Waterside 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

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 requires improvement. At this assessment the rating has remained 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 provider was previously in breach of the legal regulation in relation to safe care and treatment. Not enough improvement was found at this assessment, and the provider remained in breach of this regulation.

This service scored 56 (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. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice. Accident and incident analysis did not always identify trends and patterns to mitigate future risks. The provider was in the process of introducing a new system, this needed embedding in to practice.

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 observed a district nurse talking with team leader about someone's care. The team leader checked out what action was needed and wrote this up for staff to follow. People told us the staff arranged for them to go to the hospital if they needed to and had access to healthcare professionals. One person said, “They [staff] will tell you if they think you need a doctor and they will get one. They look after me.” Another person said, “I think the GP is due today. I lost feeling in my legs and they arranged for me to have a scan, about 3 months ago. I know they [staff] would call someone if I needed them. I saw a chiropodist once.” Professionals working alongside the home acknowledged improvements since the current management team have been in place. One professional said, “Staff are completing tasks that are asked of them within a timely manner and that the staff are knowledgeable of their residents.”

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. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately. The providers safeguarding record showed that some concerns had not been referred to appropriate bodies in a timely way. The current management team told us they were in the process of addressing this and trying to establish the outcome of previous safeguarding concerns to enable them to improve the service. People and relatives generally felt the home was safe. One person said “I am safe with most staff. Some days are better than others, they [staff] are alright.” Another person said, “I am safe. They [staff] keep a check on us and come and see we are alright at night time.” A relative said, “There is no reason to think [relative] is not safe. The staff here are great, and they care about [relative].”

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Care plans required more detail and more information to be a true contemporaneous record of care received and to evidence management of risk. For example, where people required fortified foods, these were not always recorded, and daily care notes didn’t always reflect the care given. One person who had resided in the care home for 3 weeks, had no care plans or risk assessments in place. Following our assessment the provider took action to address these concerns. People told us the support they received was safe. One person said, “I ring the buzzer when I get up. They [staff] come quickly unless they are busy.” Another person said, “They [staff] watch and tell you to use the walker if you need to. If I want a shower I will ask, and they [staff] will come the same day. They make sure I don’t have a shower on my own in case I fall.”

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care. There were arrangements in place to monitor the safety and upkeep of the premises. Environmental safety checks were in place, ensuring the environment and equipment was safe for people to use. We had received ongoing concerns regarding the temperature in some parts of the home. During our assessment we noted some areas were cool and following our assessment we received further concerns. The provider evidenced that action was being taken but initially this had not been addressed in a timely manner.

The provider made sure there were enough qualified, skilled and experienced staff, but could not always demonstrate they received effective support, supervision and development. Staff did not always work together well to provide safe care that met people’s individual needs. Staff recruitment files could be more thorough for example employment history recorded just the year. References were not always followed up to obtain more details. Some gaps in employment for one person were unexplained. We received conflicting views from staff. Some staff told us they didn’t feel supported by the management team while others felt management were approachable.

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. The home was generally clean but there were some areas that were worn and so not easy to be kept clean. The management team were aware of these issues and were in the process of taking action to address them. People told us the home was kept clean. One person said, “I think It [the home] is beautiful, it’s nice and clean.” A relative said, “They [staff] are very good and keep it [the home] clean.” People also told us staff washed their hands between tasks and wore gloves and aprons when they needed to.

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. Protocols in place to support people who required medicines on an ‘as and when’ required basis, did not always state why people needed them or how people would present if they required them. Medication audits had not identified this. People were generally happy they received their medicines as prescribed. One person said, “I get them [tablets] at 6 in the morning and 8 at night time. I can’t think of a day I have missed them. If I have back ache, I just ask for a pain killer, and they [staff] will bring them.”