Cantley Grange

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 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 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 service had effective systems in place to record accidents and incidents. Staff understood their responsibilities to raise concerns appropriately and had confidence action would be taken by the registered manager.

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. Staff worked in partnership with other professionals such as GPs, dietitians and speech and language therapists (SALT) to support people to access healthcare when they needed it. People had hospital passports in place, which provided information to health professionals on the person’s current needs, to enable smooth transitions in services.

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. People told us they felt safe. One person commented, “I feel safe here, the staff are kind to me.” Staff were knowledgeable around keeping people safe from harm and knew how to report safety incidents appropriately. The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to make particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. 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 MCA. During our assessment we found improvements were required around the documentation and recording of assessing people’s mental capacity. For 1 person at the service, a physical restraint was in place, a mental capacity assessment was completed retrospective to the decision and within this assessment, there was insufficient detail to evidence the appropriate application of the MCA to the service’s assessment. Therefore, we could not be assured that all the practicalsteps had been taken to support this person in making the decision about the restraint for themselves. The provider advised training had been provided to team leaders on the understanding, assessing and documenting required during mental capacity assessments and advised the area was still a focus for improvement within the service.

Within some of the care plans we reviewed, the provider worked well and managed risks. For example, people’s choking and dysphasia risk assessments were thorough, outlined the specific dietary requirements people needed, and provided guidance to staff on how to meet the people’s needs safely. However, there were occasions where staff did not always work well with people to manage their known risks including risks around specific health conditions. Whilst we found no evidence people had come to harm, we identified there was a risk of harm to 1 person’s well-being. This person was found to be in possession of medicines, which should have been registered and safely stored in the medicine’s cupboard. Staff were unaware these medicines were in the person’s room, and within this person’s care plan there was no risk assessment in place for this condition to provide staff with information, guidance or advice on how to monitor, support and escalate concerns should the person become unwell or require their medication. Following our feedback, leaders acted accordingly and implemented a risk assessment, spoke with medical professionals and informed the correct authorities of the situation.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. We found security on the premises was robust and there was equipment in place for people if they required it and systems were in place to ensure equipment was regularly maintained. The staff carried out regular checks on safety, including fire safety. The staff had developed personal evacuation plans to ensure people at the service were evacuated safely in an emergency. However, during the inspection we found 2 people’s prescribed thickener in communal areas. This was dealt with promptly by leaders who arranged for key-coded boxes, where prescribed thickener could be stored safely.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff were recruited safely, with appropriate pre-employment checks carried out before staff started working at the home which included Disclosure and Barring Service (DBS) checks.Staff had received appropriate training to enable them to safely carry out their roles and staff received regular supervisions and appraisals. On the day of the inspection, we observed suitable staffing levels. However, people, relatives and staff told us they felt staffing was stretched on occasions. One relative commented, “I can see staff are rushed off their feet when I visit [relative].” Another person told us, “[Staff] help me, but they are always very busy, and I have to wait my turn often.” The service told us that they have recently introduced another staff member to support in the mornings to ensure there is sufficient support staff on duty to carry out safe and effective care.

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. Prior to our assessment, the service had been working closely with external parties to ensure infection control compliance. We received positive feedback that the overall cleanliness of the service had improved and there was a full domestic team in place to maintain that standard within the service. Staff had received infection prevention control (IPC) training and told us there were sufficient personal protective equipment (PPE) supplies to enable them to carry out their roles safely. We found some gaps in cleaning schedules and during the inspection highlighted some areas of the service which required additional cleaning. However, the registered manager assured us they were carrying out more in-depth IPC audits of the service, with the introduction of a new thorough assurance tool.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. During the assessment, we identified some medicines shortfalls within 1 medicines trolly, which were immediately addressed and had no impact on people receiving their medicines.These included staff not always documenting the effectiveness of PRN (as and when) medicines. For people who required transdermal patches, recordings were not always consistent of when they had been rotated or removed. For 1 person who used a spray to relieve chest pain, we found no risk assessments in place to guide staff on how these people may present when requiring the medicine, or how to evaluate its effectiveness. For another person who required the same spray, we found no PRN protocol in place. We requested an informal action plan to be completed following our findings. The leaders at the service took prompt action, which included further training for staff on the areas we found.