Annefield 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

We assessed all quality statements within the safe key question. People felt safe and staff protected their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. Risks in people’s care and the environment were managed, whilst enabling them to do the things that matter to them. Risks of infection were controlled appropriately. There were enough qualified, skilled and experienced staff to deliver safe care, and staff received support to help them perform well in their role. Medicines were managed safely. Staff worked with partners to promote people’s safety and ensure continuity of care when people move between services. There was a proactive and positive culture of safety based on openness and honesty.

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.

People and their relatives told us they felt staff knew what they were doing and had confidence in their abilities. Everyone we spoke with said they felt staff provided safe care. Information was shared with people and their families following incidents, to make sure everyone understood what had happened and how the service were going to reduce future risks, using duty of candour.

The Registered manager demonstrated they were open and transparent and learnt from any incidents, accidents or safeguarding events. They clearly shared information with CQC and partner agencies when required and sought advice and support. There was regular involvement from external professionals such as independent mental health advocates (IMCAs), social workers or GPs. Risks and events that had happened were shared at handovers with staff. Staff felt supported and understood how to keep people safe. They reported accidents and incidents and were able to contribute their views about what happened and what they could do to reduce risks. All staff spoken to said they felt confident to raise any concerns with the deputy or registered manager.

Incidents, accidents and safeguarding events were recorded by staff and analysed by the registered manager. The provider had clear systems in place to enable effective recording and monitoring of incidents, accidents or safeguarding events. We viewed records to demonstrate action was taken where needed, including sharing information with partner agencies, involving the person and /or their family and updating risk assessments and care plans to reflect any changes or increased risks.

People and relatives told us they felt safe. They said staff took time to get to know them well and involved them in decisions about their care.

Staff described the systems in place to ensure essential information was shared when people moved between services. The management team and staff had a good working relationships with external health and social care professionals and sought advice and support when needed. Staff demonstrated they knew people well and understood any risks and associated care needs.

All professionals spoken with were positive that staff always sought and listened to advice where needed.

People had 'This is me' profiles and hospital passport summaries of their care plans. These contained information on essential needs and could be easily printed and shared with other agencies as needed.

People and their relatives told us staff were kind and they had no concerns that any harm would come to them. One person told us, "They [staff] are concerned about your comfort and safety." Another person said, “I feel safe with the room and the staff, they understand what I need. I have no fear here." One person did raise that their door did not have a lock on. We discussed this with the registered manager who said they had already ordered locks for people's rooms and these were due to be fitted in the next week or two.

The registered manager was able to describe robust processes in place. The registered manager or their deputy were available in the service 7 days a week, with one or other on call at all times. Staff were actively encouraged to report any concerns. Staff were clear about their safeguarding responsibilities and knew what and how to record concerns or events and who to go to if they felt safeguarding was not being reported appropriately. They felt any concerns they raised were listened to and acted upon. All professionals spoken with were positive staff reported safeguarding concerns when needed.

We observed staff speaking to people in a respectful manner and including them in decisions. We saw staff responded promptly when people needed support, which reduced the risk of harm. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Policies were in place to ensure staff understood how to keep people safe, respect their choices and report any concerns. Records viewed showed the number of safeguarding incidents that had occurred and what action had been taken. There were clear processes in place and no concerns were identified. People who required them had Deprivation of Liberty Safeguards (DoLS) in place and the registered manager had an effective system to enable them to monitor applications and apply for renewals when needed. One person had conditions on their DoLS, which were met.

People told us staff understood their roles and appeared to be knowledgeable. Staff knew people well and had discussion with them about their care and support needs, including any risks. One person spent a lot of time with their eyes closed, singing or talking to themself. Their care plan showed they could make sudden noises of alarm if other people or staff suddenly approached, which we observed. However, staff were very calm and gentle with the person and quickly reassured the person who had startled them, which de-escalated the situation.

The registered manager and staff clearly knew people well and we saw that risks were assessed and there was clear information in people’s care plans to describe to staff how to mitigate them. Staff described how people were supported to take risks, which enabled them to have a good quality of life.

Throughout the 3 days of our visits to the service we observed staff had time to support people and knew them well. We used our observation tool (SOFI), which demonstrated staff were available to people and monitored and managed risks.

Records demonstrated risks to people were robustly assessed. Information about risks was available for staff to assist them to understand how to safely meet each person's individual needs. Staff recognised people's choices when managing risks. For example, one person had declined regular repositioning. Records showed this had been discussed with the person and they were supported to understand the risks involved in their decision, which was regularly reviewed.

People and their relatives told us they thought the environment was well maintained. When equipment was need, they said this was quickly arranged. For example, one person was now being cared for in bed and this had been assessed with an airwave mattress and bed rails sourced. This meant risks were minimised to promote their safety.

The registered manager described robust systems in place to ensure they monitored the safety of the environment. Staff had tasks allocated to them to ensure equipment was checked before use. They felt confident any concerns they raised were quickly acted on with repairs made or replacements sought.

The environment was well maintained and in good decorative order. We observed equipment had been serviced within the last year and was maintained safely. Our observations of the service and discussion with people, staff and leaders demonstrated environmental risks were safely managed. Records viewed confirmed this.

Fire extinguishers, alarms and door closers were all maintained and staff tested alarms, doors and emergency lighting. People had Personal Emergency Evacuation Plan (PEEPs) and there were safe systems in place to ensure testing of water systems, equipment and call bells were completed. Any areas for improvement were identified through regular audits and action taken promptly. For example, one bathroom was out of use at the time of our visit. This was because it had been identified as requiring replacing, along with the flooring, to ensure it was safe and working as it should. This work was scheduled, with associated risks assessed.

People and relatives told us although there were times when staff were busy, they were always available and supported them well. One person said, “When I ring the bell it's no problem if I have to wait a bit.” Another person said, "Sometimes they [staff] are rushed off their feet." A third person said, “Yes I do think there are enough staff but the 2 on nights are rushed." A relative told us, "The staff were quick without delay and [relative] had regular checks throughout the night."

The registered manager explained they used a tool and regular audits of people's needs, including the amount of time staff need to support them with direct care needs, to assess the number of staff needed to support people. One staff member told us, "I feel 4 staff is better now in the morning, it feels there is enough staff. We have enough time to talk to people but do also have busy days too." The registered manager monitored staff training and systems in place informed them when training was due to be refreshed. Staff received regular supervision which were focussed on specific topics. There were also staff meetings and daily handovers to ensure they were kept up to date. They were supported with their wellbeing and to discuss their ideas or concerns, learning and development.

We observed there were sufficient staff to safely meet people’s needs. We used our observation tool (SOFI) and observed staff throughout our inspection visits. We observed a calm and supportive atmosphere, staff spent time with people and although there were busier times, there appeared to be sufficient staff available to safely support people.

Records of staffing rotas and how the provider determined the number of staff needed to support people showed appropriate numbers of staff were deployed. Staff were recruited safely. This included checks on their suitability to work with vulnerable people. Staff had received training to equip them in their roles and this was further strengthened by specific supervision meetings to monitor and assess their knowledge. In addition, the registered manager arranged for external training and support to ensure staff had the skills to meet people's needs. Staff had recently had training with the local community nurse team on monitoring people's health needs. This helped to ensure staff would recognise when changes to people’s presentation meant external health support was required.

The home was clean and in good repair. People and their relatives told us staff kept the home very clean and wore personal protective equipment (PPE) when needed. One person told us, "The food is superb as is the cleanliness [of the home]." A relative told us, "The service is very clean, I’m really pleased. My [relative] had an idea of what a care home would look like, but this exceeded expectations." Another said, "The home is generally clean. Staff wear gloves and aprons."

The registered manager described the processes in place to ensure regular cleaning took place. This included frequent touch spots such as handrails, toilets and light switches. Domestic staff were employed to maintain cleanliness and hygiene, but all staff took responsibility.

The environment was clean and in good repair and staff were wearing personal protective equipment (PPE) when supporting people with personal care or when serving food. There were clinical waste bins which had pedal operated lids and pedal bins for general waste. The laundry was well organised with a process to avoid cross contamination of clean and soiled items.

There were policies in place to aid staff to understand the risks around infection control (IPC) and what action they needed to take. Robust cleaning schedules and audits to monitor IPC measures were in place.

People were supported safely with their medicines, and they were given them when prescribed. The registered manager told us they assessed people's ability to manage their own medicines, however one person told us they did not feel they had been given a choice. We discussed this person's experience with the registered manager who said they would re-visit this to ensure they were supported to be as independent as possible.

Senior staff on each shift were responsible for administering medicines to people and this was done safely. Staff confirmed they had received training in safely managing and administering medicines. The registered manager described how staff have their medicines competency checked annually or if there had been any errors.

The provider had a medicines policy, and the registered manager described the processes in place to ensure medicines were stored and administered safely. Staff had received training and had at least one annual competency check. If medicines errors had occurred, these were robustly investigated and then staff had to repeat medicines training and have another medicines competency check to ensure they were safe to administer medicines. The registered manager or deputy manager completed monthly medicines audits and re-ordered people’s medicines. This helped ensure people had their medicines as required. Any additional prescribed medicines such as antibiotics, were added to medication administration record (MAR) system by them and this was shared with staff at handovers. Medicines that had additional legal measures were safely managed.