Your Support

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. This is the first assessment for this service. This key question has been rated outstanding.

This meant people were protected by a strong and distinctive approach to safeguarding, including positive risk-taking to maximise their control over their lives. People were fully involved, and the provider was open and transparent when things went wrong.

This service scored 97 (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 strong proactive and positive culture of safety, based on openness and complete honesty. Staff actively listened to concerns about safety and thoroughly investigated and reported safety events.

Systems were in place to ensure staff shared and understood lessons learned. Staff held regular person-specific team meetings. This enabled them to share the most up to date information about people’s wellbeing, needs and wishes. Staff also received feedback from wider team meetings. They participated in learning checks, reflective discussions and formal supervisions. They received guidance and coaching from the managers. Staff were supported to participate in ‘micro learnings’. These focused on very specific aspects of people’s care needs and wishes, and ways in which staff could maximise outcomes and understanding.

Lessons were consistently learnt to continually identify and embed good practice. The staff team told us they were supported to learn from when things had gone wrong. One staff member told us, “We are always learning and asking what can be done better.” A manager told us, “There is a not a day goes by when we are not all learning.”

We saw when people had experienced distress which had resulted in the risk of them hurting themselves or staff, work was done to learn from each event. Analysis was conducted to generate learning points which were shared with the staff team. This meant people benefitted from a calmer and less stressful day because staff were continually striving to understand their needs better. Learning from these events was always focused on least restrictive practice, and we found evidence of the positive impact of this approach on people’s care and support.

We could see from people’s interactions with staff and management that trust had been built. People felt confident they would be supported with understanding if they shared a concern and would not suffer any negative impact for doing so. People who could not easily communicate their needs were supported by staff who were always learning and modifying their approach to improve their care.

The provider worked consistently with people and healthcare partners to design, establish and maintain safe systems of care. Safety was always well managed and monitored. They made sure there was always continuity of care, including when people moved between different services.

There were clear processes in place to assess people’s needs before admission. The management team told us they would always ask themselves; “Can we really help this person? Can we make a difference to their lives?” They also considered carefully the impact of any new person on those already receiving support. Bespoke transition plans were agreed in each case. Every effort was made to ensure people had the opportunity to meet with their full staff team before they moved to the service. This helped build a sense of familiarity and safety at what can be a very difficult and challenging time for people. Staff teams were built around each person, and specific training was designed to enable staff to have all the skills and knowledge they needed.

Documentation was prepared and continually updated to detail how people wanted to be supported to safely engage with other services and professionals. This resulted in comprehensive, up to date individualised care records.

The staff team had a strong understanding of risks to people across their care journeys. They worked closely and collaboratively with other care providers and services to ensure a joined up and consistent approach. People were consulted and supported to plan how they could most safely and effectively engage with other services. For example, detailed plans had been agreed about how a person could receive dental treatment they needed. The options had been discussed with them, and they had agreed to the plans and understood how they would benefit from them. We saw risk assessments detailing how people could be safely supported to manage risks to themselves whilst attending appointments. Staff engaged with other professionals to help prepare and minimise the possibility of distress for people. For example, by ensuring the person did not have to attend at a busy and noisy time of day. In this way people were supported to engage with health care and services they had in some cases never been able to receive before.

The provider worked well with people and healthcare partners to fully understand what being safe meant to them and the best way to achieve that. Staff had a clear focus 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 and managers demonstrated a strong understanding of safeguarding and what steps to take to address any concerns. All the relatives we spoke with told us they felt their loved ones were safe. Care documentation detailed how staff could ensure they supported people to feel safe. Some people had experienced neglect or overly restrictive practices in previous care settings. Staff and managers had liaised with people and their loved ones to understand as much as they could about these experiences. This helped staff to better understand why some responses and situations may trigger distress for the person. Staff were therefore better able to minimise triggers which may make people feel unsafe or distressed. Staff and managers worked hard to build positive, supportive relationships with people. This allowed people to feel safe to share their thoughts and feelings and facilitate better understanding of their needs. All learning about what helped people to feel safer was shared with staff and recorded in care documentation to ensure a consistent approach.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In the community this can be done through a procedure called community Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found staff had a good understanding of people’s personalised risks and safeguarding needs. Staff were able to clearly describe the specific vulnerabilities of each person they supported, including risks related to communication, health conditions, behaviour, and social situations. Staff told us, and records showed, restrictions were only used in the best interests of the person and in the least restrictive way. Safeguarding systems and processes meant staff supported people in a way which upheld their human rights and protected them from discrimination.

Every person had been supported to reduce their need for restrictive practice and gain some independence. In some cases, with the support, stability and understanding of staff teams, people had been able to experience significant reductions in their need for restrictions. For example, one person had been subject to mechanical restraint as they had previously engaged in self-harming due to distress, to the point they had significantly injured themselves. The staff team’s understanding of the person’s sensory needs and calm approach focused on the person’s communication resulted in the person no longer harming themselves and no longer requiring restraint to keep themselves safe.

Information about any safeguarding concerns was shared with other external agencies in line with local agreements and was thoroughly investigated. This invited scrutiny from professionals outside the service to ensure transparency and maximise learning from identified risks.

The provider always worked well with people to fully understand and manage risks by thinking holistically. Staff provided care that fully met people’s needs and was safe, supportive and enabled people to do the things that mattered to them.

We saw very detailed and bespoke risk assessments about people’s care needs. These were regularly updated and person-centred. People had exceptionally detailed Positive Behavioural Support (PBS) plans in place. These described how people wanted to be supported when they were feeling safe and happy. They described changes and triggers to look out for when someone was starting to feel upset. They included what changes people might experience or exhibit if they were feeling very distressed. They also explained how staff could know when people were starting to feel calmer again. People’s PBS plans gave staff a detailed record of how to support them when coping with changes in mood and distress.

A professional who worked with the service told us, “Their PBS are the best we have seen… The level of risk interventions they provide is really impressive.”

Staff received accredited training to ensure they were able to support people safely, including when they were very distressed. This minimised the risk of people hurting themselves or other staff. Staff told us they felt well trained and confident as a result of the support they received around restraint. Staff had a comprehensive understanding of possible triggers or early signs of distress in people. They were often able to support people to feel calmer, safer and more in control in the face of challenging situations. Staff told us physical restraint was rarely used and when it had been used in the past it was when absolutely necessary and the least restrictive option. We saw analysis which demonstrated changes staff made to people’s care reduced the risk of them getting very distressed. This meant they were less likely to need any kind of physical restraint or restriction. The management and staff team shared an ethos of striving to reduce the need for any physical and chemical restraint as much as possible. These efforts had resulted in significant and lasting changes to people’s personal resilience and ability to cope with distress.

In supported living settings, the Commission do not regulate the environment in which people live. However, we do ensure people’s safety is assessed and monitored. The provider was fully aware of all potential risks in the care environment and controlled them well. They made sure equipment, facilities and technology supported the delivery of safe care.

At the outset, people’s homes had been designed in a bespoke way to ensure safety was promoted for people and their staff teams. In some cases, this additional planning enabled people to be given the chance to live independently, who might otherwise have needed to remain in much more restrictive environments. For example, the management team had worked with the landlord to ensure one person’s home had been designed with exceptional consideration to their need for additional exits and special spaces for them, and the staff supporting them, to maintain safety in times of distress.

The management team explained that the maintenance service they used was very quick and effective. If any repairs were needed, they were completed quickly and to a good standard. They understood the potential stress to people if their home was not looking or working as effectively as it should. We visited 4 people in their homes and saw they were maintained to a high standard. Risk assessments were created and reviewed to guide staff on how best to support people to remain safe in their homes. Staff we spoke with were clear about what action they needed to take in the event of an emergency in the home as well as out in the community. People were supported by staff who had access to technology which enabled quick access to care documentation, guidance and records. This ensured staff always had access to the most up to date information to support people.

The provider made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. They worked together well to provide safe care that met people’s individual needs. A safe and robust recruitment system was in place to ensure staff had the right skills and experience to support people well.

The management team explained they never used agency or bank staff. A bespoke staff team was built around each person receiving care. This enabled the person and their team to get to know each other very well. Senior support worker roles were developed so that they spent time supporting and overseeing the care of different people over time. This meant they could cover regular team members in the event of sickness or planned leave to ensure safe and consistent care for people. The management and staff team recognised the distress unplanned staffing changes could cause for people. One of the managers told us, “We would never use agency staff, managers would cover if needed to ensure consistency.”

Senior support workers told us about the programme of training they had completed over a year. This gave them the skills to monitor the quality of care provided and supervise support workers. Staff told us they received a lot of training and support. They told us training was tailored to ensure they could meet the needs of the people they were supporting. All staff we spoke with told us they were given opportunities to develop in their roles. Staff also told us about knowledge checks they had to complete. One staff member said, “We have knowledge questions. We are asked about subjects like PBS and infection prevention control. There is lots in place to remind us.” Another staff member told us, “If we need extra training [the managers] make sure we have it.” Staff told us they were encouraged to complete formal qualifications.

We saw that understanding learning disabilities and autism was not only part of the induction and ongoing training process but also incorporated into regular supervisions. This ensured learning was built upon and consolidated, leading to better care and understanding for people. Staff told us about the 16-week induction programme they participated in. They told us they felt very well prepared to support people in a person-centred way during this induction period. Time was invested to ensure each staff member had a high level of understanding of people’s needs and wishes. All this was in place before they became part of the person’s regular team. The particular skills and interests staff brought were considered and matched to people carefully. This resulted in people being supported by a team of exceptionally caring and knowledgeable staff. Staff understood how to maximise communication and build rapport and trust with people.

This also resulted in people feeling seen and understood and being able to make the best of each day with the support and encouragement they needed. We saw staff worked very well together as a team. They demonstrated an unspoken, shared understanding of subtle changes to people’s mood and how to work together to support them. The communication between team members was exceptional. This allowed teams to provide a sense of safety and consistency which helped people feel understood and safe.

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 supported to limit the risk of infection by maintaining good personal hygiene and keeping their homes clean.

We saw that people’s homes were kept clean and well presented. Staff received training to ensure they understood how best to limit infection risk. Staff understood their responsibilities and followed practices such as safe hand hygiene, the correct use of personal protective equipment (PPE) and adherence to appropriate cleaning routines. Wherever possible, people were supported to participate in making sure their homes were clean and tidy.

The homeliness of the environment was not compromised by the need for safety. Cleaning products and equipment were stored away safely but remained accessible when needed. People’s homes were clean and well presented but still retained individuality and the sense of warmth homes should provide.

We saw examples of good wound care management. People were supported to heal well from skin injuries with careful care from staff to promote good hygiene.

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

The management and staff teams shared an ethos of ensuring people’s behaviours were not inappropriately controlled by medicines. Where possible people’s views about their medicines were central to how they were supported. One person had expressed their wish to discontinue a particular medicine which they had been prescribed for years. They were supported to achieve this goal with careful planning and support. This was a hugely positive step for the person who no longer had to tolerate unwanted side effects. They felt a sense of achievement and progress in no longer needing a particular medicine.

People received their medicines in a safe and timely way. Medicines administration records (MAR) were maintained. Records showed no gaps in medicines administration and stock balances were regularly checked. This prevented people from running out of medicines or storing up excessive amounts of unwanted medicines.

People were supported to take some medicines only when they needed them. These are known as ‘PRN’ medicines. There was detailed guidance for staff to ensure they fully understood how to safely administer these medicines. Body maps and MAR were used to record the need for and use of topical creams and ointments. This ensured staff knew how to apply creams safely so that people could get the most benefit from them.

People’s care documentation contained clear person-centred details about how they wanted to be supported to take their medicines. When people did not want to take their medicines, they were supported with kindness and compassion. Where possible, staff helped people to understand why the medicine was prescribed for them. Information was presented in ways which would optimise people’s ability to understand. In this way they were supported to make informed decisions.

Records showed regular checks to ensure medicines were being stored correctly and disposed of when needed. When people needed to attend appointments to receive their medicines, the staff team worked hard to support them to attend regularly. We saw analysis of the effectiveness of people’s medicines. One person was being supported to improve their sleep. A data analyst reviewed the sleep and the medicine used over a timeframe to see if it was helping. This data was shared with professionals to help them consider other alternatives. We also saw many other efforts had been made to support the person to sleep well before medicine was considered. A holistic approach was applied by the staff and wider supporting professionals.

Staff told us they felt confident to support people with their medicines. They received 6 monthly refresher training and had observations to ensure they maintained good practice. Relatives told us they were happy with how their loved ones were supported to take their medicines.