City Support Limited

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 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. Lessons were learnt to continually identify and embed good practice.

There was a positive culture at the service which focused on people’s quality of life and continual improvement of their care. Although there had been no incidents in the previous 12 months, there were robust processes in place to analyse and learn from these should they happen. People’s care arrangements were regularly reviewed to ensure they continued to meet their wishes and identify any improvements that could be made to the care they received. The registered manager participated in local care provider networks to share best practice and ways to further improve the support they were able to deliver.

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.

There were clear systems in place to make people’s transitions between services seamless, and ensure people received care that was joined up to meet their needs. This included through completing detailed assessments of people’s needs prior to commencing care, so they could determine if they could safely meet people’s needs. One person had recently started receiving care from City Support Limited and had formed close and trusting relationships with staff from another care provider which had ceased trading. The provider worked to transfer staff across so this person could continue to receive the care that was important to them, from people who they trusted and were safely able to meet their needs. A relative stated, “It was important to us that there was no transition. It was a seamless process. It’s so important to (person) to have carers who know them, and they are like family.”

The provider did not always ensure staff were sufficiently knowledge about their responsibilities to safeguard people from harm, abuse or neglect.

We found no evidence that people had been exposed to any risk of abuse or neglect, or that incidents of this had not been reported appropriately. However, staff had an inconsistent understanding of what their responsibilities were should they be concerned that this was happening. Although sStaff stated they would speak to the registered manager; they were not always aware how to formally raise a safeguarding referral should they be concerned that appropriate action to protect people was not being taken. Some staff stated they would inform a GP or district nurse instead, rather than reporting to the local authority to ensure prompt action was taken. Refresher safeguarding training was organised immediately after the assessment.

People and relatives told us they felt safe with the support they received, and staff were knowledgeable about how people’s health and care needs should be safely met.

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.

Risks to people were well understood, and the provider worked in partnership with other organisations and people to manage these safely. Staff were very knowledgeable about each person and the support they needed to manage any risks. For instance, where people had poor skin health staff could tell us the signs they would look out for that this may be deteriorating. There was a repositioning plan in place to help reduce this risk and they knew how to relieve people’s pressure areas should they be in discomfort. Other risks posed by people’s health and care needs were similarly well managed.

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

Assessments were undertaken of people’s homes to ensure any risks to them and staff were identified, and measures put in place to manage them safely. For example, where people were at risk of falls there was a clear plan of how staff should support them navigate around their home safely including with equipment such as walking sticks and pendant alarms. This allowed people to remain in their own home safely in line with their wishes. When complex equipment was in place such as hoists, there was appropriate guidance on how to use these which staff were knowledgeable about. Staff received specific training and were observed using this equipment by a suitably qualified person before being able to use it, to ensure they were able to do so safely.

The provider made sure there were enough qualified, skilled and experienced staff. They had always made sure staff received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

There was a small team of staff who were trained and knowledgeable about how to support people safely, and they had been assessed as competent to perform higher risk tasks such as administering medication or moving and handling. They received ongoing supervision to monitor their wellbeing and performance, which included feedback being sought from people and families to support this process.

Staff were safely recruited using checks such as Disclosure and Barring Service (DBS) checks. A DBS is a check against the police national computer to support providers in making safer recruitment decisions.

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 by staff who were knowledgeable about how to protect them from the risk of infections. Staff used personal protective equipment (PPE) such as gloves and aprons to maintain a high standard of hygiene. We received positive feedback that staff ensured the cleanliness of people’s homes and supported people to maintain a good standard of personal hygiene. One relative us, “The house is always spotless and people who come to visit always say how impressed they are with how well presented my relative is. This is all thanks to the support by staff.”

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.

Medication was administered by staff assessed as competent to do so safely and in line with best practice. This ensured people received the medication they needed to manage their health needs in a timely manner. Staff were knowledgeable and had access information regarding the medication that each person required, including when they might need to offer “as and when” medication such as pain relief. People who had previously struggled to manage their medication independently were now able to receive support to ensure they didn’t miss any doses. One relative told us, “(Person name) was not always taking her medication before. Their staff member is very good with them and supporting them to manage it. If they run out of medication and need this re-ordering, they let us know straight away.”