Diverse Abilities Plus - 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 requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 72 (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.

Safety was a priority for the service. This involved people and their families as well as staff, so any risks were managed in a way that met people's needs and preferences. People and relatives told us they or their family member felt safe with the care provided. For example, a relative commented, "[Person] is very safe there, happy and secure now. Taken a worry off me." There were regular reviews of risk assessments and management plans, which were updated as needed.

There was a clear process for reporting, investigating, reviewing and learning from accidents, near misses and other concerns. The management team checked accident and incident reports to ensure any necessary action was completed following each occurrence. The registered managers reviewed and analysed accidents and other incidents monthly, to identify possible trends that might prompt further changes to practice.

People, families and staff were encouraged to raise concerns, and to report accidents and near misses. They felt comfortable doing so and were confident managers would listen to them. The management team took concerns seriously, welcoming the opportunity to learn lessons and put things right. This learning was put into practice. For example, following concerns raised about a person's care not addressing identified risks, the registered managers had re-designed the person's staff team and the way their support was supervised. The registered managers continued to seek feedback from the person and their family about how the changes were working.

The registered managers understood the duty of candour. They ensured staff kept relatives informed of people’s accidents, incidents or health concerns. Relatives confirmed they were kept informed about what was happening. For example, relatives commented, "Even a minor thing they are very thorough, and I am kept informed of everything" and "A couple of times they made mistakes with medication; they always let me know."

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 safety and continuity of care were prioritised. The registered managers recognised that moving house or getting to know new staff might be difficult for people. They ensured people had a managed transition into or out of the service, or when they moved to different accommodation within the service. This involved getting a clear picture of people's needs, preferences and interests, and matching them with staff accordingly. A relative explained about their family member's move, "Did a slow process, went smoothly. I was dreading it but had a lot of input. I was pleased how it went when [person] first moved in."

People had up to date care passports. These set out clearly what was important to people, what they could do independently, and what hospital staff would need to know to provide safe, effective care.

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 understand what being safe meant to them, and how to raise issues when they did not feel safe or had concerns about the safety of others. This included their safety in public, and in friendships and relationships. People were at ease with the staff supporting them and told us they liked and felt safe with their staff.

The registered managers and staff shared a commitment to immediate action to safeguard people from abuse and neglect. The registered managers and staff knew how to identify signs of possible abuse and how to report these. The registered managers also understood their role in gathering information for safeguarding enquiries overseen by statutory agencies. The management team acted promptly on safeguarding concerns, reporting these to the appropriate authority and working in consultation with them to undertake investigations.

The provider's procedures helped protect people from discrimination and abuse. These included clear processes for supporting people with their money and finances, to ensure these were fully accounted for.

The registered managers recognised that people who were not free to go anywhere without agreement from staff were deprived of their liberty. The provider worked with commissioners of care to ensure people were only deprived of their liberty if authorised by the Court of Protection, as required in law.

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.

The provider ensured a balanced, proportionate approach to risk that supported people and respected their choices and preferences about their care. People and relatives told us they were happy with their or their family member's care and support, which staff had planned in partnership with them. This included managing risks in accordance with people's preferences, without undue restrictions. Staff knew people well and had a comprehensive understanding of how to do this.

People's risk assessments for their care and support were personalised, reflecting their individual needs and preferences. They included any risks associated with people's health conditions. Staff regularly reviewed and updated them and ensured they were reflected in people's care plans.

Staff understood how care and support could be restrictive in some circumstances. Where people needed care that could restrict their freedom, such as the use of bedrails, staff followed Mental Capacity Act 2005 requirements in relation to restrictions. They only used restrictions if these were in people's best interests, as the least restrictive option for care, unless the person was able to give or withhold consent. People's care plans reflected the circumstances in which these restrictions should be used.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

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.

The provider understood the importance of people having regular staff. They had recruited a resource planner to oversee shift cover, including allocating agency staff, maximising the continuity of staff for people. People and relatives confirmed they or their family member had support from a consistent team. A relative commented, "[Person] doesn’t like change. If they are short of staff, they try to get people in [person] knows and is comfortable with."

Where there were not enough of the provider's staff available, agency staff were used. Active efforts to recruit new staff were ongoing.

Robust recruitment practices helped ensure staff, including agency staff, were suitable for their role. Pre-employment checks included confirmation of identity, enhanced Disclosure and Barring Service (DBS) checks, a full employment history with an explanation of any gaps, and checks on entitlement to work in the UK. A relative commented, "In recruitment Diverse Abilities must vet very carefully. I've met a couple of dozen new [staff], never encountered a person I’ve been uncomfortable with."

Staff received the training and supervision they needed. Relatives expressed confidence in the abilities of staff: "[Staff] get a lot of training and are encouraged to do [qualifications]" and "They’ve got another person in a wheelchair who has more needs; they deal with them. All are very well trained." Staff had training about autism and learning disability. New staff induction and probation reflected Care Certificate requirements. The Care Certificate defines the knowledge, skills and behaviours needed for care work. Staff confirmed they had received relevant training and had regular supervision. This included checks of their competence in areas such as moving and handling and medicines management.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with relevant agencies promptly.

The provider assessed and managed the risk of infection. Staff had training in food safety and infection prevention and control, including hand hygiene and how to use personal protective equipment (PPE). They had the PPE they needed. Staff supported people to keep their properties clean and to do their laundry. The provider's quality assurance processes helped ensure this was happening as it should.

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

People were involved in decisions about their medicines, including medicines for use when required ('PRN'), and in managing their medicines. They had annual GP health checks, which included a medicines review. If someone did not have the capacity to consent to taking medicines, staff administered them only in the person's best interests, in line with the MCA. There were clear guidelines for how and when staff should administer PRN medicines. If someone was prescribed PRN medicines to support them during times of distress these were not used routinely and were only a last resort. Staff kept clear and accurate records about medicines offered and administered.

Staff were trained in the safe handling of medicines. Senior staff with the appropriate knowledge and skills assessed staff competence with medicines at least annually. Some people had rescue medicines prescribed for use during prolonged epileptic seizures. These people received support from staff trained and assessed as competent in this area. Similarly, staff who administered medicines through specialist feeding tubes had been assessed as skilled and competent to do so.

Managers investigated reports of medicines errors and addressed the factors involved. This included ensuring staff had sought health advice and the relevant authorities had been informed. Managers also acted on any issues identified through regular audits of medicines.