Agincare Enable Limited (Wiltshire and Swindon)

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 inspection we rated this key question good. At this inspection 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. Concerns were raised to the registered manager and these concerns were investigated.

Lessons were learnt to continually identify and embed good practice. Staff analysed audits and changed their ways of working with people. This meant that staff were able to learn to make things better for people.

Incidents and accidents were recorded and reviewed by the management team to ensure actions were implemented. We looked at several incidents and found the provider had provided support to people involved and a lessons learnt exercise had been completed. This ensured continuous improvement and development had occurred, including how staff could speak to a person to ensure they did not become anxious.

However, during our inspection, our presence unintentionally made one person anxious when they were undertaking a task they regularly do. We were not informed of the impact of our presence, which meant the person’s anxiety could have been avoided.

Learning from incidents was shared with all staff in team meetings to ensure they understood changes in the way they needed to support people. Staff shared best practice examples and good news stories in team meetings.

People and staff spoke to us about how they would raise concerns outside of the management team to help prevent the development of a closed culture. Staff knew who to contact in the event of any concerns.

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 were supported to review their own care plans and helped to write their hospital passports. Hospital passports ensure health care staff have a good understanding of the person’s needs to ensure continuity of care. We attended a “speak up” meeting where people were supported to raise any concerns. People were confident to share their views.

Care plan documents demonstrated people were put first and that the provider was thinking about how people would feel and what support they would need to move between homes. Staff spoke positively about recent transitions people had experienced since leaving their family home. People told us their move was “good”, “enabling” and they were “happy to live with their friends”.

The provider proactively looked at ways to enable and empower people and successfully worked with community businesses to support people into paid work. We saw risk assessments which had helped people to safely work at farms, cafes, shops and as cleaners. This meant people were supported fully when transitioning between venues.

The provider had a tracker in place for all Deprivation of Liberty (DoLS) applications and evidence showed they regularly reviewed this. Best interest decisions demonstrated they were the least restrictive option to support people safely.

The provider worked with people 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 safeguarding concerns quickly with the Local Authority. However, the provider did not always inform CQC of safeguarding referrals. During our inspection, they informed us of two instances of abuse that had not been raised as a notification to us. We asked the provider about this and the provider felt it was not necessary to inform us. We outlined that had they informed us, it would have demonstrated they had an awareness of guidance relating to autistic people.

People told us they felt safe in their home and staff helped them stay safe. Staff received training but out of the seven staff we spoke to, not all were able to assure us they understood what safeguarding meant. One member of staff informed us that they would speak to their manager. We looked at staff supervisions and found there to be a lack of safeguarding scenarios and actions taken. Within staff supervisions, despite there being a prompt to discuss safeguarding it was listed as ‘competent’ or ‘no new safeguarding concerns’.

People were supported to develop skills to stay safe in the community. One person told us they had helped write their risk assessment for accessing the community. There were easy read documents on how to speak up if people wished to discuss anything. Although the provider did not have guidance for people related to menopause and sexual relationships, staff had researched good practice and were able to support people with these subjects.

People were proud of their homes and wanted to show how they had personalised their spaces. Some people told us what being safe meant to them and spoke about safe relationships. People spoke about their housemates positively.

Staff and managers challenged other agencies when they felt it appropriate to do so. This meant when a person’s long-term medicine dosage was changed, the service manager was able to work in partnership with the local health team to review it immediately.

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’s health, safety and welfare had been assessed and action taken to manage those risks. Staff demonstrated a good understanding of the risks and ensured care plans were updated regularly with people when their needs changed. We viewed signed and dated changes and care plans were checked regularly and any changes noted immediately by the provider.

Regular meetings were held where a person’s progress and their outcomes were discussed. Outcomes were either signed off as complete or new outcomes discussed with people. One person was supported to visit their family who lived in another country. This was previously done by travelling by train. However, staff had worked with the person to grow in confidence travelling on their own to the extent that they spent less time traveling as they were now confident to fly overseas instead.

There were health implications about food for one person. This person helped write their own risk assessment and their housemates helped them to stay safe by agreeing to lock cupboards so that the person can remain safe from harm by not having access to foods which were unsafe for them. The person understood that other ways had been tried and supported by the provider but did not work. This meant consent was gained and least restrictive practices were explored and well thought out. The provider recognised this was the least restrictive practice.

The provider had also successfully worked with a person to reduce their support when they became anxious. This showed the provider’s commitment to supporting people in a less restrictive way and to reducing anxiety and the use of restraint.

The provider controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Communal areas in the service were free from obstructions. This meant in an emergency people could leave their homes easily.

The provider assessed people’s homes for risks and took action to ensure people, staff and visitors remained safe. During the inspection, we saw a ‘keep safe in the community’ session which was led by people who used the service. This was arranged as they wanted to develop “in case of emergency” identification cards.

The provider worked with landlords to ensure actions they were responsible for were logged. However, some issues were not completed in a timely way. We saw faulty window locks and gutters overflowing which the provider had not raised with the maintenance team This meant that some buildings were not safe. When we spoke to the provider about this, they took further action with the landlord to book a site visit to rectify this. Despite the delay in reporting the risk, people had not been put at risk.

Some outside areas required more than the agreed scheduled visits to cut grass and bushes. We saw long grass in some communal areas and areas which required strimming. We fed this back to the provider whose response was that there are fortnightly visits from the maintenance team for groundskeeping purposes.

There were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care that met people’s individual needs. When the provider identified there would be a gap in permanent staff providing care and support to people for example due to sickness, the provider had a good relationship with an agency who provided the same staff. This meant, where possible, people received continuity of care and support from staff they knew.

People and their relatives told us they felt there were enough staff to meet their needs, including support for them to attend the community activities they enjoyed.

Pre-employment checks had been completed for staff before starting work. New staff received an induction, including shadowing experienced staff. Staff told us they received regular training, supervision and an annual appraisal.

Staff told us there was always someone to talk to if they had any queries out of hours. They said there were always plenty of well-trained staff to support the service.

The provider assessed and managed the risk of infection and told us they would raise anything with appropriate agencies promptly. People told us staff supported them to keep their home clean.

Staff completed infection prevention and control (IPC) training and told us they had access to all the personal protective equipment they needed. We saw IPC audits had been completed and evidence of cleaning schedules in people’s homes which were being followed. Where possible, people were cleaning their rooms and helping in communal areas.

The provider made sure medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning their medicines support, including when changes happened. Staff and managers felt confident to challenge decisions of partnership organisations. Managers told us a person’s medication was changed. The change was trialled and the provider fed back to the prescriber that the change had not worked for the person.

People told us staff provided good support for them to take their medicines. Staff had completed training in the safe management of medicines and leaders regularly observed their practice, to ensure they were doing this safely. Some people had their medicines in their bedrooms and processes were in place to enable them to self-manage this.

Where some people lacked capacity to take their own medicines, records showed these medicines were stored in a central medicines store area within people’s homes. This had been risk assessed and capacity assessments were undertaken.

People were supported to have regular reviews of their medicines with their doctor. This ensured they were not prescribed more medicine than necessary. Any medicines errors were documented and raised in the appropriate way. All people had medicine risk assessments and guidelines in place. This ensured people were taking the right medicines at the right time. This was evidence by the medication administration record.