ESPA Agency

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 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.

Accidents and incidents were recorded in a timely way. The registered manager monitored and analysed records to identify any themes, trends or lessons learned and communicated those with all staff.

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.

Staff regularly updated people’s care records to ensure they met people’s individual needs, interests, choices and preferences. They also maintained information to enhance individual people’s quality of life.

Staff supported people to complete and maintain health and care passports to be used to share crucial information with other services in the event of a person being transferred, for example, to hospital. The care passports contained details about people’s care and support needs as well as things that were important to them and their personal preferences, likes and dislikes. They were regularly reviewed to ensure they remained up to date.

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. The provider shared concerns quickly and appropriately.

Staff supported people to keep them safe and protect them from abuse. The provider had a safeguarding system in place to follow in the event of any potential abuse. Staff had received up to date safeguarding training and knew how to report any incidents. A staff member said, “Any safeguarding concerns are reported immediately to the manager or designated safeguarding lead and are recorded clearly. If necessary, external agencies are contacted to ensure the safety and wellbeing of the individual.”

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.

Staff assessed and managed risks to people’s health, safety and wellbeing effectively. Assessments were regularly reviewed, and strategies were in place to help minimise harm. For example, positive behaviour support. This is a person-centred framework for providing support to people with a learning disability, and/or autism, including those with mental health conditions, who have, or may be at risk of developing, behaviours of distress.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Environmental risk assessments were in place to ensure the safety of staff and people from things such as slips, trips and falls or other potential environmental hazards.

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.

There were appropriate staffing levels and skill mix to make sure people received consistently safe, good quality care that met their needs. A relative told us, “[Team Leader] does his utmost to ensure that experienced staff support [Person]. He is very safe.”

Staff received a comprehensive induction and regular training to ensure they had the skills and knowledge to support people effectively and safely. A staff member said, “I check my care skills every few weeks and complete any training needed. If I feel like I need refreshers I would mention this in my supervisions.”

Staff were recruited in a safe way. The provider had an effective recruitment and selection policy and procedure which included all appropriate checks.

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.

Staff completed regular infection control training to ensure they remained up to date with their knowledge. The provider ensured there was enough PPE available and accessible to staff to promote infection control best practice.

Staff encouraged people to follow infection control best practice such as prompting them to wash their hands after they have been to the toilet and before they eat food.

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 managed safely. The provider had systems in place to help ensure medicines were administered in line with people’s needs. A relative told us, “[Person] has medication, and it is dispensed safely. They (staff) make sure he swallows it, and it is kept safely in a locked room and recorded.”

Staff received regular training in medicines administration and routinely had their competence checked. Senior staff carried out regular medicine checks and audits to identify any errors and take appropriate action.