Harrier Grange

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 72 (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.

Records showed incidents had been reported, investigated, and lessons learned were shared with staff. Where needed, people’s care plans had been reviewed and referrals made to health professionals for advice and support.

There was a culture of positive learning, where incidents were fully discussed, and staff told us they felt comfortable reporting incidents and sharing good practise with colleagues. Staff told us they were kept informed if they had raised concerns or queries. One staff member said, “We had someone fall due to a Zimmer frame being in the way. The managers told us how to rearrange the dining room tables at lunchtime so that people are able to move around easily and people’s equipment isn’t in the way.”

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.

Records showed the service was supported by a range of health care professionals. There were established links with local services, such as the GP surgery who visited weekly and more often if needed. This meant people’s health could be monitored and their medicines could be regularly reviewed.

People and their relatives told us they had good access to GP’s and other health professionals, and care plans included relevant assessments and clinical guidance.

We saw records that showed people were reviewed by other health professionals for advice and support when required. Most health professionals told us the staff team were proactive in seeking professional advice and support in a timely manner.

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.

People told us they felt safe living at the service. People’s relatives told us they felt confident their loved one was safe. One person’s relative said, “Absolutely, [relative] is safe. I can't fault them. I'm so happy my relative is there. It's first class and [relative] is definitely safe.”

Staff had been trained in safeguarding and understood their responsibilities in reporting safeguarding concerns. One staff member said, “If we notice any kind of wounds or bruises then we let the nurse know that we have found this, and if we don’t know how it happened. Safeguarding is about raising concerns about any form of harm or abuse.” Staff told us they felt confident raising safeguarding concerns to the management team.

There were safeguarding procedures in place. The management team understood their responsibilities regarding any action needed to protect people from harm. The necessary internal documentation was completed including accident and incident logs and body maps. The registered manager ensured referrals and notifications were made to both the local authority and the Care Quality Commission in a timely manner.

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.

Staff had assessed people’s risks in relation to skin damage, malnutrition and falls for example. Where risks had been identified, care plans provided clear guidance for staff on how to reduce the risk of harm. For example, when people were at risk of skin damage, care plans detailed any pressure relieving equipment in use and how often people should be supported to change position. When people had been assessed as being at risk of falls, care plan guidance was informative. Staff knew which people were at risk of falling and how to monitor people’s safety.

Staff we spoke with knew which people were at risk of choking and were able to tell us about any modified diets or thickened fluids that people required. Staff spoke confidently about how to position people to reduce the risk of choking, and how to support people with food and drink. Staff knew the steps to take if people did experience a choking episode.

However, we noted that when people were prescribed blood thinning medicine, the increased risk of bleeding was not included within care plans. We fed this back to the management team who told us they would review the relevant care plans to include the information.

The environment was visibly clean and well maintained. Staff were able to report any maintenance requirements. Equipment that we looked at was fit for purpose. In the main, equipment such as wheelchairs and moving and handling equipment were in good condition and visibly clean.

We reviewed records of checks carried out to ensure the premises were safe. This included gas, electrical and fire safety checks. Regular checks of equipment were carried out. Although there were some gaps noted in records, such as outlet flushing, the management team were aware and were taking steps to address this. Personal evacuation plans were in place. These had been regularly reviewed to reflect people’s support needs in the event of needing to evacuate the building in an emergency.

There was a well-maintained secure garden area for people to use, and we observed people going out for walks. We did raise a concern about a double locked garden gate which was a signed fire evacuation route. The provider was responsive and provided us with updated information and steps taken to ensure people were able to use the garden exit in a timely manner during an emergency evacuation. This included liaison with the local fire service.

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.

People living at the service raised no concerns about staffing levels. People’s relatives told us they felt there were enough staff on duty. One person’s relative said, “I would say there are enough staff. Sometimes I go there and you might be waiting a while for bells to be answered, but the staff don't ignore the bells, they come and see to the person and say they’ll be back soon. I'd also say that weekends are fine.”

The service used a dependency tool to calculate staffing levels based on the needs of people living at the service. The staff rota reflected the dependency tool. Most of the staff we spoke with told us they felt staffing levels were adequate. However, a few staff told us an additional staff member on shift would be beneficial. The management team told us they had identified the need for additional staff during key times and had been trying to recruit into those positions. During the inspection, we saw staff responding to call bells in a timely manner, and staff did not appear rushed.

Safe recruitment procedures were followed. At the last inspection, frequency of staff supervisions was inconsistent. At this inspection, there was a supervision plan, and records showed staff had regular 1 to 1 sessions with a line manager or supervisor.

Staff completed an induction period when first employed. Staff told us this included shadow shifts and that they felt supported during this period to feel confident starting their role. Staff had been trained to carry out their roles. Training completion was monitored and staff told us they received a mix of on-line training and face to face. Additional training, such as positive behaviour support was currently being provided by the registered manager. They told us they had implemented more training for staff to provide them with additional skills to support people living with dementia.

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 completed infection prevention and control training. We saw evidence of staff being assessed for their competencies to wash their hands correctly, and to put on and take off personal protective equipment (PPE). Housekeeping staff were on duty 7 days a week. In the main, the service was visibly clean and odour free. When we identified 1 torn pressure cushion and 1 visibly dirty piece of moving and handling equipment, this was reported to the management team who responded swiftly. The equipment was cleaned and the cushions were disposed of.

People and their relatives told us they were happy with the level of cleanliness. One person told us, “This is the cleanest home. Cleaner than most houses!”

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 who administered medicines had completed training and had their competencies assessed. Medicines were stored safely. Medication rooms were temperature controlled and records of temperature checks showed that rooms and medicine fridges were maintained at suitable temperatures. Records showed people had their medicines administered on time as prescribed. This included time sensitive medicines.

If medication errors occurred, staff reported them promptly, monitored people, contacted the GP and completed reflective practice to support learning. Lessons learned were shared. Homely remedies (over the counter medicines used to treat minor ailments) were used safely with GP authorisation.

Protocols were in place for when people needed additional medicines on an as required (PRN) basis. However, some of these had not been reviewed and did not always reflect people’s current needs or needed more personalised information; these were reviewed and updated by day 2 of the inspection.

The service had good links with the local pharmacy. People’s medicines were regularly reviewed, and we heard how the service was working with health professionals to reduce the use of certain medicines.