Church Farm at Rusticus

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

People were not always protected from avoidable harm. One person was given medicines covertly by staff who did not have appropriate written guidance or support.

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.

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 and their relatives told us they felt safe as they were assured staff knew how to protect them from the risk of harm and neglect. People confirmed they knew how to raise concerns about their safety, and they were confident managers would act appropriately. One relative said, “They [managers] inform me about incidents, and I know they update the local authority when they need to about things, so I know [relative] is safe.” However, we found concerns that people and their relatives where appropriate were not always included in decisions that affected their safety. For example, a person who lacked capacity was given medicine covertly without written guidance from a medical professional. This meant we were not assured people and their relatives were fully informed about their care or risk relating to safeguard and keeping people safe from harm and abuse.

Staff were knowledgeable about safeguarding concerns and could describe situations people face that could potentially cause concern at them being at risk of neglect or harm. Staff knew how to report their concerns and told us managers were responsive to ensure people remained safe. One staff member said, “We receive training in safeguarding and the registered manager is open to discussing our concerns, so things are actioned quickly before anyone comes to harm.” We spoke with management about the concerns found with covert medicines and this was addressed immediately, however these concerns had not been identified prior to our assessment and had not been reported to the local authority which placed people at ongoing risk of harm.

We saw people and staff had positive relationships. There was an open culture of communication and we saw no evidence that people were at risk or anxious around the staff team.

If an allegation of abuse was made, there were appropriate policies in place to guide the staff team. However, records showed that incidents were not always referred to the local authority safeguarding team, if needed, in a timely manner. For example, we reviewed incidents which recorded falls and people who had experienced physical altercations from other people living at the home. We found 7 incidents that had not been reported. These incidents were also not reported to the CQC in line with requirements. We spoke with the registered manager about these concerns, and they took immediate action to review the process and submit notifications where required to ensure people remained safe.

We received mixed feedback from people and their relatives surrounding potential risk and how they were included to identify and manage these concerns. For example, one relative said, “Staff have been fantastic, [Name] has regained so much mobility and independence and we continually update the care plan to ensure this continues.” While another relative said, “I have never seen [relative’s] care plan and I have not been included in any reviews or updates it does worry me that everything they need may not be in there [care plan].” Another relative told us that they felt their loved one was at risk from other people living in the home, they said, “I had to assist a staff member in the main lounge. Another resident was just about to hit them if I hadn’t have stepped in, I worry what happens when I'm not here, that could have been my [relative] who was hit.”

Staff told us they received appropriate training to support people to manage risks and maintain their independence. However, some staff said care plans did not always contain up to date information on people’s needs. One staff member said, “We know people really well and update each other, that’s how we keep people safe as it can take a while for care plans to be updated. We spoke with the management team, and whilst some care plans did require updates at the time of the inspection, this had been identified through the home’s governance audits prior to the inspection and the registered manager was in the process of updating care plans.

During our assessment we saw varying levels of support from staff when supporting people with risks. For example, when one person became distressed, we saw staff were quick to respond to this person and offer support that reduced their agitation. This meant the person was kept safe as their distress did not escalate.

People’s needs were not always clearly documented in their care plans, so staff did not have clear guidance on a person’s mental, physical and social needs. Where incidents had occurred, staff did not always complete a robust or comprehensive review of the incident to identify measures that could prevent recurrence. For example, one person had experienced a period of distress. Paperwork completed by staff stated, ‘left to calm down’. This action did not support the person or staff to manage risk and we were not assured the person was kept safe during their period of distress. Another incident recorded that a person had forcefully removed their curtains and cover to a radiator within their bedroom when they became distressed. Records show staff left the person alone with these items. This meant the person was at further risk of harm. We spoke with the registered manager and the provider at the time who took immediate action by implementing refresher training for staff on paperwork completion and a full review of care plans within the home to ensure people we safe going forward.

People and their relatives told us they were safe living at the home and were proud of the facilities available to them. One relative said, “It’s a joy to come into the home, there are wide open spaces to enjoy. The staff work hard to keep the home clean and nice for everyone.”

Staff knew how to monitor the safety of the environment, and where to report any maintenance concerns to. Staff told us the building was well maintained. For example, the area manager gave us a tour of the home and identified areas that had been fully refurbished such as flooring. They said, “We have refurbished all the floors from carpet to laminate to ensure cleaning standards remain high and we maintain infection prevention and control.” The management team described a clear process for monitoring the safety of the environment. For example, the registered manager documented their regular checks around the building and explained how they passed concerns to the maintenance team to resolve. We saw that any areas they had picked up, had been resolved to keep people safe.

There was adequate equipment available to support people with their care needs, such as hoists and wheelchairs. We observed staff undertaking these tasks safely and in line with best practice guidance. The home was safe in the event of a fire. Corridors were clear of any blockages, allowing people to follow easily to read escape routes. Staff had access to firefighting equipment throughout the home and fire alarms were throughout the building.

The environment was kept safe, by regular checks and maintenance. We saw there had been regular checks to ensure the home was safe in the event of a fire (for example, by checking the alarm systems). Systems were in place to ensure the water quality was maintained to reduce the risk of water-borne bacteria (like legionella). The gas heating system was regularly serviced to prevent harm to people. People had access to call bells to call for support if needed. Documentation showed these call bells were regularly checked, to ensure they were working and effective.

We received mixed feedback from people living at the home regarding staffing. Everyone we spoke with stated staff were kind and compassionate. One person said, “I feel happy with the staff levels always 2 or 3 around. Even weekends it’s the same cover.” However, some people felt at times there were not enough competent staff available to help them. One person said, “They need training especially in my personal care, sometimes I have a long wait when I’m wet, they don’t wash me they just change my pads.” Notwithstanding some people’s feedback we did not observe this practice on the day of assessment.”

Staff told us they felt there were enough staff employed and deployed effectively within the home to meet people’s needs safely and timely. One staff member said, “It can be really busy at times but there is always enough staff and managers will always help if we ask them to.” Staff spoke highly of the training provided to them. They explained how it had supported them to be more effective in their roles. A staff member said, “We have a really good training package, but I like the annual refreshers we do as they keep my knowledge up to date.”

We saw there were enough staff to provide support to people safely. Staff were deployed effectively around the building, to provide timely support to people. We observed staff spending time with people socialising which aided trusting relationships to be built. We saw staff were suitably trained to complete their roles. Staff used their training to respond effectively to people’s needs. For example, one person who was at risk of falling was supported by staff to mobilise around the home. This ensured the person remained as independent as possible whilst the risk from falling was reduced.

There were clear processes to ensure there were enough staff. The provider had used a calculation tool to assess how many staff were needed to meet people’s needs. The rota’s suggested these staffing levels had then been arranged according to this calculation. Safe recruitment processes were followed. For example, previous employers were contacted to give references on the staff member. Staff had also had regular Disclosure and Barring Service (DBS) checks. These check the police database for convictions or warnings that may impact the staff members safety to work with people. The service employed some nurses. These nurses were registered with the regulatory body (The Nursing and Midwifery Council). The management team completed regular checks to ensure their nursing registration was maintained.

People told us the home was kept clean and tidy. One person said, “Staff are really good when it comes to cleaning, and I have my room cleaned daily.” A relative said, “They [staff] keep [Name] very clean, and the bedroom always looks fresh. The laundry does a good job on clothes too.

Staff were knowledgeable about Infection Prevention and Control (IPC) and knew how to identify and mitigate risks to people. Staff told us they had received food hygiene training; they were able to explain what actions they took to reduce the risk of food borne infections.

We observed staff using Personal Protective Equipment (PPE) appropriately and disposing of this safely, this kept people safe from the risk of infection. We saw any dirt or spillages in the home were quickly resolved. We saw the kitchen was managed in a hygienic way to ensure people did not get food borne infections. The most recent check from the food standards agency, had rated the service 4 stars on the 11 April 2024.

There were clear processes and policies, to ensure the environment was kept clean and hygienic. This protected people from the spread of infection. If an infection outbreak occurred (for example diarrhoea and vomiting), there were clear processes in place to reduce the risk of this spreading to other people at the service. Staff had received training in infection control, how to put on protective equipment and how to keep people safe in the event of an infection outbreak.

We received mixed feedback from people regarding medicines and their experience. Most people told us they thought staff were knowledgeable about their medicines and supported them in their chosen way. However, some people said they were frustrated with how their medicines were administered. One person said, “My medication is timed and should be at 9.00am it doesn’t come until 10.00am. About five times now they come to give me medication and I tell them I’ve already had it, it’s so frustrating.”

Staff were knowledgeable about people’s conditions and their medicines. Staff were able to describe side effects and risks people faced if they experienced these and knew how to support people to remain safe. Staff described how they worked in partnership with other medical professionals such as speech and language therapists to ensure people received care and medicines safely. However, some staff raised concerns about how busy night times could be when nurses had to cover 2 units in the home. One staff member said, “It can be like firefighting at times when multiple people need us, or they have complex needs.”

Staff had received training on how to administer medicines safely. The management team had regularly assessed the staff’s competency, to ensure they were following best practice. Staff did regular checks of the amount of medicine in stock. This ensured that suitable stock levels were always in place, and more medicine could be ordered from the pharmacist as needed. Some people required ‘as needed’ medicine and staff had clear written guidance on how this should be administered. For example, where people needed medicine for the relief of pain and could not communicate this need there was clear guidance to support staff in identifying this, such as body language and facial expressions. The provider has appropriate policies and procedures in place to support staff with medicines optimisation. However, these policies were not always followed. For example, we saw that one person had refused their medicine on 3 occasions, so staff have given them covertly. The person did not have a covert medicine plan in place. This meant that the person was at risk of not receiving their medicines safely or in line with manufacturers guidance or GP recommendation. Although no one came to harm, we raised this concern with the provider and registered manager who took immediate steps to ensure the appropriate covert medicine plan was in plan and contained clear guidance for staff to ensure the person received their medicines safely going forward.