Carrington House Limited

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 inspection we rated this key question good. At this inspection, the rating has changed to 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 that people could be harmed.

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 had a proactive and positive culture of safety based on openness and honesty. However, they did not always identify concerns about safety.

Audits and checks in some areas of people’s care such as fire safety and the administration of medicines were not always effective in identifying where improvements could be made. The management team were not aware of some of the less dignified ways staff were supporting people during the day. This made it harder to promote a learning culture at the service.

However, there were multiple ways where a learning culture was promoted at the service in ways such as staff handovers and meetings. Incidents and accidents were reviewed to see where lessons could be learned. Staff told us they discussed incidents and changed the way they supported people if necessary. One person said, ‘‘I do have some falls sometimes as I walk by myself. Staff are quick to respond and always make sure they talk to me about what happened.’’ A relative told us, ‘‘I would say the staff are always learning all the time. They change things if something happens to [family member] and they let us know.’’

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. Staff supported people to access other services such as health appointments. They advocated for people during these appointments. People also had ‘passports’ which they took with them when they used other services which gave staff and professionals key information about how to support them. One person said, ‘‘I see [health professionals] when I need to and the staff take me.’’ A visiting health professional told us, ‘‘[Staff] always make sure they tell us how people are getting on when we visit so we can all work together to help them.’’

People were protected from abuse and improper treatment. However, the management team had not identified some of less positive ways staff were supporting people which we identified at this inspection putting them at an increased risk of improper treatment. Audits of areas of people’s support such as pressure area care or food and fluid intake were not always thorough meaning people were at increased risk of not being supported safely.

However, safeguarding concerns were taken seriously and investigated. The management team reported concerns to the safeguarding team where necessary and reviewed outcomes to see if lessons could be learned. Staff were trained and knew how to report concerns. One person said, ‘‘I have no worries here. I always feel safe.’’ A relative told us, ‘‘[Family member] is very safe. We can visit whenever we want, and they always look well cared for. I get a good idea of what the care is like because staff are never expecting me.’’

The provider did not always work well with people to understand and manage risks. Staff did not always provide care that enabled people to do the things that mattered to them. Some risk assessments and care plans were not as detailed as they could be to help staff support people safely in areas such as personal care. People were not always being supported to take risks and do the things that mattered to them, for example following their preferred pastimes. It was not clear how people who found it more difficult to give verbal feedback were involved in discussing their care plans and risk assessments.

However, other risk assessments and care plans were detailed and gave good guidance about how to support people to take risks safely. Staff knew how to keep people safe and no one at the service had experienced pressure area care or issues with their nutrition. We observed staff supporting people to use equipment such as hoists safely. A person told us, ‘‘[Staff] are always on the lookout for us and make sure we have what we need.’’ A relative told us, ‘‘[Family member] walking by themselves is very important to them and the staff support them to do this safely.’’

The provider failed to detect and manage all potential risks in the care environment. There were issues in relation to fire safety at the service which had not been identified by the provider. On our first visit to the service most fire doors were not safe and did not shut properly, putting people at risk in the event of a fire emergency. Several people were using objects to hold fire doors open. As a result, a fire officer visited the service and immediate measures were taken by the management team to make the fire doors safe. However, we could not be assured this would have happened without our direct intervention.

Other areas of the environment such as living areas and bedrooms were safe. Staff kept equipment people used safe and in good working order and carried out checks of the building to help make sure it was safe. One person said, ‘‘I am very comfortable here and it feels like home.’’ A relative said, ‘‘Whenever I visit the place seems to be in good working order and I think there is a family atmosphere there.’’

The provider did not always make sure staff deployment was effective or ensure staff had all the training and knowledge to support people with specific health conditions. Some people went for long periods of time without meaningful staff engagement. Staff knowledge in some areas such as the Mental Capacity Act (MCA) was not as thorough. Staff were not all trained to support people living with specific health conditions such as Parkinsons disease.The management team took actions to address these areas during our inspection including reviewing staff deployment.

However, there were enough staff to support people with their needs such as personal care and eating and drinking and people and relative feedback confirmed this. Staff told us there were enough staff to support people safely. Staff were knowledgeable about most areas they had training in such as moving and handling and health and safety. The provider recruited potential new staff safely in line with legislation. One person said, ‘‘There is always someone about if I need anything and [staff] always check to make sure I am okay.’’ A relative told us, ‘‘I would say there are plenty of staff. They never seem to be rushing and everything seems to move at a relaxed pace.’’

The provider assessed and managed the risk of infection. Staff were trained in Infection prevention and control (IPC) and told us they had the necessary equipment to keep the service clean. We observed the service to be visibly clean. Staff whose role was to keep the service clean took pride in their work and knew how important it was for people’s home to be kept clean. Audits and checks were in place to monitor the cleanliness of the service and the effectiveness of the IPC measures in place. A person told us, ‘‘We are lucky here. [Staff] really care and make sure our home is kept clean and tidy.’’

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities, and preferences. On our first visit to the service, we observed medicines cupboards to be left open unobserved by staff, increasing the risk people or visitors could access medicines. Some medicines were being administered to people on an ‘as and when required’ basis, however staff were not recording the reasons for these medicines being administered. We observed staff to not always change their gloves between supporting people with medicines posing the risk of infection and cross contamination.Audits of medicines were not always effective in making sure medicines were being administered safely in line with the prescribers’ instructions Following our first visit to the service, the management team put immediate measures in place to address these areas and make improvements.

Other areas of medicines administration were safe. People received their medicines on time and staff knew how people liked to be supported. Staff were trained to administer medicines and had their competency to do so checked regularly. One relative told us, ‘‘[Family member] takes a lot of medicines and it is a relief I can fully trust the staff team with all of this.’’