Cairn Home

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 changed to Requires Improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation 12 in relation to people’s safe care and treatment, due to a lack of staff training.

This service scored 59 (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 did not always have a proactive and positive culture of safety based on openness and honesty. The service did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice. People told us they felt safe raising safety concerns to management. One person told us, “I feel comfortable speaking to them [managers] about any problems I have.” People and their relatives had the opportunity to share their views and concerns during monthly meetings. A relative told us, “I feel managers listen to any concerns I have with [relative] and will take action.” Complaints were effectively dealt with, where we found where complaints had been made, these were appropriately recorded and actioned. Systems were in place to record accidents and incidents. However, lessons were not always learned from these, to embed a more proactive learning culture amongst leaders and staff. Staff understood their responsibilities to appropriately raise concerns and had confidence action would be taken by the manager. However, we found 2 incidents which had not been appropriately reported to the CQC or Local Authority. This was discussed with the management team on the day of our assessment, and we were assured notifiable incidents would be reported moving forward. Managers told us that these notifications had been submitted retrospectively following our Inspection.

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 evidence of good working relationships with professionals. One professional told us, “Cairn Home know their residents extremely well and can identify any changes, health or behaviour that may be of concern.” Staff held a weekly GP round for non-urgent issues, and anything urgent was appropriately dealt with. One professional told us, “The service will respond rapidly to any concerns.” There was an awareness of the risks to people across their care journeys and the approach to identifying and managing these risks was proactive.

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.

Most staff told us they had received training in relation to Safeguarding, the Mental Capacity Act and the Equality Act. However, when inspectors reviewed the staff training matrix, we found some staff had not completed mandatory training modules within the set timescale. Therefore, we have requested an action plan from the provider, to ensure the right staff, with the right skills are effective and safe in carrying out their roles.

People were observed to be well-cared for and people told us they felt safe. One person told us, “Oh yes, I feel safe here, the staff treat us very well.” Staff told us how they protected people from abuse and neglect. Staff told us they could approach the management team with safeguarding concerns and felt appropriate action would be taken. One staff member told us, “I know how to raise concerns with managers and CQC if I feel someone is at risk.”

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risk assessments were person-centred, proportionate, and reviewed with the person and their relative, where possible. There was a balanced and proportionate approach to risk that supported people, and staff respected the choices people made about their care. One person told us, “I’ve got the freedom to do what I like (within reason) and am only restricted by my own limits. For example, if I want to go to the shop, I need a carer with me now my sight has got worse.”

Staff knew people and their individual needs well and could identify positive ways in managing risk for individuals at the service. Staff were viewed to managed risk safely. For example, supporting people to mobilise around the home and ensuring call-bells and equipment were in place to reduce the risk of falls.

One staff member told us, “It’s about knowing each resident individually and what they like and want. For example, one resident might want to be as independent as possible, and I will just guide them when needed to ensure safety.”

One relative praised staff in responding to risk, they told us, “My [relative] had a fall during the night, [staff member] was calm under pressure and knew [relative] well and how to respond to their needs. [Staff] did everything right to keep [relative] safe.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People were cared for in a safe environment which met their needs. Facilities, equipment and technology was well-maintained. Systems were in place to monitor the safety of the environment and the upkeep of the premises, such as water temperature checks and fire safety drills.

Appropriate signage and orientation aids were in place, to assist people with sensory needs. One person told us, “Having the red carpet and rails in the corridors are helpful in supporting me to use the stairs and know my way around.” At the time of our assessment renovations works were being undertaken, we discussed this with the management team, to ensure people were protected from the risk of harm from the environment.

The provider did not make sure there were enough qualified, skilled and experienced staff.

They did not always make sure staff received effective support and development.

Not all staff had kept up to date with mandatory training. Although management were in the process of up-skilling staff by arranging face-to-face training, this was a key issue found at the time of our assessment to ensure safe and effective staffing was in place.

However, we found staff were recruited safely, with appropriate pre-employment checks taking place. This ensured staff were suitable for the role. New staff took part in an induction, which included specific ‘Visual impairment’ training, specified to enable new staff to support people in line with their needs.

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.

All areas of the service, including people’s rooms were clean, tidy and hygienic. Systems were in place to enable effective Infection Prevention and Control (IPC) practices and sufficient Personal Protective Equipment (PPE) supplies were noted around the service. Staff were observed to use PPE appropriately and kitchen staff were very knowledgeable around safe food practices, people’s dietary needs and ensuring food was stored and handled hygienically.

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.

Staff ensured people routinely received their medicines, and stock was monitored, to ensure people received their medicines as prescribed, including controlled drugs. When asked if peoples medication was given on time, a person told us, “Yes, always.”

However, we found for people that were prescribed ‘as and when needed’ (PRN) medicines, people did not have robust protocols in place, to ensure staff had detailed guidance specific to each person on how to administer these medicines. We found where people self-administered medicines, risk assessments were not in place.

We observed a cupboard, used to store creams was not locked when not in use. Medicines were not given for one person in line with the Mental Capacity Act (2005) guidance and had conflicting information documented around their ability to consent and make decisions relating to their medication. Staff records did not always evidence medicines patches were rotated in line with a person’s documented body-map.

Staff had their competency assessed prior to administering medicines to people. However, competency assessments for all staff were not visible during the inspection when requested.