Pathway House

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 Requires improvement. At this inspection the rating has changed to Good. This meant people were safe and protected from avoidable harm.

People were safe using the service. Staff were trained in safeguarding and knew how to report concerns if necessary. There were enough suitably trained and competent staff to support people. Risks to people were assessed and mitigated as far as possible and people were supported safely with their medicines. Staff supported people to take positive risks and knew how to support people when they were upset or anxious. The environment at the service was safe and staff followed good IPC procedures to help keep the service clean.

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. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. When incidents and accidents happened, these were reviewed and discussed with the staff team so any improvements could be implemented. The management team had several audits they used to monitor improvements and help make sure actions were being taken to improve the experience for people using the service. Staff adapted their practice when supporting people based on learning from incidents and accidents. For example, if people had more incidents at a certain time of day, staff would look at potential reasons for this and adapt their support accordingly. One relative said, ‘‘There have been some challenging times, but the staff continue to turn it around and do what is best for [family member].’’

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. Staff contacted professionals such as GP’s or psychologists, if people needed support. If professionals gave advice that needed to be followed, this was recorded and staff followed this. The management team made sure any changes to people’s support after visiting other services were clearly recorded and shared with the staff team. One relative told us, ‘‘[Family member] sees [health professionals] whenever they need to, and the staff let us know how things are going.’’

People and their relatives told us they/ their family member was safe living at the service. Staff were trained in safeguarding and knew what signs may indicate potential abuse and how to report concerns to external partners such as the local authority or CQC. Safeguarding concerns were reported, and any actions were taken seriously by the management and staff team. People showed us how safe they were feeling through their interactions with the staff team and by showing signs they were happy, as they went about their day. One person told us, ‘‘I’ve been here a little while now and I always feel safe.’’

People had detailed care plans and risk assessments in place to guide staff in supporting them and mitigating risks as far as possible. Staff were knowledgeable about the risks people faced and how to support them to be safe. Staff understood the importance of supporting people to mitigate risks, whilst still being able to live their lives how they wanted. People were supported to take ‘positive risks’. For example, people were supported to access the local community and take part in their preferred interests and past times. There was a risk that people would become overstimulated and upset or anxious in the community, due to their support needs. However, staff still supported people to do what they wanted, when they wanted, whilst mitigating risks as far as possible. One person returned from an activity and was visibly very happy and relaxed. A relative said, ‘‘[Family member] is out and about all the time now and staff keep them safe whilst doing this.’’

The provider took action to deal with potential risks in people’s home environments. The environment was decorated according to people’s preferences and looked homely. The environment and any equipment people needed to use was safe. Staff completed checks to make sure this was the case, and these checks were audited regularly. One person said, ‘‘I like my bedroom.’’ A relative said, ‘‘There has been a real improvement in the environment at the service and it looks really nice now.’’

There were enough staff to support people safely. People had the correct staffing level throughout the day. For example, people who needed 2 or 3 staff to support them in the community always had this available, so they could leave the service when they chose to. Staff told us there were enough staff to support people and people’s assessed staffing levels were adhered to at all times. Staff were very present at the service, always being on hand to support people at any given moment. One person was asking staff members who would be supporting them later on and staff showed them a pictorial board with staff pictures on. The person was visibly happy to know who would be supporting them.

Staff had the training they needed to support people and their competency to support people was checked after their training. Staff were knowledgeable about their training, particularly in relation to supporting autistic people and people living with learning disabilities. The provider recruited staff safely in line with legislation to help ensure they were suitable for their job roles. A relative said, ‘‘The staff know my [family member] well now and it has been settled for a little while.’’

The provider assessed and managed the risk of infection. Staff were trained in infection and prevention control (IPC) and told us they had the necessary equipment to keep the service clean. We observed the service to be visibly clean. Staff supported people to take part in cleaning some areas of the service if they chose to do so. Audits and checks were in place to monitor the cleanliness of the service and the effectiveness of the IPC measures in place.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. One person did not have any protocols in place to guide staff when to administer and support them with ‘as and when required’ (PRN) medicines. One person had been supported to start taking a PRN medicine on a regular basis with no recorded discussions, to make sure this was in their best interests with a relevant health professional. The registered manager told us they would address these issues. Staff were trained to safely administer people’s medicines and their competency to do this was regularly checked. The management team audited and had checks in place to make sure medicines were being administered safely. The staff and management team proactively worked with health professionals to reduce the use of medicines used to help support people when they were feeling anxious. Staff supported people with other techniques when they felt anxious, and this had a positive impact on people’s quality of life. One relative said, ‘‘I do not think [family member] takes half as much medicines as they used to (to help them feel better when they feel anxious).’’