Cera - Cumbria

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 66 (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.

There were clear systems and processes in place to record and manage accidents and incidents. Staff were aware of the procedures to follow for this. All information from these were collected by the registered manager who then shared this with more senior management.

Any learning from these incidents was shared with staff, either in one-to-one meetings or through the use of a staffing messaging app on mobile phones.

People told us they knew how to raise concerns and felt comfortable in doing so.

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’s relatives we spoke to, told us they felt communication from the provider could be improved when their relative was admitted to hospital. However, we found people’s information was shared quickly and appropriately with other professionals if people were admitted to hospital or moved services. This ensured people received the correct level of care and support they needed. The management team informed us that when people were in hospital, they requested regular updates from hospital staff to ensure care plans remained appropriate upon people returning home.

Care plans were completed in full prior to people receiving care, this information was then available to all staff on handheld digital devices. People and their families told us they had been included in care planning.

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.

The provider had clear safeguarding processes in place.

We found evidence of clear recording of incidents and of sharing these with relevant agencies in an appropriate manner. The electronic system to record safeguarding concerns clearly provided timelines, relevant contacts, witness statements and other information all in one place. The management team shared any learning from these incidents with the wider staff team.

Staff received training in safeguarding and the Mental Capacity Act 2005 and were able to tell us how to raise concerns and how they supported Best Interest decisions.

People and their families told us they felt safe, one relative told us, “I feel that my relative is very safe with these carers. A person told us, “They take time with me, and I feel safe with them.”

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

We found some risk assessments had not always been completed for people, although there was no evidence that people had come to harm. We discussed this with the management team during the inspection, and these were immediately put in place.

We found evidence that most people were supported well to manage risk. For example, staff had supported a person to attend a local college where there had been significant risks identified for them.

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.

We found evidence that where bed rails were in use, there were not always clear risk assessments in place or consent documented. In discussions with the provider during the inspection, these were immediately addressed.

Care plans and assessments were completed appropriately and included information on the home environment around potential risks.

Staff were aware of potential risks and hazards within the home environment and had ways of managing these. For example, for people who smoked there were clear guidelines of how staff addressed this with people. The provider made referrals to local fire services, if they had safety concerns for people.

Staff were aware of the accident and incident recording process. This was via their electronic devices; these were then reviewed by the registered manager and wider health and safety team within the organisation.

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.

The staff team were supported by the registered manager and care- co-ordinator.

Staff told us they received regular supervisions and appraisals.

Staff completed mandatory training and induction programmes before starting in their roles and shadowed more experienced staff until competent to work alone.

The provider employed internal trainers who provided some staff training. Staff received specific training around learning disabilities and autism to assist them in supporting people.

Staff told us they felt they had received the necessary and appropriate training to help them do their jobs. One member of staff told us they “Felt ready and prepared”.

A person told us “I have 2 carers twice a day both men and women and there have not been any issues. They take time with me, and I feel safe with them.”

A lone working policy and procedure was in place for all staff.

There were appropriate policies and procedures in place to manage staff performance issues. We saw evidence of clear management of poor performance and disciplinary procedures being undertaken.

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 were trained in the use of personal protective equipment (PPE) and were aware how to use it effectively. Supplies of PPE were stored centrally at the office location where staff could pick them up. Alternatively, the management team would take PPE out to staff if they were undertaking spot checks. Spot checks on staff were in place regularly and were unannounced by the management team. The spot checks covered a number of areas including the use of PPE.

The management team had regular contact and links with the local infection prevention control practitioners. Any updates and information were shared with staff.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Staff used a comprehensive electronic recording system to manage and record medication administration. This recording system provided immediate feedback to the management team on times, doses and key information on people’s medications. However, we noted the recording system did allow for staff errors. This was highlighted to the management team at the time of our inspection, and we were informed that this would be addressed immediately.

We found as and when required medication protocols were not always detailed or specific to individuals. This meant that staff may be unclear whether or not a person required their medication. We discussed this with the management team at the time of our inspection and were informed that clear up to date and individualised forms would be completed.

We found risk assessments associated with certain medications were not always in place, for example with blood thinning medication. We found no evidence that people had come to any harm because of this. The management team immediately addressed this issue and shared the assessment with staff.