Leaf Somerset

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. This is the first assessment for this service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 84 (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 strong proactive and positive culture of safety, based on openness and complete honesty. Staff actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice. Effective systems were in place to report and manage incidents, accidents and safeguarding concerns. Staff fully understood their responsibilities to report incidents in accurate detail. A staff member said, “In the form I explain everything.” Incidents, accidents and safeguarding concerns were always reviewed to ensure actions were taken to understand behaviours and reduce future incidents or risks. Regular reviews of safety data were conducted to look for patterns and trends. This included looking at any physical interventions or restrictive practices. This was completed with staffs’ involvement. Staff told us the provider considered the reasons behind why an incident or accident may have occurred. A staff member said, “I’ve worked in a lot [of organisations] and these are the most interested in the why. They do a lot of positive behaviour and look at different patterns.” Following this the provider ensured strategies were implemented or reviewed to reduce incidents. This had positive impacts for people as it enabled them to have a good quality of life and be engaged in activities of their choice. For example, incidents had reduced for 1 person who then could travel safely to enjoy a holiday. A staff member said, “I strongly believe they continue to look in to cause and concerns. They understand situations and put support in place, so situations don’t happen again.”

The provider demonstrated a commitment to safety through proactive learning and a "no-blame" reporting culture. A staff member described where learning had been shared through the organisation such as updated security checks for exits following a recent report. A staff member said, “We are offered debriefs at the end of an incident. They made it clear for us as support staff don’t be ashamed to put anything down as a behaviour, we can always learn.” Internal learning was complemented by regular information sharing with families and involved professionals. The provider’s quality assurance systems demonstrated effective oversight to ensure the best outcomes for people were achieved.

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, for example when people used a number of different services. Detailed transition plans were undertaken by the service when they began working with people. This was at a pace that suited them. The service had skilled staff who worked in the service who were able to support with transitions to other services if needed. The service worked with people’s wider multi-disciplinary team to ensure care and support was consistent. A relative described how transition for their family member had been challenging due to leaving a previous placement. However, they were now settled in their home.

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. Staff knew how to identify and report abuse. Staff confirmed they knew who the designated safeguarding lead was and understood the process for sharing concerns with them. A staff member said, “Any concerns you need to report to the manager.” Staff had received regular training in safeguarding children and adults. Staff’s understanding of safeguarding was checked and reflected upon within individual supervisions. Safeguarding concerns were reported as required to the local authority and Care Quality Commission (CQC). The provider maintained a clear and accurate overview of reported safeguarded concerns and actions taken. These actions included sharing of learning. A health and social care professional said, “Safeguarding concerns have been addressed promptly and professionally.” Where people had a community Deprivation of Liberty Safeguards (DoLS) authorised these were known and documented.

The provider always worked well with people to fully understand and manage risks by thinking holistically. Staff provided care that fully met people’s needs and was safe, supportive and enabled people to do the things that mattered to them. Individual risks were assessed and specific guidance detailed how staff should plan, manage and communicate for known risks. For example, travelling in a vehicle. Risk assessments were regularly reviewed and adjusted as risks changed. People had positive behaviour support plans to promote consistent staff approaches which enabled people to life their live as they chose. Positive risk taking was promoted to ensure care was person centred and people could engage in activities of their choice. For example, enjoying the local park, being involved in food preparation and social interaction with family members. The service involved people, family members and relevant professionals in agreeing and managing areas of risk. A health and social care professional said, “Incidents and risks are handled effectively and with a high level of professionalism.” The provider had specialist staff who assessed and reviewed risks, to coordinate and guide on positive behaviour approaches taken. A health and social care professional said, “They have supported a person successfully in all areas which has reduced the risks of self-neglect significantly.”

The provider ensured nationally accredited training supported staff when physical intervention was required as a last resort. This training was focused on recognising triggers for people, avoiding distress and using a range of strategies to deescalate any potential situations. Approaches were agreed with a multi-disciplinary team and family members. Any interventions were monitored and reviewed. The service always focused on minimising incidents and interventions. A family member said, “They keep [Name of person] safe, it is brilliant.” The provider had on-call system was available to support staff out of office hours. A staff member said, “The on-call system is amazing. At weekends they are there immediately. They are very good.” Personal emergency evacuation plans directed staff how to respond in an emergency situation. These clearly described how to communicate effectively with people in these circumstances.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Environmental risks had been identified and assessed. This included different locations where care may be delivered. For example, the persons home or in the community. Environmental risks were assessed and managed. For 1 person their garden area had been designed to meet their needs and support their well-being. A relative said, “[Name of person’s] home is decorated to a high standard.” A business continuity plan detailed procedures to follow in unforeseen circumstances, such as extreme weather.

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. Thorough recruitment procedures were followed including identity and disclosure and barring service (DBS) checks. References were sought for all previous positions held working in health and social care. Gaps in employment were verified and any area where further information was needed was sought. For example, when a date of employment did not match the application form. Recruitment procedures were value based and clear on the organisations aims. This was demonstrated through in depth interviews to ensure potential staff had the skills and experience to meet people’s individual needs. Positive feedback was provided from a health and social care professional who said, “Leaf Somerset demonstrates a high standard of staffing, with team members who are well-trained and competent in their roles.”

New staff were provided with a comprehensive induction programme, which was tailored to specific roles within the organisation. This included the organisations aims and ethos and how this was to be achieved in the care and support delivered. A staff member said, “The induction process was really good. Clear guidance and their values, what they expect of us and standards [of care].” Staff received regular supervision with a manager. Supervision was balanced around staff well-being, training and development. Staff received additional support and debriefing if any incidents had occurred. A staff member said, “They check our wellbeing, are we safe, they want to keep clients safe but check we are safe too.”

The provider’s training programme covered a wide range of topics through both face to face and remote training. This included supporting adults and children. Staff received training in mandatory areas and those specific to people’s needs. For example, epilepsy training. Staff had completed training in line with recommended guidance for meeting people’s needs with a learning disability and autism. Training focused on prevention of incidents and a compassionate approach.

Staff received training in restrictive intervention with a focus on restraint reduction, de-escalation and strategies to positively support people when in distress. Training compliance was high and continually monitored. Bespoke training was designed for specific people and conducted for staff members working with this person. This enabled the staff member to fully understand the persons needs and the individual approaches to support the person. A relative said, “[Name of person] has a small bespoke team providing consistent support, necessary for [Name of person] to feel safe.”

The service was focused on providing consistent staff for people. New staff were introduced in a planned way. We received positive feedback about staff. A comment gathered from a recent survey with relatives said, “Staff are caring, knowledgeable and calm.” Staff we spoke with knew people well. Staff were matched to care packages based on their skill set. Staff teams were reviewed and changes made if the relationship between the person and staff had not developed as planned. A health and social care professional said, “On rare occasions where individuals have not been a suitable fit, Leaf Somerset has acted promptly to make appropriate replacements.”

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. Staff received training in infection, prevention and control. Staff told us they had access to person protective equipment. A staff member said, “We have aprons and hand gloves and all that’s required for personal care.” Care plans gave directions in infection control. For example, how to clean equipment to reduce infection risks. People were supported in managing infection risks in their home. For example, staff supporting a person to manage their own laundry safely.

The provider made sure medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. The service managed and administered people’s medicines safely and as prescribed. Staff had received training in medicines administration and their competencies were assessed. A staff member said, “We had medication training before, and I’ve just had training again on teams.” The provider ensured recognised guidance such as, Stopping Over Medication of People with learning disabilities, autism or both (STOMP) was adhered with. People’s medicines were regularly reviewed. As required medicines were monitored for frequency of use and effectiveness. For example, 1 person had reduced their use of as required medicines over time with other strategies being used.