Adult Pathways 1

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 people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to 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. Systems were in place to record, report, monitor and review accidents and incidents. Staff understood the process for reporting and recording events which occurred. Events were reviewed on a regular basis by the registered manager and the provider. This enabled them to analyse trends, identify any lessons learnt and work with people and staff to identify why events had happened, and how to avoid situations in the future.

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. Families felt well informed of any changes in care. One told us, “I live a long way away, but I do rest easy. I do get phone calls in middle of night if something is wrong. They do that because I asked them to, I do know what is going on.”

The provider was making significant changes to the living environment across the campus, and some people were planning to move into new accommodation. This redesign was based upon the needs of individuals and, once finished would provide bespoke layout and facilities.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Systems were in place to protect people from the risk of abuse. Staff received training and understood the actions they must take if they felt someone was being harmed or abused. The provider shared concerns quickly and appropriately. Referrals had been made to the local authority safeguarding team when abuse had been suspected, and investigations had been completed. Information was available explaining how people could raise concerns if they felt someone was being abused. This was available in pictorial and easy read formats for people who needed this.

Some people were unable to consent to the care they received and were being deprived of their liberty through the deprivation of liberty safeguards (DoLS) framework. We reviewed the systems in place to ensure such restrictions were lawfully authorised and found all authorised restrictions were appropriately assessed and accurately reflected in peoples care plans. The provider was committed to reducing and restrictions placed on people. The providers Positive Behaviour Support (PBS) lead told us about work they were doing to implement this commitment and explained work was ongoing to develop staff skills and knowledge in this area of people’s support.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. We identified some shortfalls in the accuracy of risk assessments and care plans. For example, the provider used an electronic care plan system which had a separate section where important documents such as detailed epilepsy and PBS plans were stored. For some people, this information was not incorporated into people’s daily routines and staff were instructed to read the separate document. We found this confusing and created the risk of conflicting information being created. We fed this back to the registered manager. Immediate improvements were made to one person’s plan where this had resulted in a discrepancy. Improvements were made to another person’s plan where the daily routines lacked important information about preferences in care.

We were assured however, staff supporting people were fully aware of the risks to people and how to support them safely. For example, one staff member sought assurances from one inspector to check they didn’t have any items on their person which could affect a person’s allergy before introducing them.

Family members told us they believed their loved ones received safe care and confirmed they were involved in the development and review of people’s risk assessments and care plans. One told us, “It is very secure and I can tell by [Name’s] behaviour they are settled and happy.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Routine checks on the environment and equipment were up to date, and certificates were in place to demonstrate this. Bedrooms had been decorated according to people’s wishes and preferences. One family member told us, “When [Name] first moved in, the family decorated their bedroom with personal things. The standard has been maintained. It is always lovely. Bright, clean, airy and they show respect for [Name’s] property.”

The provider made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. They worked together well to provide safe care that met people’s individual needs. There were robust and safe recruitment practices in place. Appropriate checks had been made before applicants were offered employment to ensure they were suitable and of good character.

People were encouraged and supported to be involved in the recruitment of staff, and their views were valued throughout this process. A family member told us, “They involve [Name] in everything, for example, new staff being interviewed.” The family member explained they had recently sat on the panel with their loved one. “[Name] always chooses the chair behind the desk, and they are fine with that. [Name] has a conversation as much as they can with the applicant. Such a wonderful thing!” Staff in senior positions confirmed they had been interviewed by people who used the service. The recruitment lead was passionate about people recruiting their own staff and described how people had helped to shape the recruitment process and there were plans to expand this.

Staff received a full and supportive induction. The provider had recently introduced a work-based mentor system. A mentor we spoke with explained their role was, “To see new staff through induction and support them, coach them with anything they need.” A new staff member told us, “It’s amazing, it’s an incredible place.”

Staff told us, and records confirmed they received training as well as observation of their practice which enabled them to perform their job to a high standard. Staff had an excellent knowledge of peoples care needs and demonstrated a high level of competency based on learning from the training and support they had received. People and their families were involved in the delivery of training. For example, people who used the service had developed an ‘In their shoes’ video which was shown to new staff to promote person centred practice. People were involved in delivering specialist training around their own needs, for example, epilepsy as well as learning disability and autism training. One person had been involved in delivering awareness training to healthcare professionals. A family member described how they were involved in the induction of new staff to ensure a deep understanding of their loved one’s complex health needs.

There were always enough staff on duty to ensure people received safe, good quality care which met their needs, as well as to ensure people led full and enriched lives through access a variety of activities. Many people always required staff with them throughout the day to maintain their safety. We observed these interactions were very respectful and very positive relationships had been formed. Family members told us, “The consistency of staff is very good, and they are well trained and really helpful” and “Those that work with [Name] know him really well and they put the right staff with him.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

There were some minor improvements in one building however, generally the service was cleaned to a high standard. Action was taken to address any shortfalls we identified. There was enough personal protective equipment (PPE) throughout the service for staff to use when needed.

The provider made sure medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people and their loved ones in planning, including when changes happened. Records of administration were maintained and in line with best practice. Guidance was in place for all prescribed medicines administered on an ‘as required’ basis. This helped staff to understand why certain medicines were prescribed; and under what circumstances they should be offered to a person. The effective use of ‘as required’ medicines was monitored and reviewed by the management team and professionals who worked with people. This ensured people were not at risk of being over medicated. Medicines were stored securely and only administered by staff who were suitably trained. Families were aware of the medicines their loves ones were prescribed and any changes. One family member said, “They keep me well informed.”