Caraston Hall

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, investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The registered manager described the systems in place to review accidents and incidents in order to identify themes, trends, and any learning that could help prevent a recurrence. Evidence showed that when something had gone wrong, the registered manager responded appropriately and used incidents as learning opportunities.

In addition, the provider held regular practice meetings with staff at all levels, including senior staff and board members, during which all accidents and incidents were reviewed. These meetings helped determine whether there were any wider lessons to be learned and shared with staff across the services to prevent reoccurrences. This approach supported greater security, peer support, and shared learning.

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.

The registered manager described the transition process, which involved assessing the person’s needs and arranging multiple visits to the service, including overnight stays. This process was led by the person, with involvement from their relatives and/or healthcare professionals as appropriate. This approach enabled both the individual and staff to get to know one another before any decisions were made about offering a placement.

People’s care and support needs were continuously assessed, and support plans and risk assessments clearly outlined their individual needs and the support required. People were supported to safely access and move between different healthcare services; essential information was readily available to assist them when attending appointments and in the event of a hospital admission. Staff were confident they had access to the right information to support people safely. One staff member said, “We have regular meetings and handovers and are kept up to date when people’s needs change.”Relatives told us their loved ones were supported by staff who knew them well.

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 continued to be protected from the risk of abuse. Policies relating to safeguarding and whistleblowing were in place. Staff had received training to enhance their understanding of how to protect people from any form of discrimination. They were aware of when and how to report concerns and were confident these would be dealt with appropriately. One member of staff said, “I do not have any concerns about people’s safety, but if I did, I would report it to [Registered manager name]. If they did not act, I would report it to the local authority and the CQC [Care Quality Commission].”

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this is usually through the Mental Capacity Act 2005 (MCA) application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service.

Where restrictions had been placed on one person’s liberty to keep them safe, the registered manager had worked with the local authority to seek lawful authorisation for this. This ensured that any conditions of the authorisation were being met.

People told us they felt safe and were happy living at Caraston Hall. One person said, “Yes, I do feel safe, and I like living here.” Relatives had confidence in the service and did not raise any concerns about people’s safety. One relative said, “Yes, I know that my [relative] feels safe living there.”

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.

People were mostly protected from the risk of harm [see the environment section of this report for further details]. Records showed that risks relating to people’s mental health, medical needs, and social needs had been assessed and were being managed safely. Each person had a comprehensive risk management plan linked to their support plan, outlining what needed to happen to keep them safe. These plans were regularly reviewed and updated as needs changed. Staff had a good understanding of individual risks, potential triggers, and early signs that a person might be becoming unwell. The registered manager told us that specialist advice was sought from healthcare professionals when needed and acted upon.

People’s involvement in developing their care and support varied depending on their individual needs and preferences. We noted that some people required information in accessible formats, such as in different languages, and this was being provided.

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.

Some aspects of the environment did not fully support people’s safety. We observed that some external doors were unlocked and had no alarm or alert system to notify staff if someone left the building unattended. This was concerning because the registered manager told us that DoLS authorisations had been requested for some people who would not be safe if they left the service without supervision. This exposed people to a risk of avoidable harm. We raised this with the registered manager, who informed us that discussions were underway with senior managers to address the issue. Following our visit, the registered manager confirmed a door alarm had been installed.

The environment was bright, clean, and well-maintained. Regular checks were completed to ensure the maintenance and safety of equipment; environmental risk assessments were carried out and routinely reviewed.

Fire safety systems were regularly serviced and audited, and staff had received fire-awareness training. People had individual emergency evacuation plans that clearly outlined the level of support required to keep them safe.

Relatives and external healthcare professionals did not raise any concerns about the living environment.

The provider had not ensured there were always enough qualified, skilled, and experienced staff on duty to meet people’s needs at all times. However, staff who were employed had the necessary skills, experience, and training, and received regular supervision and support. Staff worked well together to provide safe care that met people’s individual needs.

Staffing arrangements at night were not sufficient to meet people’s assessed needs. At night, people living at Caraston Hall were supported by one night staff member, who was also responsible for another service owned by the provider next door. This staff member could access the second property through a separate door located in the sleep room. This arrangement meant there could be occasions when no staff were available to support people in the regulated service, placing them at potential risk. We discussed this with the registered manager, who told us there had previously been two-night staff covering both buildings, but this had been reduced as the additional cover had not been used. Following the site visit, the provider wrote to the Commission confirming that a second night staff member had been reinstated with immediate effect.

People continued to be protected by safe recruitment processes. Systems were in place to ensure staff were suitable to support people who might potentially be vulnerable due to their circumstances. For example, we reviewed 3 recruitment files and found the necessary employment checks had been completed before staff started work.

Staff at all levels told us they felt supported by the service’s management team and the provider. One staff member said, “I have always felt very supported 100%.” Another said, “We have regular supervision. While the managers are very professional, you can talk to them about anything, which is really important.”

Staff told us they had good access to training when they needed it. Following the inspection, we were provided with the service’s training matrix. This showed that staff had completed training across a range of subjects, including specialist training required to meet the needs of the people they were supporting and relevant to their roles.

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.

The provider had good systems in place to prevent and control the risk of infection. The premises were clean throughout with no unpleasant odours, and systems were in place to prevent and control the risk of infection. Appropriate personal protective equipment (PPE) was in place, and cleaning records were up to date and being completed.

People were encouraged and supported to maintain the cleanliness of their own space at a pace that suited them. For example, we saw that people were supported to maintain their independence by taking part in cleaning their rooms and managing their own laundry.

Relatives and healthcare professionals did not raise any concerns about the cleanliness of the service.

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.

People’s medicines were managed safely and stored securely at the correct temperatures. Systems were in place to audit medication practices, and clear records were kept showing when medicines had been administered or refused. A sample of records were reviewed and found to be correct.

Where people were prescribed medicines to be taken only when required (PRN), clear guidance was available for staff. Where additional health checks were necessary because of certain medicines, these were being completed, such as regular blood tests.

Staff had received training in the safe administration of medicines and told us their competency was assessed regularly.

Relatives did not raise any concerns regarding the safe administration of people’s medicines. One relative said, “My brother receives his medication on time. In fact, when he comes to visit us, the staff member accompanying him makes sure that he takes his medication at the correct time.”