Alison House

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 changed to good. This meant people were safe and protected from avoidable harm.

This service scored 75 (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.
The provider now had clear documentation of risk levels and strategies, and used systems to monitor, record and learn from incidents. Incidents and accidents were reported, recorded and reviewed for themes and trends to determine any learning or actions for staff. Identified areas of learning were routinely explored in weekly professionals’ meetings, multi-disciplinary team (MDT) reviews, staff meetings and debriefs. One professional said, “The team are reflective in their practice and utilise debriefs after incidents to learn, identify triggers, and improve the consistency of care. This reflective culture supports ongoing learning…”

The provider worked with young 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 for young people.
The provider kept detailed information about young people’s individual health and support needs. They shared this with other professionals, where required, when young people visited other healthcare services. Professionals spoke highly about the way that staff worked alongside them to improve outcomes for young people. One professional said, “The clinical team keep me informed of their meetings with [other healthcare professionals]. This is extremely helpful, as it allows me to maintain an accurate understanding of the young person’s…needs, treatment plans, and any changes in risk or medication. It also supports consistent, joined up working across agencies, ensuring that we are all aligned and able to provide coordinated care.”
We saw an example where a referral for a young person had been made to a bespoke healthcare agency in a timely way. This demonstrated that there were effective systems in place to manage risks and maintain continuity of care.

The provider worked with young 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.
At the last assessment in June 2023 we identified that safeguarding incidents had been managed inconsistently and we could not be assured that staff had received appropriate levels of safeguarding training. At this assessment we followed up on the previous concerns and found improvements had been made.
Staff had received appropriate levels of safeguarding training and knew where to access the safeguarding policies for reference.
We reviewed young people’s care records and found evidence that incidents, accidents, and injuries were reported appropriately using a Significant Occurrence Report (SOR). This captured what had happened and used a series of prompts to determine whether information needed to be shared and escalated to agency partners, such as local authority safeguarding teams. We found these had been routinely reviewed by management, and the appropriate safeguarding referrals had been made. The deputy manager discussed the SOR and told us, “It is a detailed form with a lot of requested information…It is not a document that can be completed by one person and needs a lot of input depending on who was involved and their role…It is about dotting the I's and crossing the T's. I am always a final filter and check to make sure that all the information is there…”
Staff were supported by a well-established duty system which operated 24 hours a day. This enabled staff to contact management at any time for support and guidance if they had any concerns.

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.
At the last assessment in June 2023 we identified the provider had not always monitored and mitigated risks to young people or reviewed their practice in line with up-to-date guidance. We issued a Warning Notice to the provider after the inspection. A Warning Notice is part of enforcement action taken by us, where serious concerns are identified. At this assessment we followed up on the previous concerns and found improvements had been made.
Care plans and risk assessments were detailed and included in-depth information for staff to support young people to manage risks. Staff worked alongside external professionals to review planned care to ensure it reflected best practice guidance for mitigating risks. One professional told us, “[The staff] communicate effectively with external agencies and values multi-agency input.” Another professional said, “My impression is the team are focused on providing a safe and supportive environment to young people.”

The provider detected and controlled potential risks in the care environment. There were comfortable communal rooms and outside spaces.
Young people lived in an environment that was well maintained and had personalised their bedrooms. The service had an on-going maintenance plan and records showed regular environmental audits had been actioned and completed.

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.
Staff were recruited safely. All required checks were made before new staff began working at the home. These included Disclosure and Barring Service (DBS) checks which provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.
The provider told us recruitment had been a challenge, so they had taken steps to address this as a priority. The registered manager said, “We have a new social media representative and we have tweaked the [job] advert. [Interview] questions are updated and much better now. We now have more diversity across staff.”
The registered manager calculated the needs of young people, against the number of staff needed. Young people’s care needs were reviewed regularly and after any incident, One Staff member said, “Staffing fluctuate and increase in line with people's needs. For example, one person was on 1:1 and so a while back for [a two-week period] we [increased staffing].”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and knew how to share concerns with appropriate agencies when required.
The home was clean and hygienic. Personal protective equipment (PPE) and required cleaning materials needed were available.
Staff had received training to support with minimising the risk of infection and information about safe infection prevention was easily accessible.

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.
Medicines were stored, administered and disposed of safely. Staff were trained and deemed competent before they administered medicines.
Medication administration records (MAR) had been completed and showed people received their medicines as prescribed. Staff followed guidance when giving medicines prescribed on an 'as and when required' basis (PRN). The provider had a system to monitor and audit people’s medicines on a regular basis.
Young people's medicines had been routinely reviewed to monitor the effects on their health and wellbeing. We saw an example where the service had worked in partnership with the multi-disciplinary team to reduce high risk medications for one person. This had provided positive outcomes for the young person and had a positive impact on their quality of life.