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 remained changed to requires improvement. This meant people were not always safe and protected from avoidable harm.

The provider was in breach of legal regulations in relation to people’s safe care and treatment.

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. One member of staff told us, “We have learnt from previous incidents. There have been examples where policies and procedures have been reviewed and this is shared with staff through a variety of means to ensure everyone understands the changes made.”

The service worked to ensure transitions were well planned and handled with sensitivity. When people were planning their move into a supported living setting there were detailed transition plans in place. These included multiple visits to the new home to help people get to know staff and other people. This also helped them to overcome any fears or anxieties they may have. 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. They knew how to raise concerns and how to escalate them if they were not satisfied with the response. One member of staff told us, “The registered manager always tells us to raise concerns if we see them. We are always being reminded about that.” 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.”

The service worked with people to understand and manage risks. The provider assessed risks to ensure people were kept safe from avoidable harm. There were guidelines put in place to support positive risk taking and enable people to try new things. There were severe weather risk assessments in place including guidelines to ensure staff knew how to mitigate the risks. People and their relatives told us they were always involved and felt safe with the support they received. Comments included, “Yes [family member] is safe and yes I know who to go to if she wasn’t.” and “We are very close with the staff. They look out for [family member].”

The service assessed the risks associated with people's home environment. They assessed the risk of fire and put personal evacuation plans in place. Despite some generally good principles, we found some personal evacuation plans had not been thoroughly tested to ensure they were an accurate reflection of how people would respond in an emergency. We also found some plans showed there were times when some people would not be able to be evacuated from their home by staff due to their mobility needs and staffing levels. We raised this with the provider, and they were liaising with the London Fire Brigade for advice and guidance around fire risk assessments and evacuation plans.

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. One relative said, “I am very confident in the level of knowledge of the staff.” Staff benefited from an induction that included completion of the care certificate. The care certificate is an agreed set of standards that define the knowledge, skills and behaviours expected of specific job roles in the health and social care sectors. Staff also received ongoing training and supervision. A staff member said, “We get lots of training and regular refreshers and we can always ask for additional training if we think we need it.” The provider was following safe recruitment procedures to ensure staff were suitable to work with people who used the service. 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. The provider carried out infection control audits in people’s homes, however, we were not assured the frequency of infection control audits (every 6 months) was enough to identify infection control issues in good time. We discussed this with the provider, they have reviewed their policy and practice and introduced more regular infection control audits of people’s homes. During the assessment we observed people’s homes to be clean and hygienic. Staff told us they had an ample supply of personal protective equipment.

There were processes in place to support the safe and effective management of medicines however, we identified some areas needed improvement. There was not always sufficient information in place for staff to safely administer when required (PRN) 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. The provider’s audits had not identified these shortfalls. We raised this with the provider and they have carried out audits of all people’s medicines and reviewed PRN guidelines where necessary. They have also re-assessed all staff competency and put a plan in place to ensure this is refreshed annually. 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.