Casa di Lusso

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 75 (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.

Staff promptly and accurately reported incidents and accidents. They felt confident raising concerns, knowing the registered manager had effective systems to review incidents and take action to reduce risks. One staff member told us, “Accidents and incidents are reported to the nurse in charge and the management team. Outcomes will be discussed during flash meetings if appropriate.” Another staff member said, “If there’s an accident or incident, I just follow the process,fill out the forms, let the nurse, senior or manager on duty know, and make sure it’s all recorded. I do get feedback if something could have been done better, which I appreciate.”

All accidents, incidents and significant events had been logged and the registered manager carried out regular audits to identify any patterns or learning opportunities.

Relatives reported being kept informed about significant updates or incidents. A relative told us, “They [staff] ring us up if necessary.” Another said, “The communication is quite good, spot on, they [staff] rang me and told me that she [my relative] had knocked her right arm and had a bruise. She [my relative] has a key worker.”

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.

People told us they felt reassured that their needs would be met and that key information would be shared appropriately to ensure continuity of care. Staff confirmed they had access to the necessary information when working with external professionals.

There were 10 pathway beds at the home, (these are temporary admissions to the home, from hospital for people who are medically ready to leave but requires 24-hour care to complete their recovery or have their long-term needs assessed before returning home). The registered manager and deputy manager confirmed there were effective communication processes to manage transitions safely and consistently.

Health and social care organisations who support people at Casa di Lusso reported that the service had taken a proactive and collaborative approach. They highlighted the team's responsiveness and willingness to share information in a timely manner to help meet people’s changing needs. Comments included, “Our clinicians have consistently experienced a positive working relationship with Casa di Lusso. Staff are approachable, competent, and committed to the care of their residents” and “There are weekly meetings held online where we discuss people’s progress, for example, how they are settling in any concerns staff have had or concerns brought to staff by resident’s families are all discussed regularly and constantly. The care staff prepare diligently for these meetings and attend on time, so these forums are an excellent communication channel between myself [clinician] and the staff at the home.”

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.

Most People reported feeling safe, content, and well cared for at the service. One person told us, “I am happy here, I feel safe.” However, 2 people raised concerns about another person living in the home, entering their rooms during the day and at night. The registered managerconfirmed there was a sensor systemin place to alert staff and they were exploringfurther preventative measures to stop this happening. They had discussed this with the 2 people who were satisfied with their actions.

All staff had completed safeguarding training, with regular updates, and were knowledgeable about their responsibilities in protecting people's rights and well-being. Staff had a good understanding of safeguarding principles and were confident in recognising and responding to signs of potential harm or abuse. They clearly described how they would escalate concerns both internally and to external agencies if necessary. Staff told us they trusted the registered manager to respond promptly and appropriately to any concerns raised.

Records confirmed that safeguarding referrals had been made to the local authority, and statutory notifications had been submitted to the Care Quality Commission (CQC) in line with legal requirements.

Where people were deprived of their liberty for care or treatment purposes, legal authorisations had been sought through the Deprivation of Liberty Safeguards (DoLS). The registered manager, maintained oversight of all applications, authorisations, and associated conditions, ensuring that all documentation remained accurate and up to date.

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.

There were risk assessments for all aspects of people's individual care and support. These assessments were personalised, detailed, and regularly reviewed. The provider used an electronic care planning system so staff had access to the most current information regarding peoples identified risks.

Where people had been assessed as being at risk, wellbeing checks had been put into place. One staff member told us, “For our residents, we have wellbeing check. Wellbeing checks are based on the level of risk of an individual resident.”

People had Personal Emergency Evacuation Plans (PEEPs)in place, which were regularly reviewed and updated. This meant in an emergency, the emergency services would have the information needed to help support people to safety.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The home was safe and well maintained. Regular checks were completed to help ensure the safety of the care home’s physical environment and fire safety equipment.

We reviewed records of checks carried out to ensure the premises were safe. These included electrical, legionella, water temperatures, window restrictors and fire safety checks.

Staff were able to report any maintenance, health and safety concerns. Equipment was fit for purpose. For example, wheelchairs and moving and handling equipment were in good condition and clean.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They were working with staff to ensure the staff levels provided safe care that met people’s individual needs.

People and relatives did not raise concerns about the staff levels at the home and told us they felt there were enough staff to meet their needs. Comments included, “It’s a wonderful place, there are enough staff, they are all very pleasant to me, I think that it is ok.” We observed people’s needs being met and call bells being responded to promptly. However, 1 person told us their call bells were not always responded to promptly. The management team undertake call bell monitoring audits to monitor staff response times and had not identified a concern and said they would look into this person’s concern.

We wrote to all staff to ask for feedback about staffing levels at Casa di Lusso. We received feedback from 19 staff, 17 raised concerns about the staffing levels. Most concerns were raised about the staffing levels at night and a reduction in housekeeping. This comment summarised staff views, “I believe there are enough care staff on each shift. However, I think the activity team and domestic team are understaffed. Our staffing has been reduced since CCG (Care Concern Group) took over and I believe the residents are having too little time with the activities team. I also believe our home has declined in its cleanliness.”

We received 2 positive responses from staff, when asked about the staffing levels. One staff member said, “Most of the time, staffing is fine, but like anywhere, it can get a bit stretched during busy moments. When that happens, everyone just pitches in to make sure residents are supported”.

The providers regional director explained that the Care Concern Group (new provider) completed a dependency tool, which was reviewed weekly to assess the staff levels needed at the home. We reviewed this assessment and confirmed the staffing level at the home was usually 10% above the assessed level. We were told the registered manager also had the authority to increase the staffing levels if needed for changing needs at the home. The regional director showed evidence that clinical risks had reduced under the new provider. They felt this would not have been the case if there was not enough staff to support people.

Staff felt they had not been listened to at staff meetings when they raised concerns about staffing levels at night. The regional director confirmed the registered manager and deputy manager had undertaken night duties and night spot checks to monitor the staffing levels and had not identified any concerns. We were told; these checks will continue to ensure people’s safety and they would keep monitoring staff levels at the home and speaking with staff.

Recruitment procedures were thorough and ensured all necessary background checks were completed before staff began their employment. This included enhanced Disclosure and Barring Service (DBS) checks for working with adults. These checks provide employers with essential information, such as previous convictions or cautions, to support safe recruitment decisions.The registered manager had a checklist which they reviewed and signed when they were satisfied the required checks were in place, so a new staff member could start working at the home.

Staff told us they received regular training which was appropriate and relevant to their role. The providers training matrix confirmed this. One staff member told us, “They make sure you are confident with the skills you need and they make sure that mandatory skills are up to date.”

However registered nurses told us, they received training but not all the training they required to renew their registration and needed to source these themselves. The providers training matrix showed registered nurses received training to have the clinical skills to support people’s clinical needs at the home.

Staff received effective support and supervisions. One staff member told us, “I do feel supported here. I’ve had supervisions and my appraisal, and I know I can speak up if something feels off. I’d go to my manager, and I’m confident they’d take it seriously.” Another told us, “We do have supervisions every 3 months and an annual appraisal.”

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.

We received mixed feedback from people and relatives about the cleanliness of the home. Comments included, “It’s always clean, they are always wiping tables, in the evening they wipe the chairs. Laundry is all done, it goes and it comes back, nothing lost” and “I do think that the rooms could be kept cleaner. if I bring it to their attention, it is resolved.”

Staff told us the housekeeping team had been reduced under the new provider. Staff rotas showed there were sufficient housekeeping staff allocated on duty.

The environment appeared clean and well maintained. We identified a few malodours around the home on the first day of our visit. Between our visits an external company undertook planned carpet cleaning. There were no malodours noted on the second day. We observed housekeeping staff carrying out cleaning tasks and using a cleaning checklist.

Staff had received training in infection prevention and control, ensuring they remained informed and capable of implementing current best practices. There was appropriate personal protective equipment (PPE) available throughout the home. We observed staff wearing appropriate personal protective equipment and adhering to infection control procedures throughout the day.

Infection control audits had been conducted regularly and aligned with recognised good practice guidelines.

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.

The provider had a medicines electronic system in use. The medicines policy in place reflected the electronic system, to ensure staff had clear guidance about how to use it.

People received their medicines safely and in accordance with prescribed instructions. We observed the service had effective systems for ordering, storing, and disposing of medicines, including those requiring refrigeration or secure storage. Medication requiring cold storage had regular temperature checks carried out to ensure it remained within safe and effective limits.

People were happy with how their medicines were managed. One person told us, “They bring them around, usually ok, they come appropriately, very well organised.”

Staff responsible for administering medicines had completed training and were subject to regular competency assessments to ensure medicines were administered safely and correctly. Regular medication audits were completed to maintain safe practices.