Broughton House and College

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 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There were systems in place to report, review and discuss incidents. Staff described an open culture where concerns could be raised with managers and felt able to contribute to discussions regarding people's care and support. Staff were generally positive about the support available from leaders and described incidents being discussed through meetings, debriefs and review processes.

However, incident records did not consistently demonstrate how learning from incidents had been fully analysed, embedded and evaluated. Whilst incidents were reviewed and immediate actions were generally recorded, it was not always clear how the effectiveness of those actions had been assessed or how learning had informed wider improvements in people’s support and staff practice.

Staff generally described incidents being discussed and reviewed. However, some staff felt feedback and learning following incidents was not always shared consistently. This reduced assurance that lessons learned were routinely communicated across the staff team and used to strengthen practice. The provider had recognised these areas for improvement and was taking action to strengthen incident review, learning and oversight.

There were systems in place to support continuity of care and partnership working. Detailed pre-admission assessments were completed, and people had access to a range of specialist professionals including speech and language therapy and psychiatry.

Staff described working alongside specialist professionals when people's needs changed and referrals were made when additional support was required. Recommendations from professionals were incorporated into care planning and support arrangements.

Feedback from relatives, staff and professionals was positive regarding communication, responsiveness and collaborative working. Information was shared to support continuity of care, including when people accessed healthcare services and specialist support.

There were safeguarding systems in place, including safeguarding training, reporting processes and routes for staff to raise concerns. Safeguarding information and speaking up resources were available throughout the service.

Staff demonstrated a good understanding of safeguarding responsibilities, knew how to recognise and report concerns and described an open culture where concerns could be raised and acted upon. Feedback from relatives was positive regarding people's safety and the actions taken when concerns arose. Staff were able to describe safeguarding processes and provide examples of how concerns had been recognised, escalated and responded to in practice, providing assurance that safeguarding principles were understood and applied within the service.

There were person-centred approaches to mental capacity assessments, best-interest decision making and Deprivation of Liberty Safeguards (DoLS) processes. Where restrictions on people's liberty had been identified, appropriate DoLS applications had been made and authorisations were sought in line with legal requirements. Communication tools and accessible approaches were used to support people's involvement in decisions affecting their lives.

There were detailed risk assessments and individualised support strategies in place. Staff demonstrated a good understanding of people's individual risks and support needs. Relatives were positive about how risks relating to epilepsy, choking, allergies and community access were managed, and described staff as knowledgeable and consistent in their approach.

Risk management arrangements generally reflected people's individual needs and included guidance to support staff to respond consistently.

However, incident reviews did not consistently demonstrate how information relating to distress, risk events and known triggers was used to review support approaches and ensure they remained appropriate to people's current needs. It was not always clear whether the underlying causes of distress had been fully explored, or whether existing support arrangements continued to represent the most effective options for the individual. Further consideration was needed to ensure support approaches were routinely reviewed and adapted to reduce foreseeable distress and promote people's safety and wellbeing.

The environment was clean, homely and well maintained. People had access to personalised bedrooms, communal living areas and kitchen facilities that supported everyday living and independence. Relatives were positive about the environment and described it as safe, clean and appropriate for the people living there.

Staff demonstrated a good understanding of individual environmental risks and the measures in place to support people safely. Communication resources and risk management arrangements were available where required to support people's health, wellbeing and safety.

Staffing levels were sufficient to meet people's needs and relatives consistently described continuity of care, with people being supported by staff who knew them well and understood their individual needs, routines and risks. Staff demonstrated a good understanding of the people they supported.

Staff spoke positively about the training, support and development opportunities available to them and described managers as visible, approachable and supportive. Recruitment records reviewed contained the required pre-employment checks, including references, background checks, right to work documentation and employment history.

Infection prevention and control (IPC) arrangements were in place. The environment was clean and hygienic, with cleaning schedules, environmental audits and monitoring processes in place to support good standards of cleanliness. Relatives were positive about the cleanliness of the home.

Staff completed IPC training and competency checks, including hand hygiene and the use of personal protective equipment (PPE). PPE was readily available throughout the home and staff demonstrated an understanding of infection prevention and control responsibilities.

People received their medicines safely and in a timely manner. Medicines were stored securely, administered as prescribed and subject to regular audit and oversight. Staff received medicines training and competency assessments, and clear guidance was in place for medicines prescribed on a “when required” basis.

Regular medicines reviews were completed with involvement from healthcare professionals. The service demonstrated consideration of STOMP principles (Stopping Over-Medication of People with a Learning Disability, Autism or Both). Medicines prescribed to support people's emotional wellbeing or distress were reviewed regularly to help ensure they remained appropriate to people's needs.