California 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 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.

Systems were in place to report concerns. Staff demonstrated a clear understanding of how to report and escalate issues appropriately.

Where incidents occurred, there was a supportive and inclusive ‘fact-finding’ investigation led by managers and involving staff. This provided a thorough assessment into the circumstances and identification of actions and opportunities to learn.

There was a no-blame culture and a constructive debrief process which allowed staff to discuss incidents, reflect on their role and get involved in individual and collective learning. Learning outcomes were shared at staff meetings.

Learning was used to drive improvements and embed best practice.
 

The provider worked with people and healthcare partners to establish and maintain safe systems of care including where people moved between services.

The provider had effective admission procedures, which allowed for safe transitions from community settings into the service. Where the service was unable to accommodate people, they were informed in a timely manner, so existing care pathways could be maintained, or alternative support could be sourced.

Staff prepared detailed personal information and communication records for people, which was shared between services to ensure a seamless transition. Staff made sure there was continuity of care for healthcare needs, day services and contact with family members.
 

Staff worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that.

Staff focused on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. Staff supported people to make independent decisions, informed choices and engage in positive risk-taking activity.

Staff advocated for people who required support and accessed professional advocacy services to give people a voice to ensure their rights and safety was protected.
Staff had taken time to get to know the people they supported, and they knew how to respond to situations which had the potential to escalate. Sensitive and effective deescalation techniques prevented safeguarding matters.

Where safeguarding concerns arose, staff were aware of their responsibilities to report this immediately. Staff were trained in safeguarding and the provider had effective safeguarding procedures to protect people. Staff completed a regional safeguarding adult board training programme and associated competencies, alongside their own internal training, to reinforce best practice in safeguarding vulnerable people.

Where people were subject to a deprivation of liberty, these arrangements were clearly reflected in care and support plans to ensure they were safe and protected from potential harm or abuse..

The provider 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.

People had individual care plans which included risk assessments, which detailed measures implemented to reduce risks. Staff discussed care, support and risk plans with people and their relatives.

Staff supported positive risk-taking to enable people to exercise their rights, promote independence, to partake in activities, to challenge themselves and achieve their personal goals. This was managed in a person-centred way as risks differed considerably for people.

People took part in various activities from supported household chores and cooking, going on independent outings, attending community events, using public transport and taking up educational and occupational opportunities where risk and safety were factors.

People described improved wellbeing and positive outcomes from this proactive approach to managing risk.
 

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

There was a structured health and safety process to ensure facilities in the home were safe and fit for purpose. There were regular safety checks as part of on-going maintenance and environmental upgrading. Staff were respectful of people’s personal spaces and ensured they were informed and involved in any proposed home related changes.

The home provided an adapted kitchen, ceiling hoist tracking, a multi-sensory area and secure outdoor gardens which were installed and maintained to support people’s safety.

At a recent fire safety audit, the inspector reported, “Building management was very good and staff responded very well to our input.”

Personal Emergency Evacuation Plans were in place to support people to safely leave their home in the event of a fire or untoward event. Safety signage was written in an accessible format and displayed.
 

The provider made sure there were enough qualified, skilled and experienced staff to safely support people.

Recruitment checks were completed to ensure staff were fit and proper to work with people. There was a thorough induction, support and training programme for staff. This included an induction pack, supported shifts, and probationary reviews. Staff described how the team were supportive and how training helped them carry out their role safely and effectively.

There was a coordinated supervision process, and these were completed with regularity. Appraisals were structured and meaningful.

Staffing levels were sufficient to meet people’s needs safely and consistently. There were occasions where the service could not accommodate all respite requests. This was to ensure safety was not compromised and all people’s needs could be met.

Families commented how the service was sufficiently staffed to ensure they were able to meet both the health and social needs of the people they cared for. One family commented, “They don’t just sit in the house, they get out and have different experiences.”
 

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 were trained in infection prevention and control (IPC) and assessed people’s individual infection risks on admission into the service. Staff sought assistance when they had concerns about a deterioration in a person’s condition which may be due to an infection.

Systems were in place to detect and control the spread of infection. Staff followed cleaning schedules and the communal environment was well maintained. Staff supported people to take care of their personal spaces, shared areas and carry out housekeeping tasks. This promoted ownership, responsibility and independence.
 

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Medicines were safely stored in a locked clinical area. Staff had completed required training and were assessed as competent. There were audits undertaken to ensure best practice, compliance with safe medicines procedures and to monitor outcomes for people.

Staff ‘double-checked’ medicines with a colleague prior to administration and used the photo functionality within their electronic care planning system to take an image of all medicines given. This procedure assisted in audit, stock check and reviews in the event of a medicines related incident or concern.

People had personal medicine profiles and daily notes demonstrated where people were involved in the process. There were specific medicine care and support plans for people with asthma and for seizure management which had been co-developed in consultation with specialist care teams.

The service adopted the principles from STOMP (Stopping Over-Medication of People with a Learning Disability, Autism or Both) initiative. Staff had worked with people and their healthcare team to reduce reliance on ‘as required’ medicines and had seen some positive outcomes.