Chy-An-Towans

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.

Staff were aware of their responsibility to report any incidents. Incidents and accidents were recorded and flagged to managers. These records were regularly reviewed so any emerging pattern or themes could be quickly identified.

Supervision records showed staff discussions took place when things went wrong and lessons were learned to help mitigate future risk.

A relative told us they had been kept up to date during an investigation when their family member had been identified as being at risk due to safety concerns. They confirmed they felt assured all necessary steps were taken to keep people safe. They told us, “Straight away, they phoned me up and I couldn’t have wished for more as every step of the way they let me know what was happening.”

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.

When anyone moved into Chy-an-Towans they were given opportunities to visit the service first and meet staff and the other people living there. This helped ensure any new resident would be happy living there and staff could build a relationship with them. A member of staff told us; “It has got to be the right person that fits."
People had hospital passports which included details about their preferred method of communication, any important contacts and their physical and emotional wellbeing needs.
 

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 Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.
Mental capacity assessments were completed to evidence when people lacked capacity to make decisions. There was no evidence people had been involved in capacity assessments or supported to understand the decisions being made. A manager told us they would address this in future capacity assessments. Where appropriate relatives had been involved in decision making to help ensure any decisions were in people’s best interest.
There were systems to ensure people were protected from the risk of abuse, including financial abuse. Expenditures were recorded and receipts saved. These records were checked weekly so any discrepancies would be identified quickly.
Staff had completed training in safeguarding and the MCA. They understood their responsibilities under safeguarding and reported any safety concerns to management. Staff were confident any concerns they raised would be dealt with but were aware how to escalate issues outside of the organisation if needed. Relatives were confident their family members were safe. One commented, “Absolutely. I’m quite confident in the staff.”

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.

Risk assessments were completed for people who were identified as being at risk. These highlighted the risk and provided guidance for staff on how they could mitigate future risk. Care plans and risk assessments were updated regularly and when people’s needs changed. Relatives told us any risks were well managed. One commented, “Staff follow the food guidelines when they prepare food.”
There were plans to support staff in the event of an emergency. Business contingency plans covering various scenarios had been developed. Personal emergency evacuation plans had been developed for each individual and were available for first responders in the event of an emergency. These outlined the support people would need to evacuate the building.

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.

The garden area had been neglected; rubbish and discarded fittings had accumulated over time. Garden furniture had deteriorated and the garden was overgrown. Work had started on a memorial and sensory garden area, however this had stopped the previous year. A small shed was in a state of disrepair. These factors presented a hazard to anyone using the garden. Furthermore, the garden did not provide a pleasant space where people could relax and enjoy the space. The provider took immediate action to improve the garden following our initial visits. Rubbish was removed and the area generally tidied up. An external contractor was being organised to complete the work including the sensory area.
Checks of utilities and equipment were regularly carried out by an employed maintenance worker and external contractors. Some areas of the service were tired and in need of updating. This had been identified and decorating had started.

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.

New staff were recruited safely and completed an induction before starting work. There were sufficient staff to meet people’s needs and enable them to take part in any pastimes or hobbies they enjoyed.
There was a consistent staff team, many of whom had worked at Chy-an-Towans for several years. They received regular training, which was updated, this included training specific to the needs of people with a learning disability and autistic people.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

A cleaner was employed but had been absent from work for several weeks. Cleaning schedules were not being completed to evidence cleaning had taken place as planned. However, the service, including the kitchen and shared bathrooms, appeared clean. The provider told us they had contracted a company to complete a deep clean in the near future. Staff received training in infection prevention and control and were provided with appropriate protective clothing, such as gloves and aprons to use when carrying out personal care.

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.

A review of medicines administration records (MARs) showed that people received their medicines as prescribed. Medicines with a variable dosage, for example one or two tablets, and medicines to be taken on an ‘as required’ (PRN) basis were supported by protocols to advise staff how to adjust the dosage based on the specific needs of the individual.

For those prescribed topical moisturising creams, administration was supported with guidance including body maps to guide staff where the creams should be applied and how frequently.
Some people were prescribed paraffin-based emollient creams, which can present a fire risk. The service had recognised this risk and included control measures within a service-wide risk assessment. However, risk assessments could be further strengthened by considering the fire risks associated with these products on an individual basis, taking account of each person’s specific circumstances and level of risk.

We found that relevant care plans were in place and contained person-centred information about people’s needs. However, care plans did not always reflect the medicines prescribed to manage those needs. For example, 1 person was prescribed 2 laxatives to treat constipation, but these medicines were not referenced within their continence care plan. This meant care records did not always provide a complete overview of how people’s conditions were being managed.

Records showed that risks were appropriately considered within the service. People with significant health conditions had person-centred risk assessments, which included guidance for responding to emergency situations and considered risks associated with activities that were important to them.