Access for Living

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 inspection we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people were not always safe and protected from avoidable harm.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a positive culture of safety, based on openness and honesty. The provider listened to concerns about safety, investigated and reported safety events. A health and social care professional told us, “Access for Living does have a culture of learning, they are open and honest and ask for feedback to improve their practice.” Staff told us they had opportunities to learn from incidents which were regularly discussed during team meetings. The provider had learnt from serious events and put in measures to help reduce the risk of similar incidents happening again.

The service worked to ensure transitions were well planned and handled with sensitivity. When people were planning their move between services there were detailed plans in place to facilitate smooth transitions. Staff worked with other health and social care professionals to support smooth transitions and safe and effective care. One professional who worked with the service told us, “Joint working is very much valued and supported by Access for Living.” Staff showed a good understanding of the risks to people’s health and wellbeing and how to mitigate these.

The service had a proactive approach to safeguarding. Managers and staff supported people to understand how to stay safe, how to recognise abuse and how to report any concerns they had. Safeguarding was a regular topic during service user forums and meetings. Staff received regular training and showed a good understanding of safeguarding procedures. Staff were confident that managers would take action to address any concerns raised. One member of staff told us, “If I had any worries I would report to my manager. I know they would look into things and do the right thing.” The registered manager was aware of their responsibility to report safeguarding concerns to relevant organisations including the local authority and CQC. One professional who worked with the service told us, “They take safeguarding very seriously. They have professional curiosity.”

Despite generally good practices, not all risks assessments contained sufficient information to ensure staff would understand how to mitigate the risks. For example, one person was at risk of falling on the stairs and their family member told us staff needed to monitor them whilst on the stairs. Although, relatives told us they were confident staff were monitoring the person when they used the stairs the guidelines were not included in the person’s care plan or risks assessments. We raised this with the provider and they made immediate improvements. People and their relatives told us they were always involved in the management of risks and felt safe with the support being delivered. One relative told us, “Yes, [family member] is very safe. We have had the same provider for many years. If the care wasn’t safe we would not tolerate it.” The service worked with people to understand and manage risks. There were guidelines put in place to support positive risk taking and enable people to try new things.

The provider assessed the risks associated with people’s homes; however, we found risk assessments did not contain guidance or prompts about what the potential hazards staff should consider. We discussed this with the provider and they have reviewed their risk assessment processes and included comprehensive risk assessments which contained additional prompts and guidance to ensure all potential risks would be considered by staff when assessing people’s environment. Whilst the provider was responsive to the concerns raised, we have further reported on these shortfalls under the ‘Well-Led’ question.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. People and their relatives told us staff were skilled and experienced in supporting them. Staff benefitted from an induction that included completion of the care certificate, ongoing training and regular supervision. Staff told us they received good support to fulfil their role. One member of staff said, “Managers are very supportive and always available if you need them.” Relatives of people also told us staff received a thorough induction and ongoing training to ensure they were skilled and knowledgeable. One relative said, “We insist that all staff working with [family member] has a thorough induction and shadowing so they can understand [family member’s] routines and needs. This works very well.” The provider recruited staff safely. Pre-employment checks included obtaining a full employment history, appropriate references, right to work documents and proof of identity and DBS checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

The service assessed and managed the risk of infection. They detected and controlled the risk of infections spreading and shared concerns with appropriate agencies when needed. People told us staff observed safe hygiene practices when delivering care. One relative told us, “The staff are always clean and tidy, they put on shoe covers when they come in and wear gloves when necessary.” There were guidelines in place to ensure staff understood how to follow safe hygiene practices when providing personal care. Staff told us there was an ample supply of personal protective equipment (PPE) such as gloves, aprons and shoe protectors.

There were processes in place to support the safe and effective management of medicines however, we identified some areas needed improvement. Care records showed staff were occasionally administering one person’s medicines but this element of care was not included in their care plan and staff were not recording this on a medicines administration chart in line with best practice guidance. The provider’s audits had not identified staff were delivering this unplanned care. We raised this with the provider and they have updated the person’s support guidelines and put in place the relevant medicine administration records so staff can accurately record when they administer the person’s medicines. Staff completed training and had their competency assessed before they started supporting people with their medicines. However, the provider was not reviewing staff competency on an annual basis in line with current best practice guidance. We raised this with the provider and they have assessed all staff competency and put in measures to ensure this would be repeated annually. Whilst the provider has acted upon these concerns, we have further reported on these shortfalls under the ‘Well-Led’ key question. People told us staff managed their relatives’ medicines safely. The provider was aware of national initiatives such as STOMP(stopping over medication of people with a learning disability and autistic people)which is aimed at to stopping the over prescription of psychotropic medicines which are sometimes used to control people’s behaviour.