Crumble Cottage

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 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 had a proactive and positive culture of safety based on openness and honesty. However, leaders and 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. Accidents and incidents were recorded but there was minimal evidence of analysis of trends and patterns. The registered manager told us this had been identified in the recent local authority audit, and they were working to address this issue by implementing an analysis document.

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 had hospital passports in place which gave information about how people presented when in hospital or having a medical intervention. There was information regarding discharge planning stating where people lived and assistance required about taking medicines home and who to alert when they were ready for hospital discharge. Family details and contact numbers and any health screening were also included.

he 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 with the local authority but did not always report incidents to CQC in a timely way. Staff were knowledgeable about safeguarding people from the risks of abuse and knew how to recognise and report concerns. 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). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place, when needed, to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. Staff and leaders were knowledgeable about MCA and DoLS and worked in line with guidance.

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 associated with people’s care and support were identified and managed to keep people safe. People had risk assessments in place which gave guidelines for staff on how to mitigate risks.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.We found window restrictors in bedrooms, but the kitchen was quite a large window and had no restrictor in place. There was a small bathroom window without a restrictor fitted. One person’s bed was very worn, the divan base was sinking and the headboard was ill-fitted. The registered manager said they would take action to address these issues. We also found radiators without covers, which was a potential hazard to people who were not temperature aware. The fridge seal was worn and broken, and the freezer compartment was in need of defrosting. The registered manager told us they would evaluate the risks identified and make appropriate changes where necessary. On our second site visit we found a new bed had been purchased to replace the worn one.

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. We found staff received training and support to carry out their role well and had their medicine administration competencies checked. However, we reviewed 3 staff recruitment files and found some application forms did not provide a full employment history, and gaps had not been explored. The registered manager told us they would address these concerns immediately.

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. We looked around the service and found it was predominantly clean. Staff supported people with cleaning tasks and they were knowledgeable about infection prevention and control. They confirmed they had access to personal protective equipment (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. People received their medicines as prescribed by staff who were trained and competent to administer medicines. Medicines were safely stored and medicine administration records (MARs) documented stock balances of medicines. Staff knew what action would be taken if there was a medicines error and were committed to ensuring safe administration.