medicines and treatments were safe and met people’s needs, capacities and preferences. Some prescribed medicines were not always stored safely. For example, topical creams and eyedrops which were stored in bathrooms were not secure and one person’s drink supplements were stored next to a hot radiator. There were no records checks made on the temperature of these areas to safely store in line with manufacturer’s instructions. This was raised and the management team put systems in place to address these shortfalls. Staff had received medicines training, but observations had not been made on the competency of staff when delivering this aspect of people’s care. The clinical lead took steps to address this when raised. Other aspects of medicines management were safe. People received medicines as prescribed and information was available regarding medicines which were prescribed on an ‘as required’ basis.