One to One Plus South

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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last inspection we rated this key question Good. At this inspection the rating has remained Good.

This meant people were safe and protected from avoidable harm.

This service scored 72 (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 created 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.

Staff told us how accidents and incidents were reported. Systems were in place to record and investigate incidents. The registered managers had oversight to analyse and identify any themes or treads to ensure that appropriate actions were taken to reduce risk and maintain people’s safety. For example, a recent medicine error was identified through the provider’s audit process. A thorough investigation was carried out to understand the cause and identify learning. The investigation found that some staff required additional training and competency assessments to strengthen safe medicine practices and reduce the risk of errors reoccurring.

The registered managers encouraged staff to be open, honest and accountable when things went wrong, creating a culture of reflection and responsibility without fear of blame. This approach supported learning, continuous improvement and safe delivery of care.

Lessons learnt were clearly communicated to staff in team meetings and handovers to ensure that they were aware of important updates and changes to people’s needs. Learning from incidents were seen as an opportunity to strengthen best 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.

People’s needs were comprehensively assessed before moving into the service, this included the completion of in-depth preadmission documentation and functional behaviour assessments. The registered managers and staff worked closely with people, their relatives, and professionals to ensure that transitions were well organised and to minimise the risk of distress.

Staff advocated for people when they went into hospital to ensure they received their ongoing planned care. A relative told us, “When [name] was very unwell in hospital, he had two carers with him all the time, they knew him well and this made a big difference. The staff were tremendous. They fought for [name] to be discharged home and upskilled their staff to meet his changing needs.”

The registered managers had effective systems in place to ensure continuity of care during planned and unplanned transitions including hospital admission, discharges and transfer between services. People’s hospital passports were detailed and up to date, they included how people communicated to show that they were in pain. Staff completed handovers and communicated changes in people’s needs promptly, ensuring everyone had the information required to provide high-quality support.

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. Concerns were generally recognised and shared appropriately to help keep people safe. Staff had received mental capacity training and knew how to support people to make day to day decisions. However, the principles of the Mental Capacity Act 2005 (MCA) were not always fully followed.

Mental capacity assessments were not consistently recorded, this meant that there was no clear evidence of how people had been supported to make informed decision or how decisions in people’s best interests had been reached. These shortfalls risked limiting people's rights by failing to evidence that individuals were supported to exercise choice and control over aspects of their lives. The registered managers had recognised this and had plans in place to strengthen recording and oversight in this area.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. This is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). Staff had received DoLS training, and community DoLS authorisations were in place and had been sanctioned by the Court of Protection to ensure that people were not subject to any unnecessary restrictions.

People were supported to understand what keeping safe meant to them. People told us that they could confidently talk to staff about their concerns and felt listened to. One person said, “I feel happy to tell the staff if there is something wrong, they are very good and help me a lot.” A relative said, “I don’t have concerns about safety but if I did, I would speak to [the registered manager], they are always contactable and listen to me.”

Systems were in place to safeguard people from risk of abuse. There were clear safeguarding policies and procedures in place. Staff had received regular safeguarding training and understood how to keep people safe. Staff were able to demonstrate their knowledge in practice and told us, “I would contact the police or emergency services if I had immediate concerns about someone’s safety. I would also speak to my manager and report to the local authority.”

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.

The registered managers and staff worked with people to educate and understand how to positively manage risk whilst protecting them from harm. People were prompted to maintain their independence by being supported to carry out tasks that could place them at risk. For example, making meals, and independently accessing the community. These risks were assessed appropriately. The registered managers offered activities to enhance people’s skills to live independently, for example, road safety training. This empowered people to have a greater sense of control over their lives.

People’s care plans and risk assessments provided guidance for staff about keeping people safe when ‘unwise’ decisions were made. Risk assessments covered all aspects of people's health, daily living, and social activities. People were kept safe by staff regularly reviewing and updating their risk assessments as needs, interests, and activities changed.

People had comprehensive Positive Behaviour Support plans (PBS) which had been developed to help staff understand how to safely support people at times of extreme emotion or distress. Staff showed a good understanding of people’s PBS plans and knew what actions to take to prevent anxiety and distress from escalating. The registered managers worked with the provider’s Positive Behaviour Support team to ensure that the information was regularly reviewed and remained relevant to people’s needs. The impact of this was that restrictive practices had been reduced, and people’s independence maximised.

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’s personal environments had been adapted to suit their needs. For some people with reduced mobility this meant that reasonable adjustments had been made to ensure that accommodation was provided on one level for ease of access.

People had Personal Emergency Evacuation Plans (PEEPs) if they needed one and these reflected their individual needs and abilities. The plans were person-centred, easy to understand and contained clear guidance for staff. They considered factors such as communication needs, mobility and sensory impairments and equipment needs to support a safe evacuation. In some locations adapted fire systems were fitted for the deaf and hard of hearing people and staff, to provide a visual warning of danger.

The registered managers worked with people and landlords to ensure that environments were safe and well maintained, this included regular health and safety checks, for example, water temperature testing, Portable Appliance Testing (PAT), and yearly fire risk assessments. The registered managers had systems in place to monitor oversight of the environments, this included the completion of environmental audits. Maintenance issues were promptly identified and addressed, these were reported centrally to the wider organisation for action.

Staff received training including essential fire safety and prevent, health and safety, food safety, and Legionella awareness. Staff knew what actions to take in an emergency, including fire evacuation procedures.

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

People were supported by a consistent staffing team who were skilled and knew them well. We observed that there were enough staff on shift to safely support people. Staff were deployed to meet people’s needs, for example, on a 1:1 or 2:1 basis. The registered managers ensured that staff had received bespoke training to meet people’s complex needs, this included British Sign Language levels 1, 2, and 3.

Staff were recruited safely. All relevant checks were completed before commencing employment. Staff were provided with a period of induction which included extensive training, reading of policies, and shadowing of experienced staff. This supported them to understand the needs of the people living at the service and to ensure safe care was provided. One staff member told us, “My induction was very good. There are lots of opportunities for training and to develop your skills. I am currently doing my NVQ level 2 and additional online courses. I feel that I have the right skills to support the people I work with.”

Staff received regular supervisions which gave them the opportunity to discuss their personal development, identify any gaps in their knowledge, and talk about their wellbeing.

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.

People were encouraged to independently maintain a habitual living environment. Where people needed support there were systems in place for staff to help keep their homes clean, tidy and free from risk of infection. For example, using cleaning schedules and audits.

Staff received infection prevention control training and had access to essential personal protective equipment (PPE) to minimise the risk of cross contamination. Policies were in place to support the management of infectious outbreaks.

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

People were encouraged to independently self-administer medicines which were assessed as appropriate. Staff had received training in medicines management, administration, and had access to the provider’s policy. Only staff who had been assessed as competent by the registered managers were able to administer medicines.

People’s medicines were stored safely. The procedures of ordering, receiving, and returning medicines followed best practice guidance. People had individual medicines care plans that provided staff with vital information such as any allergies including when and how to administer people’s medicines.

Some people had been prescribed medicines to take ‘as required’ (PRN), for example pain relief. There was guidance for staff about why these medicines were needed and how they should be taken, this included how some people who can’t use words might communicate if they are in pain or distress.

The registered managers had embedded ‘Stopping over medication of people with a learning disability and autistic people (STOMP)’ principles. People’s medicines were regular reviewed including the use of psychotropic medicines and where appropriate and under medical guidance these were reduced to improve people’s quality of life.