Carolyne House

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 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 service 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. The registered manager shared learning with staff from incidents, accidents, complaints and safeguarding so that the service could continually improve and develop positive outcomes for people. Information was shared with staff through handovers, memo’s, daily flash meetings, supervisions and staff meetings. Following the inspection, the Chief Operating Officer devised a new monthly record of lessons learnt and guidance in the service which was detailed and encouraged the registered manager to identify themes and examples of good practice.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. The registered manager/health professionals made sure there was continuity of care, including when people moved between different services. Staff told us they read through the care plans to ensure they had all the information they needed to provide support safely. Relatives told us they were happy with the transition and admission to the service. One relative said, “Staff are wonderful with [relative] and have helped so much to settle [relative] in, I don’t have the words to thank them for how they have helped.” Another relative told us, “[Relative] has only just gone into care, it was very difficult to find somewhere suitable, and this is a really lovely home, they are very nurturing and caring, [relative] is not just a resident, and I have felt this from the very beginning.”

A visiting health professional told us, “Once we receive a referral, we assess the information, and before we come into the service, we have a meeting first with staff because since the referral some things could have changed. However, [registered manager’s name] and the team are always available and even after we meet the patient, we then have a debrief with the care team.”

Another health professional told us, “I feel that Carolyne House provides safe care and support to people in its service. As a discharge hub we always find the care home manager to be very helpful and accommodating and works closely with us to help transfer patients safely. We are very impressed at how the staff in the care home can meet the needs of the patients that we transfer. They also have very good links with community health services in Thurrock if needing support. Their End of life care is very good, and they ensure to support advanced care planning.”

The service 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 service shared concerns quickly and appropriately. Staff had received training in safeguarding and knew how to raise concerns. A member of staff told us, ''I know how to report any form of abuse, and I would take immediate action. I would know who to report to and I would continue to escalate further to the Local Authority if I needed to.'' Staff could recognise signs when people experienced emotional distress and knew how to support them. For example, a member of staff told us they would know what to say and how to support a person's distress when they became anxious

The service 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 identified risks to people and put safeguards in place to mitigate these risks. For example, if a person was at risk of pressure ulcers staff ensured they had all the correct equipment in place to minimise this risk. Where people were at risk of falls the registered manager worked with them to understand the risks and what were the best ways to reduce this risk. Staff were aware of preventative measures they could promote, such as encouraging people to stay well hydrate and nourished to minimise the risks of infections or pressure ulcers. People were supported to live full lives and this included going out into the community safely.

The service recognised there are lots of things people do in life that involves risks, and they need to do them as safely and sensibly as possible. This meant they still empowered people with activities but took steps to mitigate the risks. The registered manager was passionate that people should be supported to access activities they enjoyed whilst taking a proportionate approach to the risks involved. For example, where a person enjoyed a more adrenalin filled activity the registered manager sourced how they could experience a rollercoaster whilst mitigating the risks for the activity as safely as possible.

However, we found some examples where care plans and risk assessments lacked detail. For example, there was no care plan in place for a person who had epilepsy. This meant staff did not have clear guidance on how to support the person’s specific needs, recognise early warning signs, or how to respond appropriately in the event of a seizure. Following the inspection, the registered manager ensured all care plans were up to date and contained accurate information.

A health professional told us, “We receive referrals from Carolyne House, they send us referrals, we come in and assess patients and then give guidance on how to improve patients' lives, their mobility etc to get residents out of bed and get more mobilised. Carolyne is one of the best in the borough because staff are responsive, the manager is superb. Any of my colleagues will say the same thing. The manager is always available to offer support and work with us. Even the qualified nurses that do visits have said this.”

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The environment was adapted to meet the needs of people living there. People had access to outdoor spaces, providing an opportunity to enjoy fresh air and relax in the garden. Maintenance staff were employed to ensure the premises were well-maintained and safe. There were systems in place to ensure any maintenance needed were recorded and responded to promptly. Records of checks on equipment and the premises were up to date. However, we found 2 wardrobes were not affixed to walls in people’s bedrooms. This meant there was a potential risk for wardrobes to topple over onto service users causing crush injuries. The maintenance person immediately rectified this on the day of our visit.

Risks relating to the service's fire arrangements were monitored and included individual Personal Emergency Evacuation Plans [PEEP] for people using the service. However, some of the information lacked detailed. Following this inspection the registered manager updated the PEEPs for each person to ensure they were detailed, up to date and accurate.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care that met people’s individual needs. The registered manager had processes in place to ensure all staff received an induction and staff we spoke with told us they had an extensive induction. Appropriate checks were in place before staff started work including providing full work histories, references and a Disclosure and Barring Service (DBS) check. DBS provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. However, not all references received had been verified. The reference audit file did not specify that verification was required. Following our visit, the Chief Operating Officer devised a new reference verification form and shared this with the service.

A person told us, “There is always someone around to help me. I don’t have to wait around for help.” Another person told us, “It’s wonderful. I couldn’t be in a better place. To describe it, well its effective and good. I tap on my table, and they come straight in. The staff are very kind, the way they do my hair for me. They are just so lovely, not one that I could complain about.” A relative told us, “I think there are enough staff to cater for the residents needs including in the evenings and weekends. A relative told us, “It's a lovely home, the staff are really helpful and kind. They keep us, as a family, up to date with information. It's a nice place to visit. Every single person that comes past says hello; they make you feel like family.”

A health professional told us, “The care home appears to be staffed well. The staff are very caring and use a personalised and professional approach.”

The service assessed and managed the risk of infection. They detected and controlled the risk of infection spreading and shared concerns with appropriate agencies promptly. The service was clean and tidy with no odours. Staff had personal protection equipment situated throughout the service giving them easy access to wear when needed. The registered manager carried out regular checks and completed regular audits to monitor the cleanliness of the service. A volunteer told us, “I come in regularly and staff are always wearing the correct PPE.”

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 had systems in place to safely manage medicines including refreshing medicine training and competency checks. Audits were in place to check medicines including topical medicines and oxygen were being managed safely and people received their medicines when they needed them. We found where a person was receiving covert medication, where medicines administered in a disguised form, such as hidden in food or drink, written guidance was available for staff however, documented instructions from a health professional for this practice were not available. Following our visit, the registered manager requested the necessary documentation from the health professional, and the Chief Operating Officer devised a new medicine supervision form for the registered manager to ensure staff understanding.