Cherry Care Services Limited - Northampton

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 63 (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.

Staff told us that learning from incidents was routinely shared with the team, enabling them to reflect on events and improve practice. One staff member said, “The manager shares learning via message or meeting.” This helped staff understand lessons learned and apply these to their day-to-day work, promoting continuous improvement and supporting safer care for people using the service.

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.

We saw that people had personalised emergency grab sheets in place, containing important information about their care and support needs. These supported a smooth transition from home to hospital should a person become medically unwell, helping healthcare professionals to access key information promptly and ensuring continuity of care.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

Staff told us they had received safeguarding training, and we saw evidence that the progress of safeguarding incidents was monitored by the service. This helped to ensure safeguarding concerns were overseen and actions tracked. They told us that safeguarding concerns were responded to appropriately. One staff member said, “I have had to raise concerns. We discussed it with the person and things are pretty ok [for the person] now.”

However, improvements were needed to ensure people were consistently protected from the risk of harm. A complaints, concerns and quality monitoring log did not include the dates incidents had occurred. This could make it difficult for the service to effectively monitor whether concerns and complaints were managed in line with its policy and within expected timescales.

In addition, where people may have lacked the mental capacity to make specific decisions, capacity assessments and best interest decision-making processes had not always been completed in line with the Mental Capacity Act 2005 and its Code of Practice. This meant the service could not always demonstrate that decisions were made lawfully and in people's best interests, and people's rights were not consistently protected.

Despite the concerns identified, we did not see evidence that people had experienced harm because of these issues. Safeguarding incidents were monitored by the service, and there was no indication that people had been placed at immediate risk. However, the gaps in recording and the failure to consistently complete mental capacity assessments and best interest decisions in line with the Mental Capacity Act 2005 meant the service could not always demonstrate that people’s rights were fully protected or that safeguarding processes were operated as effectively as possible.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Some risk assessments were generic and did not clearly identify the specific risks individual people faced. As a result, the associated management plans did not always contain sufficient detail to guide staff on how risks should be managed effectively.

Risk assessments frequently referred staff to other documents for information about how risks should be reduced, rather than clearly setting out control measures within the risk management plan itself. This meant it was not always evident how the actions identified would minimise risks to people.

There was also no evidence that people had been involved in developing or reviewing their risk assessments and management plans. While some records indicated relatives had been involved, these individuals did not have the legal authority to make decisions on behalf of the person. This meant the service could not demonstrate that people, or those lawfully authorised to represent them, had been appropriately involved in decisions about managing risks to their health, safety and wellbeing.

Despite these concerns, we did not see evidence that people had been exposed to avoidable harm because of the issues identified. People told us they felt safe. Staff were able to describe how they supported people to manage risks, and there was no evidence that people had experienced harm during the delivery of care. However, the lack of detailed, person-centred risk assessments and documented involvement in risk management meant the service could not consistently demonstrate that risks were being effectively identified, assessed and managed in accordance with best practice.

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 saw evidence that staff completed checks of moving and handling equipment before use to ensure it was safe and functioning correctly. This helped to reduce the risk of harm and support people's safety during transfers and moving and handling activities.

An equipment register was maintained, which enabled the service to monitor equipment and ensure items remained fit for purpose.

We also saw evidence of an environmental risk assessment. However, this record did not clearly identify whose home had been assessed. While this had not impacted on the overall safety of the service, clearer recording would support effective oversight and ensure assessments could be readily linked to the relevant person and location.

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.

The service had effective recruitment and training processes in place to help ensure staff were suitable and competent to support people safely. Appropriate pre-employment checks had been completed before staff began working with people. We noted one staff member's application form did not include details of their education history; however, this had not prevented the provider from obtaining sufficient information to assess their suitability for the role.

We saw evidence that staff received a supportive induction when they started employment, helping them to develop the skills and knowledge required for their roles. Records also demonstrated that staff had completed mandatory training, ensuring they had up-to-date knowledge in key areas relevant to the people they supported.

People told us they felt staff had the appropriate knowledge, skills and training to meet their needs safely. One person said, “Staff have had the right training and know my likes and dislikes.” This feedback was consistent with the training records we reviewed and demonstrated that people were supported by staff who were equipped to provide safe and effective care.

Despite the minor issue identified in one recruitment record, we did not find evidence that people were placed at risk because of staffing arrangements. People and relatives spoke positively about the staff who supported them, and there was no indication that a lack of staff knowledge, skills or training had resulted in unsafe care or harm to people.

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.

The service had effective processes in place to support infection prevention and control. People told us that staff consistently used personal protective equipment (PPE) when providing personal care and confirmed this helped them feel safe. One person said, “They always wear PPE.” Staff also told us they always had access to the PPE they needed to carry out their roles safely and in line with good practice.

We saw evidence that staff competence in hand hygiene had been assessed, helping to ensure they understood and followed appropriate infection prevention and control procedures. This demonstrated that the provider monitored staff practice and supported them to maintain safe standards of care.

People and staff provided positive feedback about infection prevention and control practices, and we did not identify any concerns regarding the cleanliness of care delivery or the availability and use of PPE.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

We saw evidence that the registered manager understood the principles of delegated healthcare tasks and had discussed these responsibilities with staff. Records showed staff had received task-specific training from specialist healthcare professionals for a range of delegated healthcare tasks. For diabetes management, there was evidence that staff competence had been assessed and signed off by the delegating healthcare professional. However, for other complex tasks, such as administering medicines via a PEG (percutaneous endoscopic gastrostomy), staff had received training from specialist nurses. Whilst this provided staff with the knowledge required to undertake the task, there was no evidence that a formal competency assessment had been completed following the training. Consequently, the provider could not demonstrate that competence had been assessed and verified in the same way as for delegated diabetes management tasks.

Medicines-related risk assessments did not always identify or explore the specific risks associated with the route of administration. For example, where medicines were administered via a PEG, risk assessments did not clearly set out the potential risks and the actions required to mitigate them. This meant staff may not have had access to all the information necessary to support people safely and consistently.

We found PRN (pro re nata, as required) protocols were in place for people prescribed medicines on this basis. However, these protocols required additional detail to ensure staff understood the circumstances in which medicines should be administered and how people’s individual needs and preferences should be considered.

In addition, where people may have lacked the mental capacity to consent to receiving medicines, there was not always evidence of Mental Capacity Act assessments or best interest decision-making processes being completed. This meant the service could not consistently demonstrate that medicines were administered with appropriate consent or in accordance with legal requirements.

Despite these concerns, we did not find evidence that people had come to harm because of the issues identified. Staff were able to describe how they supported people with their medicines, and there was no evidence of medicines errors resulting in avoidable harm. However, the lack of documented competency assessments, sufficiently detailed risk assessments, PRN protocols and Mental Capacity Act processes meant the service could not consistently demonstrate that medicines were managed as safely and effectively as possible.