Sherwood 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

People received safe care and support. Staff were knowledgeable of risks to people’s safety and how to support them to minimise those risks. Safeguarding processes had been strengthened and additional coaching had taken place with staff to ensure all staff were aware of the importance of reporting safety concerns. Staffing levels had improved to ensure there were sufficient staffing levels to meet people’s needs and provide safe care and support. People were protected from the risk of infections. People received their medicines as prescribed. The provider audited medicines management processes and had identified some areas that needing improving. They were working on making and sustaining those improvements. This included ensuring protocols were in place to instruct staff when to give people their ‘when required’ medicines.

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 felt safe living at the care home and knew who to approach should they need to raise any concerns. Comments included, “I feel very safe, I know the staff and trust them”, “Yes, when I close my door I have peace and quiet but there is still someone I can call” and “I would talk to the staff and I know they would fix whatever it was.”

The management team told us they had recently improved safeguarding reporting procedures to ensure concerns were being appropriately reported and investigated. Actions were taken to support the staff team, including providing additional training and coaching sessions to improve staff's knowledge for reporting incidents. Staff were aware of the reporting process for safeguarding concerns and incidents. A staff member told us, “Safeguarding is about the best interests of the residents. Any abuse I have to report to my team leader and then the manager if they don’t do anything. After that the authority people if needed.” We found that the management team had taken the necessary actions to respond to concerns raised by a person during our visit. They appropriately reported, investigated and improved practice making sure people’s dignity was respected at all times.

People were moving around the home freely. People appeared comfortable and relaxed in the presence of staff and approached them for support when needed. Staff asked people’s permission before providing personal care and involved them in conversations with visiting professionals.

Policies and procedures were in place to keep people safe from avoidable harm. Any safeguarding concern received were appropriately recorded, reported and investigated. Lessons learnt were shared with the team to improve practice. Deprivation of Liberty Safeguards (DOLS) authorisations were applied for and requests to renew these applications were submitted by the service as necessary. Records showed mental capacity assessments were completed by the service to support people in the decision-making process. However, these assessments had not always included information as to how the decision was reached and a person was not able to communicate or retain the information provided. The management team had taken immediate actions to address this concern and met with the staff team to guide them on how to include more information in the mental capacity assessments.

People felt involved in managing the potential risks to their safety. A person told us, “Yes, if [staff] say I shouldn’t do something, they always tell me why it isn’t safe.” A family member said, “[Staff] do explain risks and mitigate them. [My relative] loves gardening and they make sure that on fine days there is someone who can be with him.”

Staff were provided with information about potential risks to people’s safety and how to support their emotional needs if they were getting distressed. Staff’s comments included, “We read the care plans to get to know if [people] have certain diets, medication, and what they want and how to be supported” and “We know residents and most of the time what they are not happy about. Residents can get forgetful which is because of dementia and we gently, not stressing them out, remind them of what needs doing.” Staff were trained and felt confident to use equipment when supporting people.

We observed staff supporting people safely. Observations showed staff had the necessary skills to manage risks associated with people’s care, including falls and nutrition.

Processes were in place to identify risks to people’s safety and welfare. Care records included risk assessments and management plans to inform staff about how to support people to minimise risks. These plans were reviewed regularly in line with any changes in people’s needs. Equipment was regularly checked to ensure it was safe and fit for purpose.

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

Staffing levels ensured people were supported safely. People told us there were enough staff to support them with their care needs when needed and that the call bells were answered in a reasonable time but that additional staff provided could ensure more effective care delivery. People’s and their family members’ comments included, “They are short (of staff) at times”, “There is always someone to hand if we have a problem” and, “nights are always less well staffed but [my relative] says they are quick.”

Staff told us previously they found there were not enough staff to meet people’s needs, but recently staffing had increased and they now had additional time to undertake their duties. Staff confirmed they were able to provide people with good care, commenting “Before the current manager we didn’t have enough staff but now we do.”

Staff were available to support people in a timely way and when they needed assistance. We saw a staff member being patient and taking their time to listen and respond to a person’s requests where they had difficulties expressing themselves.

Staff were provided with the necessary support in their job to help them continuously apply best practice. This included regular supervision and appraisals. Staff completed mandatory training to ensure they had the knowledge and skills to undertake their duties, this included in relation to safeguarding, medicines management, manual handling, and dementia. Safe recruitment practices were in place. This included staff attending an interview, providing references, checking their eligibility to work in the UK and undertaking criminal record checks before they started working with people.

People told us staff followed good hand washing practices and used appropriate personal protective equipment (PPE), such as gloves and aprons when assisting them with personal care.

Staff were aware of how to protect people from the risk of infection. Staff knew how the PPE should be worn and disposed of. Staff told us they had the necessary supply of the PPE.

Premises and equipment were kept clean and hygienic. Arrangements were in place for keeping the premises clean. Control of substances hazardous to health (COSHH) storage was maintained safely.

The service followed national guidance to prevent infections from spreading. Staff had access to the infection prevention and control policy which ensured they followed safe hygiene practices when supporting people with personal care. There was an infection prevention and control champion at the service to guide and help staff to monitor and reduce the risks associated with infections.

People told us that changes to their medicines were discussed with them and they received their medicines as prescribed. Comments included, “Yes [staff discuss my medicines with me] initially and when there is a change” and “[I receive my medicines] the same time every day.”

Staff supported people to take their medicines safely. Professional guidance was applied by staff when supporting people to take the right medicines and at the prescribed time. Staff knew people’s preferences for how they liked to take their medicines and the actions they had to take if the medicines were refused.

Systems and processes were in place to administer, record and store people’s medicines safely. Records showed that people received their medicines as prescribed. Medicines were managed by staff who completed the relevant training. Regular audits were carried out. These audits had identified some areas that needing improving and the management team were working on making and sustaining these improvements to ensure safe medicines management.