UBU - Harrogate

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.

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.

The management team reviewed all safeguarding, accident and incident records to identify any responsive action required. Any lessons learned were shared with the team and discussed in management governance meetings and local staff team meetings. Staff provided examples of improvement areas they had discussed together and learned from. One told us, “They make sure people are held accountable for errors in a positive way and learn from it.” Action had been taken across the organisation to learn from significant events that had occurred.

We noted some incident records could be clearer and more detailed. The management team demonstrated knowledge of these incidents, and appropriate action had been taken, but clearer records would help ensure potential opportunities to learn from incidents were not missed. The registered managers agreed to continue monitoring the quality and consistency of incident records.

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 using the services and relatives were involved in developing their support plan prior to receiving a service. They received relevant information about the service, including a handbook, to help aid the transition. Staff worked with relevant healthcare partners if people accessed more than one service, and there was generally effective communication between partners.

People had a health action plan and a ‘hospital passport’ which ensured key information was available to hospital staff, should someone need to transfer into hospital.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff usually protected people’s right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. However, aspects of practice and recording could be improved.

Information about safeguarding procedures was available to staff and they received training in this area. Staff were aware of signs of potential abuse, and how to report any concerns. Most staff were very confident the management team would deal with any issues appropriately and people and relatives told us they could report any concerns to the management team. The registered manager kept a record of any safeguarding concerns and action taken to ensure people’s safety and wellbeing, but some of these records could be clearer to ensure more effective oversight.

The provider usually referred any safeguarding concerns quickly and appropriately, although there was a slight delay with the reporting of a concern at one location. This investigation was still ongoing at the time of our assessment, and we will follow this up outside of the assessment process.

The provider had a system to monitor that any physical interventions used by staff were safe and appropriate. Physical interventions were rarely required, and we found several examples where staff had worked very positively with people over a period of time to reduce the need for any physical interventions or restraint. The registered manager and the provider’s specialist lead in this area reviewed all incidents where any physical interventions were used, to ensure appropriate responsive action was taken. Some records in relation to post-incident monitoring and staff de-briefs could be more detailed, and the provider was taking action to address this.

Staff received training related to the Mental Capacity Act (MCA). Where people were subject to restrictions the provider worked with the local authority to ensure appropriate authorisations were in place. The provider was aware of recent changes to legal requirements and had reviewed any impact for people. At the start of our assessment, the provider’s organisational register was not up to date in relation to people who had restrictions to their liberty authorised by the Court of Protection. The provider updated this register promptly, to ensure there was improved oversight of this area.

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.

Staff assessed risk relating to people’s individual needs, such as skin integrity, nutrition and choking, and any health conditions like diabetes or epilepsy. People, and their relatives where appropriate, were involved in the development of support plans to help manage any identified risks. These assessments and support plans were kept under regular review. The provider added some additional detail into two people’s epilepsy support plans, following our feedback.

One relative told us staff were “person centred and proactive” in relation to managing risk. They also described staff as, “Brave as well, they make their plans and try and sometimes it works.” They told us their loved one’s “world is bigger now” as a result.

Staff were very knowledgeable about how to support people with any known risks, and they knew how to access any information they needed. There was also an on-call system so staff could seek advice when needed.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People lived in clean, safe and personalised homes which reflected their individual preferences and needs. Staff completed regular health and safety checks and reported any required repairs to the landlord of the property. Repairs were usually actioned promptly. Properties we visited were generally well maintained.

One person spoke positively about their living environment and told us, "I'm happy living in my home. It's a nice home." Other people were proud to show us round their homes and told us how they had been involved in choosing their décor and developing their gardens, for instance.Future improvements had also been planned at some properties, including the development of a sensory garden at one location. People had been involved in discussions regarding the design and appearance of this area.

The provider took action to ensure appropriate instructions were available to staff in relation to pressure relieving equipment at one home, following our feedback.

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

Safe recruitment procedures were followed and the provider completed appropriate pre-employment checks. People were involved in the process of recruiting staff, where they wished to be.

Staff completed an induction and shadowed experienced staff when they started working for the organisation. They completed a comprehensive range of training, and this was regularly refreshed. The provider was in the process of ensuring all staff had completed relevant training in line with the new mandatory training requirements for support of people with a learning disability and autism. Staff also had regular supervision, competence checks and annual appraisals. Staff were satisfied with the induction, training and supervision they received. One told us, “It's super helpful training” and another said their regular supervision meetings were, “really beneficial as they have goals which work for me.”

The provider monitored that there were enough staff available to meet people’s needs and ensure they fulfilled any contractual requirements in relation to people’s individual support hours. In some areas, recruitment was more of a challenge, but the provider had worked to address this. In the main, people and relatives felt staffing was usually consistent. People confirmed staff were available to support them when they needed it. Relatives also spoke positively about the skills of staff.

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.

The provider had appropriate infection prevention and control policies and procedures, and staff completed training in this area. Staff had access to personal protective equipment (PPE) and knew when and how to use this.

Staff modelled good hygiene practices and worked alongside people, providing encouragement and practical support to help them maintain their homes to a good standard of cleanliness.

Systems were in place to make sure people’s medicines were administered safely. Stock balanced with records and medicine administration records were mostly completed. However, we saw some confusion when recording non-administration codes and handwritten records were not always clear. Medication lists were stored in different documents, and they did not always match.

People were prescribed medicines to be taken on a ‘when required’ basis or with a variable dose. For some people information for how these medicines should be administered needed further person-centred detail. Information on why medicines were given and if they were effective should also be recorded. Guidance was available for creams applied by staff as part of personal care; however, records were not always fully completed.

Policies and procedures were in place to support the administration of medicines. Where we found issues, these had not been picked up by the provider’s audits. The provider made improvements at individual support locations as the result of our feedback. These needed to be embedded in practice.

Staff ensured people's behaviour was not controlled by excessive and inappropriate use of medicines.