Lexrae Support Ltd

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.

This is the first assessment for this newly registered service. This key question has been rated Good. This meant people were safe and protected from avoidable harm.

This service scored 81 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Incidents and accidents were appropriately recorded, along with the actions taken to prevent them from recurring. When people experienced heightened anxiety and required behavioural support, this was also documented. The registered manager explained this information enabled them to review how situations were managed, identify potential patterns, and determine whether staff required additional training or support. Where necessary people had access to an Intensive Support Team (IST). IST provides specialised, multidisciplinary, and short-term intervention for individuals with learning disabilities, autism, or complex needs who require support when they become anxious and upset. Relatives told us they were informed of any incidents or accidents involving their family member.

Staff understood their responsibilities when accidents occurred and were clear about when they needed to involve other healthcare professionals to ensure people’s wellbeing.

Staff had access to detailed risk assessments that outlined potential risks and the measures in place to reduce them. Staff told us these assessments were comprehensive and supported them in delivering safe care. The assessments also encouraged people to take positive, controlled risks, such as preparing and cooking meals or being supported to self‑administer medication.

Personal Emergency Evacuation Plans (PEEPs) were in place and set out the specific assistance each person would require to leave their home safely in an emergency. Staff discussions demonstrated a good understanding of the evacuation needs of the people they supported.

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.

The registered manager worked alongside other agencies to ensure people had a smooth transition to their service. The registered manager provided an example from a needs assessment where they reviewed a person’s care requirements and prescribed medicines.

Through joint working with other agencies, people were able to access their local community, maintain regular contact with their family, and make meaningful choices about their daily life.

Hospital passports were in place which provided detailed information about the individual, their support needs, communication methods, and other key details. This ensured people received consistent and coordinated care.

People could be confident they would receive care and support tailored to help them live the lifestyle they chose. Pictorial support plans and other visual tools helped individuals make informed decisions about the activities they wished to take part in. This included the places they wanted to visit. Staff worked closely with external professionals, including advocates, social workers, and a learning disability nurse and relatives, to ensure people were fully supported in these choices.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Systems and practices ensured people were protected from the risk of potential harm. All the staff we spoke with confirmed they had received safeguarding training. They were also able to tell us how they would identify concerns relating to potential abuse for people who would be unable to tell them. One staff member told us, “Although [person’s name] can’t tell me if they are hurt or sad, I know by their facial expression and body language. I would share my concerns with the registered manager.” A relative told us, “I definitely feel [person’s name] is safe.”

Discussions with the registered manager and information displayed within the office confirmed a designated safeguarding lead was in place. This supported people to understand and recognise abuse and how to eliminate this.

All the staff we spoke with were aware of external agencies they could share concerns of potential abuse with. Pictorial aids were in place enabling people to point at how they were feeling, this helped staff to query what was upsetting them. The provider offered a service to people from various ethnic minority groups. Staff told us people were treated fairly and were respected.

Appointeeship orders were in place for people who lacked mental capacity. This is a legal arrangement in the UK where a person or organisation is authorised by the Department for Work and Pensions (DWP) to manage benefits on behalf of someone who cannot do so themselves.

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.

Staff had access to comprehensive and person‑centred risk assessments, which supported their understanding of how to keep people safe while also enabling individuals to take informed risks that promoted independence. Information was available in both written and pictorial formats, helping people to better understand their risks and make meaningful choices about their daily lives.

People were actively involved in developing and reviewing their own risk assessments. One person told us, “I like going on the bus and would like to do this alone one day.” A staff member who supported them explained, “We will continue to support them until they feel confident to do this alone.”

Risk assessments were also in place for people’s specific health conditions. These clearly detailed the actions staff should take, including when to seek medical intervention, ensuring staff could respond promptly and appropriately to changes in people’s health needs. One staff member told us, “I will let the manager know if I think the risk assessment needs changing and this is done promptly.”

Where individuals experienced anxiety or distress, risk assessments included proactive and non‑medication strategies for staff to use to help reduce the person’s anxiety. The registered manager told us all staff actions were reviewed. Any required remedial actions would be implemented to improve outcomes and the quality of support provided. This demonstrated a commitment to reflective practice and continuous improvement.

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 held their own tenancy agreement. The provider ensured environmental risk assessments were in place, this also included a fire risk assessment to promote the safety of both people and staff members. The registered manager told us routine Legionella checks were also carried out.

Systems were in place to ensure the regular servicing of equipment in use to support people’s mobility. This ensured all equipment in people’s home was safe and suitable for use. One person told us, “I have all the equipment I need, a hoist, wheelchair and a nursing bed.”

The provider made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. They worked together well to provide safe care that met people’s individual needs.

People could be assured sufficient numbers of suitably skilled staff would be available at all times to meet their assessed needs. The registered manager completed thorough and person‑centred needs assessments prior to offering a service. These assessments clearly identified the number of staff required and the specific skills needed to support each person safely, effectively, and in line with their individual preferences. With regards to people’s specific health conditions, staff were provided with additional training in these areas. For example, epilepsy and diabetes.

People were meaningfully and actively involved in the recruitment of their own staff. For example, they were supported to develop interview questions, enabling them to influence decisions about who would support them and ensuring new staff were the right fit for their needs and values. The registered manager also carefully considered the skill mix and personal attributes required for each person. For example, we saw one person who used the service spoke both English and the language of their ethnic background was matched with a staff member from the same ethnic background. This ensured the staff member had an understanding of the person’s culture, religion, and food preferences, resulting in highly personalised care. We spoke with the person’s relative who was very complimentary about this staff member regarding their approach and empathy. Discussions with this staff member demonstrated they had an in-depth knowledge of the person’s specific needs and how best to support them.

Robust recruitment and vetting processes were in place. The registered manager confirmed all staff underwent appropriate Disclosure and Barring Service (DBS) checks, and we saw clear evidence of this. Employment references were also obtained for all staff, supporting safe recruitment practices and ensuring only suitable individuals were employed.

The registered manager told us staff received regular supervision, which staff confirmed during discussions. Ongoing supervision supported reflection, professional development, and the consistent delivery of a safe and effective service. Staff felt well supported and confident in their roles.

Staff received training specific to the individual needs of the people they supported. This was confirmed through conversations with staff and a review of training records. One staff member told us, “I had an induction before I started supporting people and this entailed training.” This ensured staff had the knowledge and skills required before working independently.

The registered manager recognised some overseas staff required additional training regarding English culture, food preparation and cooking and this was provided. Routine spot checks by the managers would ensure skills learnt were put into practice. Staff’s understanding would also be discussed during one-to-one supervision sessions.

Managers carried out regular spot checks to ensure staff were delivering care safely and effectively. Where shortfalls were identified, prompt action was taken, including additional training and support. We saw evidence this approach led to continuous improvement in practice.

People who used the service were very positive about the support they received, and this enabled them to live the lifestyle of their choice. This was further evidenced by detailed information and photographs contained within care records, showing people actively engaged in meaningful activities that reflected their interests and aspirations.

The risk of infection was effectively managed through appropriate practices carried out by trained and competent staff.

People were supported to maintain suitable hygiene standards within their home. Staff encouraged individuals to participate in domestic tasks where appropriate, promoting independence while maintaining a clean and safe environment. Staff confirmed they had completed infection prevention and control (IPC) training and had access to personal protective equipment (PPE) when required, helping to reduce the risk of infection transmission.

The registered manager informed us an IPC lead was in place, who had completed Level 3 IPC training, providing enhanced knowledge and oversight of infection control measures within the service.

The provider had an up‑to‑date IPC policy, accessible to all staff, which set out clear guidance on effective infection prevention and control practices.

The provider always made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff always involved people in planning, including when changes happened.

People could be confident they would be supported to take their prescribed medicines. Staff were trained and assessed as competent in medication administration. Competency assessments were carried out by the operations manager who had undertaken relevant training to deem them competent to carry out these assessments. People were supported to manage their medicines safely, including progressing toward self‑administration where appropriate. One person told us they wanted to manage their own medication, and staff were currently supporting them to achieve this goal. The person told us, “Staff help me to order my medication.”

Consent was obtained before giving medicines, and staff provided clear explanations to support informed decision‑making. One person told us, “I sometimes refuse my medicines and staff don’t force me to take them.” A staff member who supported this person told us, “I explain what the medicine is for and what could happen if they refused.” They told us after consultation with the prescriber the person’s medication had been reduced.

Staff had access to information relating to people’s prescribed medicines and how the individual required their medication to be administered. Pictorial formats were in place to support people’s understanding and encourage their engagement.

Staff understood the use of rescue medication and when to seek emergency assistance. We saw clear written information was in place to support staff.

The registered manager applied principles of ‘Stopping the Over‑Medication of People’ (STOMP), using alternative strategies to minimise the need for the use of medicines when a person became upset or anxious. The records we looked at evidenced this. A relative told us, “Since [person’s name] started using the service their medication has been reduced.” This provided evidence the registered manager ensured people were not subject to unnecessary medication.

Pro re nata (PRN) protocols were detailed, and medicines were routinely reviewed by prescribers. PRN medicines are prescribed to be used only when required. For example, for the treatment of pain.

Discussions with the registered manager also confirmed individuals’ medications were regularly reviewed by the prescribing clinician with the involvement of people, to ensure ongoing need and to respond to any changes in the person’s health.

There was a medication policy accessible to staff. This provided staff with guidance on good medicine practices.

Oversight systems highlighted if there was a delay or missed dose, enabling the office staff to take prompt action.