Inshore Support LTD - Supported 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 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 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Although lessons were learnt to continually identify and embed good practice, records were not always completed to the same standard across the service.

The incident records and distress recording charts were inconsistent, some were detailed and gave a full account of what had occurred, but others did not contain enough detail to understand what had led to a person’s distress or how they had been safely supported. The management team had actions plans in place to address the inconsistencies across the service.

Systems were in place to learn lessons from incidents, complaints and safeguarding concerns which were analysed for patterns and trends. Staff confirmed lessons learned were shared with them and they felt involved in this process.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored.

There were systems in place to ensure people’s needs were assessed before they started using the service. Where possible the provider worked with partner agencies to facilitate a planned transition to or from the service. A relative told us, “We couldn’t do a transition from the previous placement to this service, but it’s gone really well. Staff have asked lots of questions. They really want to get to know [person] and give [person] a good life.” People had care plans and risk assessments which were completed based on their support needs.

The provider worked with people to understand what being safe meant to them and with health and social care partners on the best way to achieve that. The provider shared concerns quickly and appropriately.

People had plans in place which outlined how people might react when they were anxious or distressed. These varied in detail and quality across the service. These plans guided staff on the restrictive practices that could be used when supporting people. The provider was receptive to feedback about how the language used and the detail within these plans could be improved.

Relatives told us they thought staff supported their relatives safely. One relative said, “The staff know [person] they keep [person] safe when [person] is not able to keep themselves safe. I know the staff may have to use restraint, but they do this to keep everyone safe in particular [person]”.

Staff knew the procedures to follow if they had any concerns about people and if they identified any closed cultures developing. (Closed cultures are where people may be at risk of deliberate or unintentional harm, and people are not listened to.) A staff member told us, “I would escalate any poor practices, I would not accept it, and I know the management would deal with it. We do not allow that here.” Staff and the records we reviewed confirmed staff had received training in relation to abuse and how to restrain people safely.

When needed, the provider worked with the local authority to complete applications to the Court of Protection for them to authorise people to be deprived of their liberty.

The provider worked with people to understand and manage risks, however further improvements were required to ensure records were detailed across the service.

People had a variety of risk assessments in place applicable to their individual needs. People who required them had physical intervention risk assessments in place that detailed what restraints could be safely used as a last resort and any medical factors that may impact what techniques could or could not be used. There were some missed opportunities to include additional information such as staffing levels and environmental factors. The provider was receptive to this feedback and agreed to address this.

Relatives thought staff had the knowledge about how to support people to manage any identified risks. A relative said, “[Person] has a core staff team who knows them well. The staff know what risks to be aware of both in [person] home or when they are out in the community.” Discussions with staff demonstrated their knowledge about people and what risk factors they needed to aware of when supporting them.

Care plans and risk assessments were regularly reviewed when needed and when changes occurred.

The provider identified and took steps to control potential risks in the care environment.

The provider completed risk assessments of people’s homes, to identify any risks that may impact on the staff’s ability to provide safe support. This included fire safety. Where repairs were required staff and the provider supported people to escalate these. A relative told us, “[Person’s home] is lovely, and safe. If anything gets broken or repairs were needed, we work together to get these done quickly.”

Recruitment procedures were in place however some improvements were required to ensure all required checks were completed before staff supported people. We found gaps in employment for 4 staff which had not been explored with them or a rationale provided. This was addressed immediately by the provider and a new auditing tool introduced along with an action plan to review other staff files.

Relatives told us staff had the skills for their role. One relative said, “The staff are competent they know what they are doing. They seem knowledgeable when I talk to them.” People received support from the required number of staff. Where possible people were supported by a core team of staff for consistency.

Staff told us and records confirmed staff had received training for their role. This included core training and training that was specific to people’s individual needs including their communication needs. Staff told us they felt supported in their role. One staff member said, “The management team are there if we need them, and I get regular supervision to discuss my role.” The registered manager where possible tried to match staff skills and experience to the needs of the person.

The provider assessed and managed the risk of infection.

People were supported by staff to keep their homes clean. Staff confirmed they had received training and there was enough Personal Protective Equipment (PPE) available for them to use. This was monitored by the management team who completed spot checks.

Systems were in place to ensure cleanliness concerns were escalated so appropriate action could be taken.

Systems were in place to ensure people received their medicines safely and as required.

People were supported to take their medicines when they needed them. One person told us, “Staff make sure I don’t forget and give them to me.” A relative told us, “Staff administer the medicines to [person], they tell me if there are any issues. They are aware of any side effects as well which are monitored.” Care plans and risk assessments were in place to guide staff. This included guidance for staff on when they can give ‘as required’ medicines such as when people expressed distress. The provider knew and followed the principles of STOMP (Stopping Over Medication of People with a learning disability, or autistic people). Where possible medication was reduced and only used as a last resort when other distraction techniques had been tried.

We saw medicines were stored safely in people’s homes. Staff and records confirmed they had received training, and their competency was checked to ensure they were safe to administer medicines to people.