Kind Tailored Care Ltd

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• 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 newly registered service. This key question has been rated 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. There was evidence of an open culture around incidents. All incidents, safeguarding concerns and accidents were recorded and reviewed by the registered manager. Staff were provided with opportunities to debrief after incidents, and any learnings were communicated to staff involved in the incident and the wider team. A staff member said, “We get feedback on what is happening in the company as well as ourselves. If another support worker has done a really good job, we that will be shared across the company for learning.” Another staff member explained there was an open and calm culture when things go wrong. They said “Managers are open to knowing what has gone wrong and learning from it. It is not a toxic environment.”

Whilst systems were in place to log and audit incidents and concerns for trend identification, we found the audits of all incidents had not been consistently completed to assist the registered manager to identify trends and whether actions had been completed and effective. We found no impact on people, as staff and the registered manager knew people well and effectively monitored all incidents. The registered manager agreed to review their auditing systems for incidents and concerns to ensure they were robust and sustainable.

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 fully assessed before they began receiving support from the service, ensuring that their requirements could be adequately met and staff had the necessary skills to support them safely.

People, their relatives and key healthcare professionals were involved to ensure a smooth transition into the service. The registered manager ensured the transition was tailored to each person. People were given the time to understand their new supported living provider and make decisions around decorating and choosing their new supported living home (where applicable). They were provided with information about the service in a format that they understood.

People were given opportunities to meet their new support team and share what was important to them. They were supported at their own pace to learn about new local social opportunities.

Regular reviews were carried out for people new to the service to ensure their physical, emotional and social needs were being met and adjustments made as they settled into their new home.

Professionals acknowledge the challenges the service had faced and overcome when people transition into the service due to limited information about people and their underlying mental health conditions and past traumas.

One professional said, “They stepped in at short notice when we had concerns about the practice of another care company. Despite the urgency their professionalism and skill were evident throughout.” They went on to explain that since the transition into the service, staff had successfully supported [person’s name] into the community and had prevented hospital admissions. They said they found the service approachable, realistic professional and honest. Another professional said, “This team has worked dynamically during the transition and are able to demonstrate that the current support plans are underpinned by a robust evidence base in terms of positive behaviour support.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve this. 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.

Accessible information was provided to people to help them understand how to safeguard themselves against harassment and abuse. Relatives raised no concerns about the safety of their family members. One relative said, “They’re very vigilant and attention to detail, keeps [person’s name] safe.”

Safeguarding incidents and concerns were investigated, recorded and monitored monthly. All safeguarding incidents were reported to people’s funding authority and notified to CQC.

Safeguarding policies were in place. The registered manager agreed to review the provider’s safeguarding policies to ensure all current forms of abuse (including online abuse) were included in the policy as well as the contact details of relevant commissioning local authorities.

All staff had received safeguarding training relevant to their role and knew the importance of reporting any concerns to their line manager. Staff member said, “If someone disclosed concerns to me, I would raise it with my line manager and there will be an investigation into it to find out the truth as client have to be heard. I would report it the way the client says.”

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 knew people well and were able to provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. The service supported positive risk taking and enabled people to be as independent as possible.

People’s individual risks around their health and emotional wellbeing had been assessed and extensively recorded. Whilst we found people’s care records very detailed and extensive, staff praised the provider’s digital care management system and said access to people’s care records had improved.

Staff had been trained in Positive Behaviour Support (PBS) practices to enable them to support people with diverse needs and behaviours that challenge and to support people to live an independent and fulfilling life in the community. Person-centred Positive Behaviour Support plans were in place which reflected this approach. Staff told us it was important to recognise changes in people’s body language, facial expressions and use of distraction techniques to support people if they show signs of becoming distressed. One staff member said, “It depends on the individual but on the care plan there would hopefully be an outline of the person's hobbies or wording, so when you notice the signs of discomfort we try to keep them in proactive area, either remove [distract] them from the situation or ask them to change to do something that makes them happy to keep them calm.”

Staff knew people well and were able to recognise changes in people’s physical wellbeing and seek professional advice in a timely manner. Relatives said they kept informed. One relative said, “Know him excellently and premeditate what’s happening, they are brilliant.”

Another relative said, “Line of communication refreshing, we are told of everything we need to know about [name of person] - can’t say any problems. Openness between the CEO of Kind Tailored care to staff and us, open and honest, great deal of discussion how we can improve things although all well for [name of person]. If you keep talking and discuss keep things going and improve things, it’s like a family there.”

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

People were supported to apply for funding to adapt and decorate their home to meet their needs. People’s homes had been decorated in line with their choices and preferences. Staff had access to 24 hours on call support and supported people to raise maintenance concerns to their landlord.

Staff were aware they were working in people’s homes and were respectful of people’s choices and control over their home.

Staff would benefit from records on the support people required to meet their housing needs and to ensure their housing rights are respected and maintained in line with national guidance around ‘Supported Living’ tenancies.

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.

Staff had received training to effectively support people’s individual needs. Staff had been trained in a national positive behaviour support programme to assist people with complex care and behavioural needs to lead an active and fulfilling life in the community. This approach helps staff in identifying and preventing triggers, implement early intervention whilst developing trusting relationships with people. People and staff benefited from the skills of the registered manager who was a qualified instructor in this approach and was a member of the Restraint Reduction Network (RRN).

Staff said they felt trained well and received regular support and supervision to enable them to safely meet people’s individual needs. Inductions for new staff consisted of training and support from managers and their colleagues on site until the staff member felt confident in supporting people. One staff member said, “It is welcoming environment and there is always someone to help. They do supervisions as I am quite new. I have had them every 3 months. If I feel that there is something to bring up. I always feel that I am able to phone the manager.”

Relatives praised the skills and training of staff and told us they felt staff were suitably trained.

Safe recruitment systems were in place. Recruitment records reviewed during the inspection included Disclosure and Barring Service (DBS) checks and evidence of employment references.

Whilst we found no impact on people, we identified a few gaps in the checking of staff’s previous employment history that hadn’t been addressed in line with the provider’s policy, This was raised with the provider’s representative responsible for recruitment, who agreed to take corrective measures moving forward.

The provider assessed and managed the risk of infection. They detected and controlled the risk of infection spreading.

Staff had access to and wore personal protective equipment (PPE) when supporting people with their personal hygiene and carrying out cleaning and waste disposal tasks. Staff had been trained in infection prevention and control and there was an infection control policy in place to follow to help prevent the spread of infection and manage outbreaks. Staff told us they supported people to maintain and clean their homes.

Infection control audits were completed regularly to check that good infection practices were being maintained and in line with the provider’s policy including hand washing and use of PPE. However, the audits did not include whether people had been effectively supported to maintain their homes and raise any concerns with their landlords. However, the registered manager regularly visited people and carried out spot checks to ensure standards were maintained.

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.

Medicines administration records were accurate and kept up to date. Protocols were in place to support staff to use “PRN” or “when required” medicines, such as painkillers, and ensure people received their medicines as prescribed.

Care plans reflected people’s individual needs in relation to their medicines. However, for one person prescribed a high-risk medicine, no risk assessment was in place to support staff to manage the risks associated with this medicine. Staff supported people to receive their annual medicine reviews.

Staff completed mandatory medicines management training and annual assessments were completed to ensure they remained competent. A system of medicines audits was in place at the home which supported continuous improvement. A system was in place to report medicines related incidents and foster a learning culture. We saw that learning from previous incidents had resulted in changes to practice in a person’s home.

People’s relatives confirmed people’s medicines were managed safely and in line with ‘Stopping over medication of people with a learning disability, autism or both with psychotropic medicines’ (STOMP) principles. They said the service advocated the monitoring and reduction of unnecessary medicines.