Ryland View Care Home

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 requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 66 (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 systems to support a culture of learning. However, these systems were not constantly applied to all incidents. The service completed some reviews of incidents where they were broken down by type and reviewed for potential triggers. This showed some evidence of trend analysis; however, we found that learning from these incidents was not always shared effectively with staff. Although leaders stated that actions were assigned to staff based on learning identified during daily huddles, some staff we spoke with were unaware of a recent incident. This indicates that the systems used to share agreed updates and changes aimed at reducing future risk were not always effective.

When we discussed this with leaders, they acknowledged that the current oversight system was ineffective and explained there was a breakdown in communication through staff line management. This meant learning was not consistently disseminated.

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.

At the time of the visit the service did not have any new admissions however leaders told us people’s needs were assessed prior to admission. This included consideration of environmental adaptations any specialist training requirements in advance of any admissions. Where assessments had taken place, we found peoples care records were kept up to date following regular reviews. Staff told us they would review care plans and speak with other staff to ensure they remained up to date.

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 provider had safeguarding systems in place and staff understood their responsibilities.

They had systems in place to allow staff to remain anonymous if they felt this was required to ensure staff felt safe to raise concerns.

Staff told us they would report any concerns to managers and document the incident. One staff member said, “I always raise concerns. I notice something has changed I will raise concern to my manager first if I am worried. For example, the bruises I raised it for how it happened.”

People and relatives told us they felt their family members were safe and staff were caring. One person said, “If I was mistreated, I would tell the main carer and I’d tell my son and husband.”

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

We observed concerns regarding staff familiarity with care plans and adherence to recommendations. During an afternoon meal, a person was given food that did not align with their swallow recommendations, indicating that staff were not always familiar with the care plan details. Some staff reported not having sufficient time to read care plans, with one stating, “There’s not one person here that reads the care plan, it is read out. I used to do nights - that’s the only time I had time to sit down and read a care plan. As soon as you're in, it’s non-stop.” Additionally, we identified a discrepancy between a person’s summary information and detailed assessments, including advice to administer a pain relief medicine that had not been prescribed for the person, increasing the risk of a potential medication error.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The service had systems in place to identify and manage risks including environmental audits. For example, these reviewed fire, water and electrical safety. Daily walkarounds,

maintence audits and, monthly mattress and chair audits were also completed. This meant the environment and equipment was safe for people to use. People and their families did not raise any concerns regarding the safety of environments.

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.

The provider used systems to ensure there were enough staff, during our visit we did not identify concerns around staffing, call bells were answered promptly and this aligned with call bell audits carried out by leaders.

Staff provided mixed feedback regarding staffing pressures with some telling us they had enough time to carry out their roles effectively. When asked if there were enough staff a staff member told us, “It's ridiculous. It's hard. They wanted residents to have three showers per week. Which is impossible”. Another staff member told us “At the moment we are fine for staff because we only have 18 residents. I can't complain this time but before it was too much.”

We found staff recruitment records were not always fully completed which is a requirement to ensure staff were competent and safe to support people. Some, staff files did not contain photographic identification, records of full employment history, or fully completed interview records. These checks are required under the Health and Social Care Act 2008 and associated regulations. However, high risk indicators such as seeking references and Disclosure and Barring Service checks (DBS) were found to be complete. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Systems were in place to ensure staff received training, and staff had completed the required training.

The provider assessed and managed the risk of infection. They detected and controlled the risk of outbreaks and took steps to ensure effective control.

The service had systems in place to monitor infection prevention and control (IPC). This included up to date systems to ensure cleaning had been completed and reasons for tasks not having been completed. Leaders completed checks during walkarounds to identify IPC concerns, and the service employed designated staff at the service. Staff were observed using personal protective equipment appropriately, and training was provided in IPC standards. Staff told us that people living at the service were encouraged to take part in cleaning activities where appropriate, supporting their independence while maintaining safe standards.

People and their families felt that the service was clean, a person we spoke with told us, “It is clean.” Staff mostly described the service as clean with a staff member telling us, “We are brilliant with cleaning on Bloomfield.” Another staff member told us, “Cleanliness could be better, everyone has a standard it’s clean but could be cleaner, but it follows national guidance.”

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

We identified several concerns with medicines management. Systems for monitoring fridge temperatures, where medicines were stored, were not being completed correctly. This meant we could not be assured that medicines were stored safely, increasing the risk of deterioration and potential harm to people.

During our walkaround, we found a topical medicine left unattended and unaccounted for, posing a risk if used by someone for whom it was not intended.

Although systems existed to support staff - such as training, protocols, and audits - weaknesses in governance and oversight meant the provider could not demonstrate that medicines were consistently managed safely in practice. While action was taken when issues were raised, these measures were not always effective in preventing risks.