No 36

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 remained 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.

There were systems to learn when things went wrong. There were clear processes for reporting and investigating accidents, incidents and complaints. Staff understood people’s needs exceptionally well and were able to anticipate when people started to feel distressed. They followed proactive strategies to provide people with reassurance, choices and diverting their attention. As a result, there had been a significant reduction in the number of incidents, and the quality of people’s lives had improved because of this. For example, people were active members of the local community and could access medical services they had previously been fearful of.

Staff explained the culture of learning at the service helped them to plan how to care for people. Staff communicated well with each other and relatives to ensure everyone learnt from things that went wrong.

People had full and active lives to help alleviate boredom and distress. Staff told us this ensured people were happy, and reduced incidents where they expressed themselves negatively.

A staff member commented, “When something is wrong, our culture is not to hide it. We report, discuss, investigate and learn from it.”

Staff ensured transitions were exceptionally person-centred. For example, before people moved to the service, staff spent time working with them. They got to know each other and ensured people felt safe and comfortable with them. They provided videos and photos of the home, others living there and staff. People were invited to spend time at the home taking part in different activities. Each person’s transition plan was personalised for them. This ensured that their move to the service was successful for them and others living there. The registered manager told us, “We try to learn as much as possible about the person before they move in and make their transition comfortable and at their own pace.” Staff carried out careful assessments to ensure people were compatible with each other. Staff ensured new relatives were linked with existing relatives so they could discuss their experiences, worries and support each other. A relative explained, “The transition was great.”

Staff took a proactive approach to challenging restrictive practices and task-based care during transitions. They found ways to empower people to express themselves and try new things. One person had previously lived in a care setting where they did not take part in any social activities and were constantly supervised by 2 members of staff. They had restricted access to food and their own possessions because staff there felt they were at risk. Since living at No 36, they took part in activities throughout the day every day with others, including time in the local community. They were involved in making their own food and there were no restrictions on their freedom to move around their home or with access to their belongings.

There was a strong culture of collaborative working which supported joined-up care. Staff advocated for people using the service when working with other professionals. This enabled people to receive personalised care and support which met their needs. Professionals confirmed this explaining staff had a very good understanding of each person they cared for.

Staff supported people when they were admitted to hospital, providing fulltime support alongside hospital staff to ensure they could advocate for people as well as meeting their care needs.

There were systems to help safeguard people from abuse and improper treatment. There were suitable procedures. Staff undertook training to understand these. There were regular team discussions about how to recognise and report abuse. The provider worked collaboratively with other professionals to investigate concerns and to help prevent avoidable harm.

People using the service and their relatives told us they felt safe and trusted staff.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. The provider requested legal authorisations where restrictions amounted to a deprivation of liberty for people who did not have the capacity to consent to these. Decisions about people’s care were made in their best interests and for their safety.

The provider maximised people’s involvement, choice and independence whilst managing risks and supporting them to stay safe.

Staff provided proactive support to enable people to express themselves safely and reduce their anxiety. Some people moved to the service with traumatic experiences from their past. Many had been physically restrained and relied on medicines which controlled their behaviour or mood. Through personalised planning and the support of external experts, the provider had reduced restrictive practices and reliance on medicines. People were supported to take risks. The incidents where people expressed their anxiety and distress in ways that impacted upon themselves and others had significantly reduced. Staff had an excellent understanding about how to support people to provide safe care and manage challenging situations to empower people. The registered manager explained, “Effective support is fundamentally based on good communication. This is ultimately making them feel safe, secure and trust that we are here for them.”

The support from staff had enabled people to take part in a wide range of activities at home and outside, interacting with people, coping with changes and unpredictable situations and accessing medical appointments which some people had previously found difficult.

Staff explained they used personalised approaches to enable people to make choices and take risks. Staff constantly reviewed and updated risk assessments and management plans so that these evolved to match people’s changing needs and wishes. Staff found ways to overcome barriers and allow people to live life to the full. People had been supported to try new experiences, including camping, hiking, caving and kayaking. A staff member explained, “We want people to experience life and take positive, appropriate risks. So, we make sure we build the right support around them.”

The environment was safe, well-maintained and suitable for people. Staff completed checks to ensure safety. They received fire safety training and had robust systems in place to ensure people were protected from the risk of fire.

The provider used innovative ways to codesign the environment with people. They invited people to paint and decorate their rooms and communal areas. The provider ensured people’s requests and wishes were granted. For example, building a basketball court in the garden, a jacuzzi and a fishpond with viewing windows. Staff embraced this using their artistic skills to enhance the way the environment looked. People had personalised their rooms. There were comfortable and accessible communal rooms. The service was appropriately furnished, heated and ventilated.

There were enough staff to meet people’s needs and keep them safe. Staffing levels were designed based on people’s assessed needs. There was good staff retention and people knew staff well. They had good relationships with them. The provider ensured staffing levels could be adjusted to meet additional requirements, such as social activities and holidays.

There were systems to recruit staff and make sure they were suitable. These included checks during recruitment, a comprehensive induction and assessments of staff competencies and knowledge. The provider involved people in staff recruitment, ensuring they met potential staff. The registered manager assessed staff skills at communicating and responding to people during these meetings.
Staff completed a wide range of training, had regular supervision and appraisals of their work. A staff member explained, “I was guided and helped to understand my role when I started. Even after the induction, the learning does not stop.”

There were systems to help prevent and control the spread of infection. There were procedures and staff were trained in these. Staff were provided with personal protective equipment (PPE) such as gloves and masks to use when needed. There were systems to ensure thorough cleaning. The provider completed checks and audits to ensure the environment was clean and well-maintained.

People received their medicines safely and as prescribed.

Staff had worked with external professionals to reduce people’s reliance on psychotropic medicines. These are medicines that can control people’s mood and behaviour. The provider designed plans to help people manage their distress through positive interventions rather than medicines. This impacted on people’s wellbeing, alertness and gave them greater control over their lives. A staff member commented, “With the involvement of their healthcare professionals, some people have had their medicines reduced or stopped when it was no longer needed. For me, seeing this progress is one of the biggest rewards of the job.”

Staff had also supported people to reduce other medicines when their health and weight improved. They advocated for people and explained to prescribing doctors when they thought medicines may not be necessary. This helped ensure medicines were regularly reviewed and were right for people.

There were suitable procedures for managing medicines. Staff undertook training and managers assessed their competencies and knowledge. Staff kept clear records to show when medicines were administered. These were checked and audited. Medicines were stored appropriately. The registered manager explained, “Our pharmacy provider also carries out medicines audits and provides training to our staff. I feel this outside scrutiny is valuable, and we welcome other professionals looking at our practice and telling us where we can improve.”