Royal College Manchester

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.

Robust policies and procedures supported a strong learning culture. Both the provider and staff were passionate about identifying areas for improvement, and continuous learning was embedded into everyday practice. The registered manager told us, “There is always something we can learn and improve on. Every day is a school day.” A staff member described having regular opportunities to reflect on incidents through both “cold” and “hot” debriefs with senior staff, explaining, “When something happens, we get together and talk about this.” Another staff member added, “We are encouraged to reflect and learn from lessons within our supervision.”

Action plans were in place, monitored and reviewed routinely. The registered manager used several monitoring tools, including quality assurance audits and daily checks, to ensure people received a good standard of care. The nominated individual was also actively involved in oversight at a senior level. The provider monitored and addressed staff performance.

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.

People’s needs were routinely reviewed and updated in their care plans. Regular service reviews took place, and the involvement of relatives and advocates was actively encouraged. A relative told us, “I don’t live locally, but staff always ring me to run things past me. I’m always in the loop.”

People received support from a range of healthcare professionals, including GPs and dentists. One relative said, “My loved one experienced some dental issues recently and the team have been great at managing this.” Staff described the steps they took to support safe transitions. For example, one staff member explained how they ensured that a new provider received all relevant information, including routines, life history and communication needs, stating, “We want to support people the best we can in the next step of their lives.”

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.

Robust safeguarding policies and procedures were in place. The service promoted an open and transparent culture where staff felt confident raising concerns. There was appropriate oversight of safeguarding incidents at both the registered manager and provider level. Concerns were acted on promptly and effectively. However, not all safeguarding concerns had been reported to CQC in line with statutory requirements. The provider was reminded to review and improve this practice. We have dealt with this shortfall under the well led key area.

The provider had appropriate systems and processes to meet its responsibilities when depriving people of their liberty as a managing authority. Staff were ensuring that Deprivation of Liberty Safeguards (DoLS) authorisations were requested, appropriately authorised, recorded, notified and reviewed appropriately.

Relatives told us they felt their loved ones were safe. One relative said, “I feel my loved one’s life is enriched and he is safe.” Staff demonstrated strong awareness of safeguarding and knew how to escalate concerns. One member of staff told us, “If I did have a concern, I would go to the house manager or registered manager. If nothing was done, I would go to CQC or the police if there was immediate harm.” Staff received up‑to‑date safeguarding training.

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 completed detailed and individualised written positive behavioural support plans to help support people in distress and in line with good practice. These plans were fully informed by staff who knew them well and who worked to meet their needs proactively to prevent people becoming distressed. Where people were distressed, staff recorded full details to enable managers to understand incidents and put in measures to meet people’s needs and reduce people’s distress and risks.

Risks were identified, assessed and reviewed regularly. Risk assessments were comprehensive and person‑centred. Staff encouraged positive risk‑taking to promote independence and choice. For example, a relative described how staff supported their loved one who had previously been reluctant to access the community by gradually building confidence until they were able to visit busier places such as restaurants. They told us, “My loved one never went out in the community Today we went together. It was amazing.”

Staff had a thorough understanding of individual risks and how to mitigate them. One staff member described supporting a person experiencing new behavioural challenges by adapting a room to provide a safe environment. We observed staff proactively supporting this person in ways that kept them safe, while helping them self‑regulate in a manner that met their individual needs.

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

There were clear policies and procedures for maintaining a safe environment. A range of quality assurance and safety checks were routinely completed, and areas requiring improvement were promptly addressed.

Staff assessed people’s immediate environments to ensure they were safe and met their needs. Fire safety checks, health and safety audits, and infection control checks were completed appropriately.

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.

Overall staffing levels met people’s needs, and the provider took active steps to address any shortfalls. However, some relatives and staff felt the service would benefit from additional staffing. One relative told us, “Yes, they do have enough staff, but I’m not sure my loved one always gets 1:1.” A staff member added, “Sometimes we are short‑staffed, but we all help each other and work as a team.” The provider had already taken action, including creating a pool of bank staff.

Staff were well matched to the people they supported and had very good knowledge of individuals’ needs. One staff member explained they did not support a particular person until they understood their communication needs. Another said, “There is only a small group of us supporting this person because they have very unique needs and don’t like changes.”

Recruitment practices were safe. References were obtained, and criminal record and right‑to‑work checks were completed. Employment gaps were explored.

Staff received extensive training and a two‑week induction followed by shadowing before supporting people. One staff member said, “Even though I had experience, they treated me as if it was my first job. I was never on a shift with new staff alone.” Another added, “Before they allocated me, they asked if I was ready.” Staff had access to training tailored to people’s needs, including British Sign Language. Opportunities for development were encouraged, and staff spoke proudly about progression.

Staff competencies were assessed regularly, and the provider recognised the value of a well‑trained workforce. Staff received regular supervision and appraisals and were encouraged to provide feedback. One member of staff said, “We have supervision every 8 weeks.” Another told us, “We’re invited to meetings with the CEO where we can ask questions.”

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.

There were appropriate policies and procedures in place. Staff had a good understanding of infection control and used protective equipment correctly. We observed staff encouraging people to wash their hands before eating.

Regular infection control audits and checks were completed. Relatives raised no concerns. One relative told us, “This house is always well maintained and immaculate.”

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.

Systems were in place to ensure regular medicines were given safely and at the right time. On people’s medication administration records, allergies were recorded accurately. Medicines including controlled drugs were stored safely and securely. Information to support staff to safely give ‘when required’ medicines was in place and was person centred. Correct processes were followed for people who were having their medicines given covertly, hidden in food or drink.

Staff provided evidence demonstrating that delegated healthcare tasks (for example, insulin administration) were managed safely. Care plans contained up to date, personalised information about how to support people with their medicines. For people on high-risk medicines such as medicines for diabetes and epilepsy, care plans were very detailed to ensure that all staff involved in the care of these people knew how to manage these high-risk conditions. Medicines audits were completed at regular intervals to identify issues and drive improvement. Medicines incidents were recorded, analysed and learnt from.

Managers told us that staff had completed medicines training and had been assessed to ensure that they gave medicines safely. We were shown evidence of training records to confirm this and during the assessment, staff demonstrated good knowledge of people’s individual medicines needs.