Chetwynd House

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• 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 requires improvement. At this assessment the rating has remained 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.

The service was in breach of legal regulation in relation to people’s safe care and treatment and the ways people’s medicines were managed.

This service scored 62 (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 did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice. Concerns remained from our last assessment with medicine management. Staff trained to administer medicines told us that lessons learned had not be communicated with them. We raised this with the provider who could evidence when and how this had been communicated, however took immediate steps to undertake refresher training to help staff understanding and development, to prevent error in medicine management from recurring.

Since our last assessment, the provider had made significant improvement in the relationships with external professionals. They now supported people to establish and maintain safe systems of care, and they made sure there was continuity of care, including when people moved between different services. Care plans now contained details of external professional’s recommendations and records completed by staff showed this guidance was followed. Where people required support with routine health care appointments for conditions they were living with, such as diabetes and general healthcare screening, these were now clearly identified in care plans and review dates were monitored to ensure people received their care and support safely and responsively.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Since our last assessment the provider had made improvements to care plans and ensured staff had clear guidance on how to support people safely. For example, care plan now contained guidance on when and how people should be repositioned to prevent the risk of injury from pressure damage. Care records showed staff followed this guidance and supported people appropriately. However, people and relatives we spoke with consistently told us they had not been included in these reviews and had not seen their care plan. One relative said, “I didn’t know they did reviews and have never seen a care plan. They [staff] phone me if something is wrong but I just have to trust staff know what care is needed.”

We raised this concern with the provider who had an action plan to further review all care plans and ensure they were more person centred. For example, they were planning to implement life history books to ensure people’s needs, likes and wishes were fully documented. The provider said they would include speaking with people and relatives to develop care plans going forward.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Since our last assessment the new manager had spent time with the domestic and laundry staff teams to ensure staff were clear about their roles and responsibilities. Standards of hygiene and cleanliness in the home and the equipment used was now to a consistently high standard. Deep cleaning of bedrooms and equipment was now completed to a high standard and people living at the home told us they were proud of their environment and the standards staff maintained. One person said, “The home is beautiful, staff are always busy cleaning.”

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider had made improvements since our last assessment and risks of infection were now assessed and managed safely. The home had experienced an outbreak of the influenza virus. The management team had detected and controlled the risk of it spreading and promptly shared concerns with appropriate agencies. We observed staff wearing personal protective equipment to ensure people remained safe and risk of cross contamination was reduced. The domestic team had implemented enhanced cleaning schedules, to include areas such as frequent touch point cleaning to reduce the spread of infection. Staff were knowledgeable about infection control and prevention and we saw staff spending time with people updating them about the outbreak to provide support and assurance about their safety.

The provider had worked to up skill and support staff to make changes. For example, the provider and staff team had made improvements to the administration and management of ‘as needed’ (PRN) medicines. Staff now had clear guidance on how to safely and responsibly support people with PRN medicines. The provider was recording actual fridge temperatures and room temperatures, but since the last inspection had stopped recording maximum and minimum fridge temperatures, to ensure the medicines were stored safely.

However, people were not involved in their care planning and care plans were not clear how medicines and treatments were safe and met people’s needs, capacities and preferences.

At the last assessment, areas of concern were found with the administration of time-sensitive medicines and expiry dates of open medicines not being monitored. These issues remained at this assessment. We observed eye drops being administered after their expiry date, an expired liquid being administered, and an insulin pen being administered to a person with diabetes, with no opening date recorded. This posed a risk to people’s safety, as administering a medicine after the expiry date may reduce its effectiveness. This was escalated, and out-of-date medicines in use were disposed of correctly on the day of inspection. The provider was working with external professionals, some of whom administered these medicines, to ensure improvements were made and embedded.

Care plans did not always include detailed information on how to support people with their medicines. We saw a person taking heart medicines, but the care plan did not indicate the reason. For people on high-risk medicines, the care plans contained no information on these medicines or the precautions to take.

Covert (disguised in food or drink) medicine, best interest meeting, and pharmaceutical advice were missing for a person receiving their medicines covertly. On the day of inspection, the pharmaceutical advice on how to administer the medicines was obtained. The provider assured that the best-interest meeting would be conducted soon.

Staff said the provider spoke with them only about specific incidents and did not provide training unless they were involved in an incident. Despite the provider's evidence that they had provided additional training and communicated issues to staff since the last assessment, as safety concerns remained, we could not be assured of the effectiveness of this training and communication. For example, this was seen for controlled drugs (medicines requiring more control due to their potential for abuse) entries. Despite assurances of training, we still saw crossing-outs in the CD register; most were now being raised as incidents when picked up by management. However, on the day of inspection, we saw staff crossing out in the CD register that had not been picked up by management.