Style Acre

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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. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were generally 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. Where we found in daily notes that one person had sustained potentially unexplained bruising, staff had recorded the bruising on electronic care planning system body maps at the time and told us they knew how the bruising was sustained. However, the local authority had not been informed to ensure this was investigated appropriately. When we made the provider aware, they immediately addressed this by notifying the relevant partners. All other potential unexplained injuries were investigated, lessons for continuous learning shared amongst the staff team and shared with the relevant agencies. We have reported further on this in the well-led section of this report.

In other instances, the provider took steps to ensure relevant parties were notified as part of their duty of candour. The duty of candour requires registered providers and registered managers (known as ‘registered persons’) to act in an open and transparent way with people receiving care or treatment from them. We saw examples of duty of candour letters in different formats, such as easy read, to suit people’s preferred communication method.

Recorded accidents and incidents were analysed and action taken to reduce the risk of them happening again. The analysis was shared with service managers to look at lessons which could be learnt on a wider organisational level. We found staff were aware of incidents and accidents which had occurred, and these were regularly discussed in team meetings. For example, minutes to team meetings included discussions on recent incidents and how these could be reduced. One member of staff told us, “We talk about the incidents in the team meetings [and] if you don’t go, they will give you the notes.”

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 or left. People’s moves between services were carefully planned and steps were taken to ensure that any discomfort was minimised. People’s views were considered by staff prior to making referrals and we saw people were involved throughout the process.

The provider worked with people and partners to understand what being safe meant to them and the best way to achieve that. The provider generally shared concerns quickly and appropriately with the relevant agencies and people’s relatives. However, we identified potential opportunities to learn from incidents could have been missed. These were reported using the internal reporting systems but were not shared with the local authority. When we informed the provider, they took immediate steps to report these to the relevant authorities and implemented an improved reporting system to ensure any bruising would be reported externally. All other incidents we reviewed were reported to the local authority and included recording logs and minutes of meetings held with the local authority. We have reported on this further in the well-led section of this report.

Staff had undertaken training in relation to safeguarding and there were policies and processes in place to report concerns. Staff understood their responsibilities in relation to safeguarding people and knew how to recognise the signs of potential abuse including the steps they should take to report these. One member of staff told us, “They have a safeguarding policy in the company. First, I should inform my manager and then maybe if I am not happy with the way it’s been handled then we have a dedicated line. In case I am not happy with the outcome then I can go to the council. It’s my responsibility to make sure the people are safe.”

People’s care records contained relevant information in relation to people’s mental capacity about specific decisions. Where restrictions were in place, these were implemented in line with the mental capacity act, regularly reviewed and adjusted with the input of people, their relatives and the local council. Staff understood people’s capacity to make decisions about their care and support and used people’s preferred method of communication to enable people to be involved in decisions.

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. This meant people were able to take risks in order to improve their quality of life. People told us how staff supported them to stay safe, including on social media. A relative commented, “[Person] has developed epilepsy, and the staff understand [person’s] condition.”

Staff were knowledgeable about risks in relation to people’s care, how certain health conditions could increase risks, and they told us managers ensured they had enough time to read and understand people’s risk assessments. One member of staff told us, “[Manager] tells you, you have to read the support plan. [Manager] checks that you understand it.”

People’s care records included assessing risks in relation to people’s care and were completed with people’s, their relatives’ and healthcare professionals’ input. Risk assessments included detailed information on the specific risks and how best to support the person to reduce these.

The provider managed environmental risks. They made sure equipment, facilities and technology supported the delivery of safe care. A relative told us, “I feel very safe and comfortable [person] being here. I know [person] is safe.”

Staff had undertaken health and safety training, supported people to carry out regular checks of the premises, and knew how to escalate concerns in relation to maintenance. The systems in place meant these were addressed in a timely way. Staff had completed fire training and risk assessments for people which took into account other risk factors such as smoking and portable heaters. We observed premises were free from potential trip hazards and tailored to meet people’s needs.

Staff had received regular supervisions and training including specific training to support people with a learning disability and/or autistic people. However, we identified instances where people lived with rare health conditions which could impact on their day-to-day life and the provider had not ensured that staff were provided with adequate training. The impact on people was minimal because all staff involved in their care told us they proactively researched the conditions and understood how these affected people’s lives. The provider immediately updated CQC on the actions they had taken and the additional systems in place.

People told us there were sufficient staff to meet their needs. We reviewed documentation which showed people’s one to one hours and shared hours were met. A relative told us, “Staff are well trained and look out for changes in [person’s] behaviour so they can support [person] in the most appropriate way. They are always proactive.” Where people had raised areas of improvement in relation to staffing, the provider took action to address these appropriately. For example, they ensured agency staff were provided with an induction and ensured agency staff read people’s care plans prior to providing support to people.

Staff were recruited safely to the service. This included requesting and receiving references from previous employers, identification checks and Disclosure and Barring Service (DBS) checks. DBS checks are carried out to confirm whether prospective new staff had a criminal record or were barred from working with people at the time.

The provider assessed and managed the risk of infection. There was an infection control policy in place and staff regularly supported people to clean their home. One person told us, “Have own bedroom, single bed, picked bedding and colour, have toys and picture frames. Staff support me to clean it.”

Staff detected and controlled the risk of infection spreading and shared concerns with appropriate agencies promptly. We found premises were clean and observed staff using appropriate personal protective equipment. Staff had clear roles and responsibilities in relation to infection prevention and control. The provider monitored the premises and there were systems in place to address maintenance issues which could prevent effective cleaning. Staff told us they always had sufficient personal protective equipment to complete tasks safely and reduce the risk of infection.

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.

People and their relatives told us they received their medicines as prescribed. One relative commented, “She has her medication in a [medicines monitored storage] box and prompted. Everything is recorded.”

Staff encouraged and empowered people to take their own medicines with their support and ensured people received their medicines as prescribed. One person told us, “Came here and [manager] said, ‘Do you want to try it on [your] own if I got one to one to do it with [staff member]’? so now I do it all on my own.”

Medicines were stored securely and safely. Care plans reflected people’s individual needs in relation to their medicines. We observed that people were supported by staff to take their medicines in line with their preferences which were recorded in their care plans. Staff completed mandatory medicines management training and annual assessments were completed to ensure they remained competent. One member of staff told us, “I had the training how to administer [relevant rescue medicines]. There’s a plan in place. You call for help always – 999 for further checks and document everything.”

We found there were protocols in place for ‘when required’ (PRN) medicines. PRN protocols provided staff with sufficient information to use these medicines appropriately. Staff understood the principles of the stopping overmedication of people with a learning disability (STOMP) framework and we saw them following these. Topical medicines (those applied to the skin) were recorded in records and there were body maps to support staff on where and how to apply these.