Affinity Trust Specialist Division South

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 requires improvement . At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm. The provider was previously in breach of the legal regulation in relation to risks to the safety and welfare of people. Improvements were found at this assessment, and the provider was no longer in breach of this regulation.

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.

The provider had a culture of learning and improvement however further development was needed to ensure improvement becomes part of everyday practice rather than something that happens in response to problems or incidents. Staff listened to concerns about safety and investigated and reported safety events but did not always pick up on early indicators that may have helped to avoid people’s distress escalating and incidents occurring. The provider had acknowledged this and was reflecting openly on incidents to identify where practice could improve and ensure changes made were sustainable over time. Systems and processes had been developed to track incidents and update people’s care plans with information about changes in people’s support needs. Staff confirmed opportunities were given to consult and debrief them after incidents to minimise the risk of reoccurrence. A staff member told us, “We now have de-briefing after every incident, and this supports staff. For example, it helps identify if staff need time away from a personand helps us to learn how to support people more effectively.”

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’s care and support requirements were assessed prior to the start of their care package to ensure the staff had the information they needed to safely support people and to understand people’s support preferences and individual risks. A relative explained “When [Name] moved in, we did some getting to know you with staff but they also understood [Name] needed to get to know them too.” The registered manager described how people were supported through a lengthy transition to the service. This involved staff meeting with health and social care professionals, reviewing care information and assessments and spending time with the person before they moved in, including overnight stays. This ensured a detailed record of people’s needs, risks and preferences and supported personalised care to enable a smoother transition.

The provider worked with people and healthcare partners 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 concerns quickly and appropriately.

All staff had completed safeguarding training appropriate to their role. Managers were aware of their responsibility to investigate and report safeguarding concerns to the relevant authorities and CQC. A safeguarding policy was in place that detailed the types of abuse and how to escalate concerns. Staff understood the importance of recognising and reporting any safeguarding incidents and were confident the managers would act on their concerns. A staff member told us, “The first thing I would do is make sure the person is safe. I would record any information, I'd go to my manager, but if I suspected the abuse included the manager I'd go to operations manager or on call. Outside of the organisation I would go to the Care Quality Commission." Staff demonstrated a good understanding of the legal restrictions people faced, for example being under constant supervision or authorised restraint to prevent the person harming themselves or others. Care plans included detailed guidance and protocols to ensure these were applied using the least restrictive approaches and these were understood by staff. A staff member told us, “We have used authorised [chemical restraint] a few times; that is more the extreme cases where [Name] is very agitated, and it is not very. Normally [Name] responds very well to staff interaction or space is given; 9/10 times giving space brings [Name] back down to baseline."

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.

Improvement had been made to the management of people’s care and associated risks. People’s risks had been identified and assessed. Risk management plans described the measures in place to reduce people’s risks and promote their safety, including managing people’s specific health conditions and supporting them when they became distressed. However, further work was needed to ensure the practice of looking beneath the surface of people’s actions andresponses, and testing information rather than accepting it at face value was fully embedded in staff approaches. We found some staff applied this mindset in their approach to supporting people when they became distressed and emotionally heightened. A staff member told us, “When challenges arise, the first thing is to give [Name] space. When they are becoming distressed, they present themselves and move in a certain way. They don’t like lots of people trying to talk to them. We try to find where the problem is coming from, whether it's the environment, whether they are in pain or if it's noise or over stimulus. I give space and let [Name] regulate a bit which works.” Other incident reports and risk assessments we reviewed evidenced some staff were not always using this approach which resulted in missed opportunities to fully mitigate risks. A staff member told us, “We are getting much better at reviewing our approaches and picking up on ‘silent cues’, but some staff are still resistant.” The registered manager was aware of this and working with staff to develop a more reflective and responsive culture.

The provider detected and controlled potential risks in people's homes and where people received support. Risk assessments were undertaken by the management team on people’s homes. Guidance was provided to staff on how risks were mitigated to ensure they and people who used the service were safe during care visits. Staff supported people to keep safe and to escalate concerns about their environment to the relevant agencies including landlords. They provided advocacy to enable people to understand their tenancy agreements in line with Reach Standards. The Reach Standards are a set of nine principles designed to ensure that individuals who have Down's syndrome, as well as others with learning disabilities and autistic people, live as equal citizens with the same rights, choices, and responsibilities as everyone else.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together to provide safe care that met people’s individual needs.

Improvement had been made in the induction, training and assessment of staff to support people safely. A relative told us, “Yes there is enough staff, they are good. They give time when [Name] needs it and are there to keep them safe.” Staff told us they felt trained and supported to carry out their role safely. New staff attended a structured induction and shadowing process and worked alongside experienced staff until they were assessed and signed off as confident and competent. Staff comments included, “The training is very good. Makaton (a language that combines hand gestures, symbols and speech) is definitely one I enjoy using and de-escalation with the least restrictions was very good training, and we receive this yearly” and “I am happier with the training now and we get refresher training which is important.” Staff told us they received regular support, including de-briefings and formal supervisions. Staff received training in infection, prevention and control and food hygiene to support good practice in this area. Safe recruitment practices were in place including pre-employment and right to work checks and checks with the Disclosure and Barring Service to ensure staff were of good character.

The provider assessed and managed the risk of infection. We received feedback from people and relatives who were satisfied with the infection control measures employed by the service. Daily care records showed regular cleaning being undertaken by staff as agreed in people’s care plans. Staff had access to personal protective equipment (PPE).

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 told us they were satisfied with the support they received with their medicines, when this was required. A person told us, “The staff support me to take my medicines and help me to take them on time. I am learning how to manage my own medicines; this is something I want to be independent with, and the staff are helping me.” People’s care plans included information on their medicines and any specific guidance to ensure staff administered these safely and as prescribed. These included medicines prescribed as and when required. Staff worked with health professionals to ensure people’s medicines were regularly reviewed and remained necessary and effective in line with STOMP (Stopping Over Medication of People with a learning disability, autism, or both). The provider had systems and processes for the safe management of medicines. Staff received appropriate training and had their competency to administer medication regularly checked by the management team. Regular medicines audits were undertaken by the managers. Where medication errors had occurred, actions had been taken and lessons learnt to reduce the risk of further errors.