Grace Care Centre

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 provider 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 provider and registered manager maintained a positive culture and learned from any accidents, incidents and safeguarding. Staff reported any incidents that had occurred, which were then reviewed by the registered manager and investigated when needed. A log of incidents, accidents and safeguarding was kept and an analysis was completed. Learning took place and action was put into place to prevent occurrence. The registered manager kept a notifiable event overview. Where people had had frequent falls, the service looked into the cause, which included checking the person’s environment, looking at under lying medical causes and liaising with the service’s falls lead. Information was shared with the staff team to ensure there was an open learning culture.

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. People were safely supported to transition from their own home, hospital or from another care service. Upon admission to the service, a holistic approach to care was followed to support people to manage their care with other providers. This included registering people with the local GP surgery, arranging medicines, liaising with the district nurse team and other health professionals. If people decided to move to another service, the registered, deputy and staff supported people through their transition.

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 demonstrated a clear understanding of safeguarding responsibilities and acted appropriately when concerns arose. A staff member told us, “I would report any concerns straight away.” The staff had received safeguarding adults training, which was mandatory. The registered manager and deputy escalated safeguarding concerns to the local authority, when needed. An overall log of safeguarding incidents was maintained on a tracker. This showed that concerns reported had been investigated and the appropriate action taken. The service had a safeguarding lead, who over saw the process. If people felt unable to raise concerns to the staff, they were able to speak to the service’s ‘resident ambassador’ who supported people to speak up. The safeguarding procedure was clearly displayed for people to refer to in the reception area of the service.

People and their relatives gave feedback that they felt their relatives were safe living at the service. They were aware of how to raise any concerns regarding their care and treatment. A person told us, “In the past I have fallen. I am in safe hands with them.” Another person told us, “I’ve had no ill-treatment, and I’ve never seen any ill-treatment, If I did, I would speak to the manager and I know they would take it seriously.”

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 (MCA). In care homes, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). At the time of are assessment, 3 people had an authorised DoLS in place with their conditions met. A further 9 DoLS applications had been submitted to the local authority and were waiting assessment.

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. Risks to people had been assessed and this was recorded within risk assessments, which were held electronically, updated and reviewed. Risks to people’s health and wellbeing had been managed and clearly recorded in their care plans. For example, some people had risk assessments in place, due to the risks associated with their mobility, falls and choking. Risk assessments focused on each person’s identified needs, level of need, planned outcomes, how to achieve outcomes, interactions, risks and responsible persons. Where people were at risk of malnutrition, assessments were in place and records maintained of people’s food and fluid intake. People at risk of weight loss were weighed regularly by the staff and an overview of their weights were maintained. The staff had a good understanding and knowledge of how to keep people safe.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Systems were in place to check the safety of utilities at the service, such as fire safety, gas safety and water safety. These were up-to-date and where issues were identified, action had been taken. The service had a fire risk assessment in place, which assessed the fire safety of the building. This helped to identify any issues. The staff had received fire training, and they attended regular fire drills. Checks were carried out of fire safety equipment, such as fire extinguishers and emergency lighting. Each person had their own personal evacuation plan in place, which contained information about how many staff were needed to safely evacuate each person. The building had been well maintained with maintenance staff employed.

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. Safe staffing levels had been maintained at the service and were kept under continuous review. At the time of the assessment 36 people were living at the service, with 15 vacant beds. The provider used a staffing calculation tool; to help guide them on the number of staff they needed to safely support people. Staff rotas were planned in advance to help maintain a safe delivery of care to people. The building had 2 floors, with the second floor aimed at caring for people with dementia. The staff had a mix of skills, and some staff were rotated to cover both floors. During busy times of the day, for example mealtimes, all staff roles were expected to support each other by giving out meals to people.

Although we did not identify any risks in relation to staffing levels, we received mixed feedback from staff about staffing levels. Examples of feedback included, “Yes, we have enough,” and “I feel we do have enough staff and I am not concerned”. Some staff felt the staffing numbers needed to be increased, although they were conscious of the lower occupancy with beds. The operations manager showed us the current staffing levels by using the calculation tool. Some shifts were not covered due to the lower occupancy; however, the service were still working within safe staffing levels. We were told the service have a whole home approach and staff from all roles were expected to support each other.

People and relatives gave feedback that overall, they felt the service had enough staff. Examples of feedback we received included, “Staff go into people when they need help to get dressed, quite quickly from what I’ve seen,” “I’ve got this pendant, I press it if I am in need. Because I don’t press it very often, they come to me very quickly when I do, they think there must be something wrong.” Another person told us, “Sometimes I have a wait but usually not long.”

Staff had been safely recruited into their roles with pre-employment checks carried out. This included for example, reference checks, exploring gaps in previous employment, criminal records check and checking the staff’s right to work in the UK. All staff had completed an application form and took part in an interview. Audits of staff recruitment files had been completed by the service’s human resources department. This showed safe recruitment practices had been followed. Staff undertook a comprehensive induction, completed shadow shifts and worked with competent staff. Staff were expected to complete all mandatory training, for example safeguarding, moving and handling, first aid and fire training. Other training was given to staff to support people’s needs and health conditions. This included training in Parkinsons awareness.

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. Infection control measures were embedded in daily practice. The service had a sink in the entrance area with soap and paper towels, where visitors could wash their hands, prior to entering and leaving the building. This helped to reduce the risk of infection. Personal protective equipment (PPE) was used appropriately, and stock levels were maintained. Clinical waste bins were located around the building, where used PPE could be safely disposed of. The service was clean and tidy throughout with housekeeping staff, observed visibly cleaning. Cleaning schedules recorded areas of the building which had been cleaned. An infection control lead was allocated to oversee the practices of staff. They completed infection control audits monthly, which helped the service to focus on areas which needed deep cleaning or further cleaning.

People and relatives told us they felt the home was clean and well maintained. We received the following comments from people, “The cleaners are very good and keep things clean and tidy. They work hard”, “Seems always clean, yes”, “It is nice and clean everywhere, in fact they have just cleaned my room.”

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. The provider had systems in place for the safe storage, administration and recording of medicines. Each person had an individual medicines profile, which contained a photo of the person and information about their medical history and known allergies. Medicinesadministration charts were signed by the staff, after medicines had been administered. Clear instructions were available for time-specific medicines. Processes ensured safe rotation of pain patches to prevent overuse of the same site.

Discontinued medicines were safely returned to the chemist, with clear records maintained about each medicine being returned. Medicines error analysis and medicines audits were completed monthly by the management team. This enabled the registered manager and provider to have oversight of the medicines system. The service had worked hard to reduce medicine errors, by putting measures in place, such as re training. The staff administering medicines wore a ‘do not disturb tabard’. Staff and relatives had been reminded not to disturb the staff member allocated to medicine rounds.

People and relatives gave feedback to us, that they felt their medicines were administered safely. One person told us, “They bring in all my medication morning and night. They wait and make sure all is well.” One relative told us, “Medicines very good. If I’ve got any queries the GP checks. Her medication is sorted.”