Carpathia Grange

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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 assessed 5 quality statements in the safe key question. Everyone we spoke with told us they felt safe at Carpathia Grange. People and relatives described a consistent staff team who responded promptly to their needs. They spoke about the strong relationships and trust they had developed with staff. Risks in people’s care had been assessed and were regularly reviewed with the person or their representatives. People had confidence in the staff supporting them. People received their medicines safely and medicine was not used to control people’s behaviour inappropriately. Staff were proactive in monitoring people’s health and wellbeing and were quick to identify any changes or deterioration and seek support. Staff had a solid understanding of safeguarding and their responsibilities. Staff were recruited safely and had access to wide ranging training with considerable opportunities and support for further professional development. There were clear systems in place to underpin a proactive culture of safety. Staff, people and relatives described a positive culture where they were actively encouraged to raise any concerns. People and relatives told us issues were resolved promptly. Where areas for improvement had been identified, these had been introduced and closely monitored to ensure they were embedded into practice to improve outcomes for people living at the home.

This service scored 84 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives were encouraged and supported to raise concerns. They felt confident they would be listened to, and that action would be taken. Meetings and surveys were used to share information and seek feedback. Relatives had the option to join meetings virtually and people who could not attend meetings were consulted individually. We saw people and relatives seeking out members of the senior team. It was clear they felt at ease to do so. One person said, “You just know and feel that you are safe, there is occasionally a little snag, but they always sort it out.” A relative told us, “We have built a very close relationship with the manager and other members of staff who have all treated us with compassion and empathy. [Registered manager] has always operated an 'open door' policy and responds to any questions or queries as soon as she can. Another relative said, “They take on board what you say. Usually next time I go it has been sorted.”

Staff described a proactive and positive culture where they were encouraged to raise any concerns and learn from incidents. This then had a positive impact on people because of how staff embraced and embedded the learning. They told us they felt comfortable flagging mistakes and had confidence issues would be addressed by the senior team. Staff shared examples of changes to practice following incidents and on how reflection and learning was shared amongst the team. It was clear they understood the reasons behind the changes in practice and how this improved people’s safety. One staff member said, “I think it’s a good care home, the residents are safe and staff are encouraged to voice concerns. We have a bulletin downstairs which identifies lessons learned and people are encouraged to correct their mistakes.” Another staff member told us, “The managers, nurses and team leaders always give us feedback on different things on what action to take following an incident. We will look at what happened and how it can be prevented from happening again.”

There were clear systems in place to underpin a proactive culture of safety. Within each system, processes were embedded aimed at identifying learning and driving improvement. This included learning lessons from incidents and complaints to looking for areas that could have been done better on admissions, end of life care and in response to feedback. These processes involved people, relatives and staff, all of whom were actively encouraged to share their views. Following an incident where shortfalls in the use of a tool to assess and manage people who are unwell or showing signs of deterioration, a series of actions had been taken. This included staff training and competency checks, daily checks on forms, audits and feedback to the team. We saw staff using this tool and senior staff checking. Staff understood the benefit of using the tool. One staff member told us, “This was a lesson learnt from a resident who had a fall, to ensure we’re monitoring people more closely.” Lessons learnt, both from within the home and from the provider’s other services, were shared with staff in supervisions, team meetings and via a dedicated noticeboard situated by a lift in the staff area. Where areas for improvement had been identified, these had been introduced and closely monitored to ensure they were embedded into practice.

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 were emphatic in their responses when asked if they felt safe living at Carpathia Grange. Relatives were also very firmly of the view their loved ones received safe care. One person said, “I do feel safe, fully.” Another, “Everyone is around for me and everyone is very helpful and kind to me.” A relative told us, “[Name] is absolutely safe, they love it and I don’t have any worries at all.” People told us they felt comfortable with staff and were encouraged to share their views on their care or any concerns they had. One person said, “They look after me very well and are always there for me if I need them.”

Staff had a solid understanding of safeguarding and their responsibilities. One staff member said, “Safeguarding is keeping residents safe from harm, hurting themselves and others around them physically or mentally. I would report any concerns or abuse straight away to the home manager and if she didn’t act, I would go to the safeguarding team.” Another staff member told us, “I would report it because maybe someone hasn’t reported it yet. Management would follow this up, investigate what’s happened and look at preventing other incidents like this.” Staff supported people including in their rights under the Mental Capacity Act 2005. They understood about Deprivation of Liberty Safeguards (DoLS) and this is only used when it is in the best interest of the person. One staff member said, “People have a right to make an unwise decision, must we consider their best interest, make sure the person is involved in the decision-making process and if someone is deemed not to have capacity then you would involve next of kin or power of attorneys.” Another told us, “It’s not that you’re depriving them from going out completely but you’re putting safety measures in place so they can’t go out alone.” Staff demonstrated a commitment to keeping people safe. They were able to explain when and how they would report incidents or concerns. One staff member said, “Management always encourage us to speak up if there are any issues. As far as I’m concerned, I feel confident walking up to anyone and speaking up if there is something that concerns me.”

We observed people to be at ease with staff throughout our visits. It was clear staff knew people well and were alert to changes in their health or wellbeing. During the daily morning staff meeting, we heard senior staff discussing incidents, people’s wellbeing and feedback from teams as to changes or concerns they may have noted. Actions were agreed to follow-up, including where appropriate referrals to other professionals. Safeguarding information was clearly displayed. This included details on how to raise a concern.

Clear processes were in place to identify and report safeguarding concerns. Staff had received training in safeguarding and were encouraged to raise any concerns. Body maps were used on admission and to record any bruises or injuries. Where concerns had been identified, measures were in place to promote people’s safety. Where people lacked capacity to consent to their care or restrictions in their care, best interest decisions had been made in line with the Mental Capacity Act 2005. These included decisions for staff to support with medication or for the use of bedrails or sensor equipment to reduce the risk of falls. A tracker was in place to record authorisations under Deprivation of Liberty Safeguards (DoLS), expiry dates and any conditions imposed.

People had confidence in the staff supporting them. They told us they felt safe and were involved in decisions relating to their care. Where people required equipment to support them to transfer, they told us staff were capable and proficient in assisting them. People were supported to make choices in relation to their care, for example one person had chosen not to use footplates on their wheelchair as this enabled them to move freely within the home. The risk of injury had been discussed with the person who felt the benefit of independence outweighed the risk. Guidance for staff supported them in this decision, for example by not applying the brakes as this could increase the risk of tipping forward. A visiting professional said, “They promote independence but also increase care when required.” Relatives spoke of positive relationships with staff and felt assured the team would notice any concerns and act appropriately. One relative told us, “It is all credit to them [Name] has survived. It came on suddenly, but they picked it up quickly and monitored them closely. They heard the cough was a bit different and were on to it straight away.” Another laughed at the regularity of care plan reviews, saying they always received a call from the nurse of the given day of the month. They confirmed they could make contact at any time and told us, “I phone [staff member] and he always is great at helping me out.” Another said, “If there is something untoward, they call me.” Relatives had confidence incidents were handled appropriately. One relative had emailed following a fall to thank the staff member. They wrote, “His kindness, professionalism and compassion is a real credit to your care home and I truly can't thank him enough.”

Staff understood the risks identified in people’s care and spoke with confidence about the support they needed. They described the pre-assessment and admission process where information was gathered and discussed with the person, their families and professionals involved in their care. Staff had received training in the use of a physical deterioration and escalation tool. They spoke of identifying soft signs of deterioration and shared how they used the tool to record observations and identify when external help may be required. The use of this tool was monitored proactively by managers daily. This meant any deterioration in a person’s condition was reviewed and escalated quickly to the appropriate health care professional. Staff were proud of how this training and focus on implementation had improved their practice and benefitted people. One staff member said, “We are always striving to give the best care. We push ourselves every day.” Staff said they received good support from external professionals. A nurse told us, “If we notice a little deviation, we don’t wait for things to go wrong. We communicate with the families and surgery if needed, we get them involved. I can see the trust families have in us.” A visiting professional told us, “Care plans are followed and if things should deteriorate, they are good at making urgent contact for review.” Staff told us they received a high level of support from their seniors to manage incidents. A staff member told us, “The team leaders and nurses come on the emergency bell. The nurse will do vital signs and check for fractures.” Following a fall staff described how they completed an incident record and 72-hour monitoring, including the use of a pain scale for people unable to verbalise their needs. They told us they received feedback from their seniors as to how the incident was handled and on any area identified for improvement.

The home was purpose-built with wide corridors, good lighting and distinctively coloured handrails to aid recognition. Throughout our visit, we observed people had mobility aids in reach. Where people required assistance to transfer, safe practice was used. When not in use, equipment such as hoists or wheelchairs were stored safely to avoid creating a hazard. We observed people had call bells in reach and that staff responded promptly to requests for assistance. Some people had call bells worn on their wrists to facilitate easy access. Where people had been identified as at risk of falls, equipment was in place to minimise risk or to alert staff to when a person may require support.

Risks in people’s care had been assessed and were regularly reviewed with the person or their representatives. Where risks had been identified, proportionate monitoring and support was in place. Oversight was maintained by senior staff. There were regular opportunities for staff to discuss changes in people’s care or support. This enabled prompt action to be taken in response to concerns, including escalation to the regular multidisciplinary team meetings where staff could seek advice or request a review by external professionals. Where people were known to communicate their emotions or distress, guidance was in place for staff to ensure they received consistent and effective support. Information was shared appropriately to support the team in understanding their causes of distress and to identify how best to support them. We noted positive outcomes for people, for example one person had been discharged from the mental health team due to a ‘decrease in distress.’ There was a clear process in place to manage incidents and to review people’s care and support. This included reviewing people’s dependency to ensure they were in the best place to meet their needs. We noted some people had moved from the residential to the dementia care or nursing floor of the home due to a change in their support needs. The registered manager completed a monthly analysis of incidents and accidents. This looked at trends and sought to identify any learning to improve care and minimise future risk.

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 and relatives described a consistent staff team and spoke enthusiastically about the positive relationships and trust they had developed with them. People appreciated the skills of the staff team and told us they were extremely happy with the level of care they received. One relative told us, “We have noticed how every member of staff, be it the laundry team, the maintenance team, the chefs, they are all so kind and friendly. It makes such a difference.” People told us there were enough staff on duty to meet their needs. One person said, “The staff come, they are always available if you want them.” Another told us, “I don’t use it [the call bell] very often, but they do come running if I do”. A relative added, I see the same levels of staff on every visit, at weekends it seems the same and it seems adequate too when I come in in the evenings.”

Staff were satisfied with the staffing levels and that people were supported by a consistent staff team who knew people. One staff member told us, “It is mainly permanent staff. Staff will come and cover rather than use agency.” Another said, “When the carers are all attending to residents and the call bells are going, the team leaders will come and help. Teamwork is really good here and everyone communicates.” A third, “I have no concerns with staffing.” With the exception of nursing staff, staff told us they worked across the home which meant they knew everyone. Staff felt confident in their roles and valued the training available to give them the skills and knowledge to support people well. One staff member said, “The training is always up to date and we often have face to face workshops. It is a good opportunity to talk things through and we can speak about scenarios.” Another told us, “Management are very supportive and will always say we can speak to them if we feel like we need more training.” Staff spoke enthusiastically about opportunities to further their learning. One said, “Care UK is good in learning and supporting, they offer so much coaching. There are always opportunities.” One nurse told us, “The opportunity of training always there. There are amazing packages for career development.” A team leader said, “Care UK is really good at progressing people. If you want to do any training, it’s always there for you to do.” Newly recruited staff spoke positively about their induction. One said, “I got to know what happens on each floor, the residents and their needs, likes and dislikes. I had a buddy so if I had any questions or doubts, I would go and speak to her. I did around a month of shadowing. I feel I’ve had all the training I need.” Another told us, “I had a catch up at two weeks to discuss how I was getting on and one at four weeks. This has been really useful to check in with how I’m doing, and I’m given feedback.”

Staff appeared calm and not to be rushing. They took time with people and listened to them. Where we observed staff supporting people to transfer or with food and drink, this was done sensitively and at a pace that appeared to suit the person. Staff used appropriate moving and handling techniques and offered reassurance to people. We observed people had call bells in reach or wore them on their wrists for ease of access. Staff responded to call bells in a timely way. We noted the call bell also sounded in the registered manager’s office which allowed for additional oversight.

The registered manager completed a dependency assessment which was kept under review. The home was staffed above this level which had a positive impact on people’s experiences. Where additional resources were needed, this was addressed. For example, in response to feedback, an additional staff member was allocated to support with breakfast. The registered manager said, “We are not very rigid on staff, quality matters more.” In addition, the lifestyle (activity) team were supernumerary, and all had a background in care. Call bell response times were kept under review. There was a system in place to monitor staff training. This showed a high level of completion. Where there were gaps, training had been scheduled. Staff competency was regularly assessed. The registered manager had introduced knowledge tests to assess staff confidence in areas including falls and the Mental Capacity Act 2005. Staff received regular supervision and appraisal. Staff were supported to further their professional development. Champion roles were available in areas including infection control, sustainability and dignity. Other staff had taken opportunities such as becoming a dementia care coach. Nursing staff had access to further training at an affiliated college which also counted towards their revalidation. Staff were recruited safely. This included checks on their suitability to work in care. When new staff joined the service, they completed an induction that included shadowing of experienced staff. Staff were asked for feedback after their first day with a view to ensuring the planned support was in place and seeking suggestions to improve the process. There was a system of review over the first 12 weeks. Where agency staff were employed, their profiles and training were verified and they were given an induction prior to their first shift. Records were maintained for nursing staff to ensure they were registered with their professional body.

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.

People had confidence their medicines were managed safely. One person said, “I trust them totally.” Another, “I take several tablets and have a variety of creams. The nurses supervise all that. When you come in here they registered all my medical needs and then monitor and look after you.” A third, “My medications are controlled and administered very well. The care is generally very good.” People confirmed they were readily able to access pain relief when needed. One said, “If I ever have a pain, I ring my bell and ask for help.” We observed one person being supported by staff with their eyedrops. The staff member was friendly, explained what they had come for, washed their hands and, with the person’s consent, successfully administered the drops.

Staff spoke with confidence about the support people needed with their medicines and the systems and processes in place to ensure safe administration. Some people were enabled to manage their own medicines, which supported their independence and choices. A staff member said, “There is still a risk with them doing it themselves but it’s positive that they can be more independent and have control over this.” People’s behaviour was not inappropriately controlled by medicines. Staff shared feedback on the impact of Namaste care, which involves a range of physical, sensory and emotional approaches. One staff member said, “We have noticed with Namaste care behaviours have decreased quite a bit. We look at unmet needs like pain before jumping to medication. We have the mental health team that come in regularly and get them to review [the person] too.” The registered manager told us they reviewed the use of antipsychotic medicines monthly and aimed to hold a review with the GP every 3 to 6 months.

The level of support people needed to manage their medicines had been assessed. Where people had been assessed as able to administer their own medicines, stock checks and reviews were in place to ensure they continue to be able to do so safely. Staff administering medicines had received training and competency checks. If any errors were noted, further staff training and supervision had been put in place. We saw a double signature had been introduced for one medication to minimise the risk of any errors with the dose. Clear records were in place, with regular checks on completion and corresponding stock checks. Time critical medicines had been administered appropriately. Where medicine had been authorised for covert administration necessary authorisations were in place. Staff used pain scales to monitor people who could not verbally communicate the level of pain they were experiencing. There was a focus on ensuring people’s behaviour was not inappropriately controlled by medicines. The use of these medicines was reviewed monthly by the registered manager and people’s individual needs overseen with other professionals during a multi-disciplinary team meetings. We noted a request had been made for one person to change to a liquid form of their medication to gradually reduce the dose. Medicines were stored safely.