Halcyon Days

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• 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

We looked at 3 quality statements under this domain. Safeguarding, involving people to manage risks and safe and effective staffing. We found that people felt safe living in the service. Staff understood their roles and responsibilities in protecting people from abuse and the risk of harm. Staff had received refresher training in how to safeguard people. Safeguarding concerns had been raised with the relevant authority where required. Accidents and incident records were reported and there was analysis of themes and patterns to help prevent reoccurrence. Staff supported people safely and we observed staff carrying out care competently, for example with moving and handling following best practice guidance. Staff were able to tell us about people’s individual risks. This included pressure care management, dietary needs and fall management. However, one person was seen to be in the same position throughout our assessment, but they required 2 hourly repositioning as they had a pressure sore. We also observed a person laying down flat to eat their toast which placed them at risk of choking. These concerns were raised with the management team who took action. Views were mixed about the staffing levels in the service and the responsiveness of staff, however we saw the registered manager constantly monitored and increased staffing when needs changed. The provider had recently taken action to increase staffing numbers.

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.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe. We saw that people were comfortable around staff.

Staff had received training around safeguarding and keeping people safe from harm. Staff were clear on how to recognise and report safeguarding concerns. One staff member said, “I’d report [safeguarding incidents] to my manager or CQC.” Staff demonstrated to us through discussion where to find contact information for CQC and the local authority safeguarding team. A whistleblowing policy was in place for staff to speak up confidentially if they were concerned about the conduct of any staff member.

People appeared relaxed and comfortable with staff. We did not observe any unsafe practices or inappropriate restrictions. People said they liked living at the home and although raised some areas for improvements, they raised no safeguarding concerns with us.

Safeguarding policies were in place. The registered manager had reported incidents appropriately to the local authority safeguarding team when required. The registered manager maintained a safeguarding log and analysed this for any themes. We discussed an example where they had identified an increase in unwitnessed falls in the service. These were reported to the local authority appropriately and investigated accordingly with the registered manager and senior staff reviewing these with staff. Themes and trends emerging were not routinely shared with staff through care staff meetings, which we raised with the registered manager as an area for improvement. The registered manager discussed safeguarding concerns meetings discussed in senior staff meetings, weekly resident risk meetings and daily stand up meetings. However, these were not regularly discussed with care staff in their regular meetings. We raised this with the registered manager as an area for improvement.

Staff were supporting people safely. We observed staff supporting people to transfer or move around and this was done in a safe and appropriate way. For example, staff were gentle in their touch and used equipment in accordance with training. Staff were able to tell us about people’s individual risks. This included pressure care management, dietary needs and fall management. We observed people had equipment in place to support mobility or manage risks. For example, pressure mattresses in place which staff knew how to safely operate and monitor skin for possible deterioration. Three carers knew when these people required positional change.” However, we did see one person who the district nurse had advised to be out of bed. We saw them remaining in bed throughout our assessment, which we raised with the registered manager to action. We observed appropriate moving and handling techniques by staff when using the standing hoist who were gentle and gave direction and assurance to people to keep them calm.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us staff mainly were able to assist them when they needed. One person told us they needed to wait for support at times. Relatives gave mixed views about staffing. A relative said, “Sometimes there are lots of staff at others barely any. There have been occasions when I have visited my [person] and residents that lack mobility are calling for assistance of that they need something and there is no-one within hearing distance.”

Staff gave mixed views about staffing. A staff member told us staffing had recently been increased by 1 member each day, increasing care staff from 3 to 4 staff on Nightingale unit. Agency staff were in use on the day, and they knew the home and people well. The manager told us there was ongoing recruitment to fill vacancies.

On Nightingale unit we found lunchtime to be very busy. The manager and staff told us it was always busy. This was mainly because as people started to move to the dining room, they needed the toilet and call bells were sounding. We discussed with the manager the need for staff to be more proactive and advise people and it was almost lunch and offer the use of the facilities. This would also help prevent people being restless at mealtimes. We asked how they ensured everyone had received a meal. The manager and staff told us they remembered who they had served. We discussed the need to have a robust system in place to ensure no one missed any meals.

The registered manager uses their own observations, and a range of staffing tools to assess dependency and staff numbers. We saw evidence where this led to an increase in staffing and was in line with the registered managers assessment. We saw examples where the registered manager had brought in temporary staff in excess of the dependency assessment where they saw a change in need requiring short term support. For example, with a person struggling with their dementia and another who required palliative support and was alone. Given the feedback from staff and some people we reviewed the February 2024 dependency and staffing hours and found the dependency accurately assessed people's needs. The rota confirmed the hours provided for personal care and had been overstaffed by 25 hours.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.