Tigh Grianan

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 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The home had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Accidents and incidents were recorded appropriately and action taken because of lessons learnt. Outcomes were communicated to staff and relatives. Where appropriate, healthcare professionals were involved to ensure learning was based on best practice. The registered manager had oversight of all accidents, incidents and events within the home on the electronic systems and this helped to ensure safe processes were followed when dealing with events.

The home 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.

People’s care and support was clearly planned, this included all care documentation, which included comprehensive information about people. People received reasonable adjustments when accessing health care, for example, home visits. People’s care plans had been summarised so that important information was taken with them when they accessed healthcare, including the hospital.

A healthcare professional told us, “The carers always seem very engaged, are always well prepared for appointments and if they don't have information to hand, they will email the information after the appointment.”

Staff demonstrated a good understanding of how to work in partnership with the GP and psychiatry. This meant information was shared with partners and by partners.

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.

Staff were aware of their responsibility to safeguard people from the risk of harm or abuse and what to do if they thought people were unsafe. A staff member told us, “I would report it to the manager, record it in the incident log. [I would use the] whistleblowing policy if I wasn't happy and go higher if necessary. Social services and CQC safeguarding numbers are posted everywhere at the home.” A member of staff was the assigned safeguarding ‘champion’. They had additional training and a special interest in safeguarding, and they helped raise the profile of it and provided the team with information and developments in safeguarding.

Relatives told us that their loved ones were safe. One relative told us, “They feel very safe, one time I had him over, but he wanted to go back, and I had to drive him there at midnight and as soon as we got there, he removed his clothes, wore his pyjamas and was happy.”
 

Records showed safeguarding referrals had been made as necessary and this included notifying CQC of certain events as required by law.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). The home was working within the principles of the MCA, appropriate legal authorisations were in place when needed to deprive a person of their liberty, and conditions relating to those authorisations were being met.

The home worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Assessment of risks was balanced with outcomes, so that people were enabled to take positive risks. People’s needs were assessed and measures to reduce risks put in place, in their best interest. A member of staff told us, “We explain to them and allow them to make choices, even if unwise. We support them in the best way and promote safety. If they say they want to do it, I check the risks, hazards and put [measures] in place so they get what they want in a safe way.”

The electronic care planning system meant that information and changes about people’s care, risks and support were updated. This meant people had individualised risk assessments and these covered multiple areas, appropriate to people’s needs, wishes and aspirations.

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

People were safe from hazards in their environment. The service had processes and risk assessments in place to ensure all necessary maintenance work was carried out. There were health and safety and compliance ‘champions’ within the team. They had additional training and a special interest in these areas and ensured that matters relating to the safety of the environment were regularly discussed with the team.

The home made sure equipment, facilities and technology supported the delivery of safe care. Regular fire evacuations were carried out, and these were recorded and quality assured. Fire equipment had been checked and maintained in accordance with the relevant legislation.

There were plans in place to decorate the house and replace the flooring in ensuite bathrooms.

The service 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.

Staff were recruited safely into the service. This included having robust shortlisting and interviewing procedures and documentation, gaining references from previous employers, completing a Disclosure and Barring Service check, and checking right to work status. Disclosure and Barring Service checks provide information, including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. This meant appointable staff members were of good character to work with vulnerable people.

Staff received the training they required to provide the care that people needed. Staff training was up to date and completed within timescales needed. One staff member told us, “I am up to date with all my training, learning doesn't end. I think the organisation is supportive with training.” The home received support through the provider’s own multi-disciplinary team, meaning that staff were provided with bespoke training based on individual needs.

Staff supervisions and team meetings were held regularly. They covered multiple areas including reviewing support, people’s well-being and development for staff. A staff member told us, “Supervisions are perfect and every other month. I remember once I wanted to find out how other staff managed a situation and the manager helped me to look at different ways to support the person.”

Staff told us the registered manager was supportive and had an ‘open door’ policy. One staff member told us, “If we have any concerns, we can raise these at any time.”

We observed and staff told us there were enough staff to meet people’s needs. Staff absence and sickness was covered by permanent staff, without the need for agency staff, meaning people were supported by people who knew them well.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

We observed and relatives told us the service was clean and tidy. One relative told us, “It’s a 5 star. It’s so clean. Their room and kitchen are very clean. I cook there sometimes. I think someone is taking care of the hygiene.”

Audits were in place to monitor cleanliness and infection control. Personal protective equipment was available to staff.

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 received their medicines as prescribed. Staff who were responsible for administering people medicines were trained and had their competency assessed. There was a ‘medicines champion’, a member of staff, with additional training and a special interest in medicines safety who supported staff, checked compliance and promoted best practice.

Staff told us the home had a good relationship with the pharmacy and there were systems in place for the ordering and administration of medication. An electronic monitoring system meant that when medicines were given, administration was time and date stamped.

Medicines were stored in a locked metal cupboard. Storage temperature was recorded daily and checked by senior staff to ensure best practice was followed. A fridge was available with a temperature display should medicines need to be stored as such.

Through our checks correct numbers of tablets were observed to be in place.

Strict legal controls are needed for certain medicines which required specific storage and recording. These are called ‘controlled drugs’. These were stored and administered in line with legal requirements.

There was a file relating to the Stop the Over Medication of People initiative, which seeks to reduce the use of medicines prescribed for people whose behaviour may challenge those around them. There was evidence that staff were aware of the information contained within the file.