Crows Nest

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 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. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice but not always recorded. Risks were clearly identified, and assessments were in place to support people to reduce risk in most areas.

Staff knew how to raise concerns and were confident that these would be investigated. Staff meeting records showed that safety events were discussed with staff.

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. There were good links between people and healthcare providers with the GP contacting the home weekly. Each person had a hospital passport in case of hospital admission. Each person had an assessment of their health needs and contact with relevant specialist healthcare professionals was recorded and regular check-ups diarised.

People and their families were encouraged to complete and maintain care plans with staff to ensure that people received continuity of care and support.

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 has made recent improvements in sharing concerns quickly and appropriately.

People told us they felt safe and what it meant for them to be safe. People knew who they could talk to if they were unhappy or had concerns. Relatives also told us they had no concerns, with one telling us they had contacted the manager with an issue which was addressed.

We received information from our local authority partners as part of this inspection that confirmed the provider had made improvements in sharing concerns quickly and appropriately.

Staff and managers had a good understanding of MCA (Mental Capacity Act) and DoLS (Deprivation of Liberty Safeguards) and were actively supporting a person to have their DoLS reviewed. People had MCA assessments in place, completed in collaboration with the local authority where necessary and people were involved in the recording of these.

Staff had received training in MCA and safeguarding.

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.

People were supported to identify areas of risk and plans were created to help reduce this. Staff understood the risks and knew how best to mitigate them. Risk assessments about care were person-centred, proportionate, and regularly reviewed with the person.

People who were able to leave the premises independently were not restricted in doing so. There was a contact number for them should the need any support. The provider took a ‘least restrictive approach’ and encouraged people to plan and take part in various activities.

Care plans were updated regularly with new information and any changes communicated to the team.

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.

There were pets living in the home and although people were happy with this arrangement, little consideration had been given to risks relating to animal waste, trips and falls, allergies or placement of food and water dishes.

In relation to the home environment, some corridors did not have appropriate lighting which could potentially increase the risk of falls. We further found that most of the emergency pull cord bells had been shortened and were out of reach for people who may need to use these if they fell. We raised these with the provider who took action to rectify the issues during the assessment.

Firefighting equipment was in date with a maintenance schedule. Staff were trained in health and safety and fire safety. Regular health and safety checks were carried out by senior staff and concerns were addressed where necessary.

Fire drills took place regularly and people were encouraged to take part. Risk assessments, evacuation, and contingency plans were thorough. Fire safety signage, emergency doors and procedures were effective.

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

There was a small staff team who knew people well, most of whom had been in post for a long time, which meant there was good continuity of care and support. There were robust processes in place to support staff and share information through supervision, appraisal and team meetings. Staff rotas were designed to maximise the use of time, as most people accessed day services throughout the week. Staff were deployed effectively when they were most needed.

The provider had a system to make sure that staff DBS (Disclosure and Barring Service) checks were regularly reviewed.

However; we identified that some staff had non mandatory training that was overdue. We discussed this with the provider who explained they had to make unexpected changes to the training provider, and a plan was in place to ensure training was brought up to date. Staff did however receive training in learning disabilities and autism.

Recruitment and induction records were in place but not fully completed. We identified gaps in employment histories and education. Staff had been in post for a considerable time and there had been no new appointments made however; this information was required in accordance with regulatory requirements.

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.

Staff had access to appropriate PPE (personal protective equipment) and handwashing stations. Staff understood their responsibilities for maintaining high standards of cleanliness and hygiene.

The building was clean and tidy; bathrooms were cleaned daily. Senior staff completed regular audits.

Policies were in place regarding infection control and how to address an outbreak.

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. Staff were trained appropriately in medication administration and had regular competency assessments. MAR (medication administration records) sheets were completed accurately and signed by 2 staff for each administration. Medication was counted regularly and stored in a locked room, we assessed the medication stored and all were in date and stored per guidance, a medication returns book was in place. ’When required’ medication protocols were in place and used. There was a robust plan in place to ensure that medication remained well stocked and it was checked in by trained staff. We saw evidence that people had annual medication reviews.

We did identify a discrepancy between the number of tablets in storage and the expected amount recorded. The provider confirmed that this had been a storage and recording error and that no administration error had occurred.

We observed that all people had their medication administered in a communal area rather than in a private space. People told us that they were happy with this arrangement.