Tony Long 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 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 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, 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.

Relatives told us the service was responsive to concerns about safety and took these seriously. Staff explained that learning from incidents was regularly shared during team meetings and supervision sessions, and we saw evidence to support this. For example, we saw evidence of scenario-based case studies being completed with staff to support their learning, particularly in managing situations where people may become anxious. These discussions explored both good and poor practice, the impact on individuals, and the positive outcomes that could be achieved. This approach enabled staff to reflect on their responses and consider how their actions could influence outcomes for people.

Effective systems were in place to ensure all incidents and accidents were clearly recorded, detailing what had occurred and the actions taken. A professional who works closely with the service told us, “Staff escalate appropriately any concerns, and the response and communication is now good. If safety issues are raised, we work together and involve others if needed to investigate and take appropriate action.”

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 and their relatives told us transitions into the service were positive. One person said, “I came from the hospital, it all went ok.” We observed good practice when staff were supporting people to transition into the service. Staff supported existing people living in the service to welcome new people, encouraging inclusive discussions about how they could help individuals feel settled. A carer who supported a person’s move told us they felt reassured by the approach of staff and leaders, particularly given the emotional nature of the transition.

Staff told us they received information about people when their needs changed or if a new person started living at the service. The registered manager told us there had been an extended vacancy at the service, as they prioritised ensuring any new admission was the right fit for both the individual and those already living at the service. This demonstrated a thoughtful approach in line with ‘Right support, right care, right culture’ guidance.

People were supported to develop hospital passports, ensuring important information about their needs and preferences could be clearly communicated with healthcare professionals when required.

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.

People told us they felt safe living at the service, and we observed they appeared relaxed and comfortable in the presence of staff. Relatives also told us they were confident people who lived at the service were safe.

Staff had received training in safeguarding and the Mental Capacity Act (MCA) and were able to clearly describe their responsibilities in protecting people from harm. They demonstrated a good understanding of MCA and how this applied to their practice.

The registered manager had completed enhanced safeguarding training. They told us they intended to share key learning from this training with staff to further strengthen their knowledge and practice.

Effective systems were available to ensure safeguarding concerns were appropriately recognised and referred to the relevant authorities for investigation.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that the provider was able to identify when people were potentially being deprived of their liberty, complied with the basic principles of the Act, and made applications and urgent authorisations in a timely manner.

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.

Relatives told us risks were managed effectively at the service, and they were involved in discussions when any changes occurred. People were supported to develop clear and detailed positive behaviour support plans, which guided staff on how to provide appropriate support when individuals were feeling anxious or distressed. These plans had been developed in collaboration with professionals and relatives to ensure a consistent and personalised approach.

Staff demonstrated a good understanding of the risks people faced and how to support them safely. Risk management plans were regularly reviewed and updated in response to changes in people’s needs, ensuring staff remained informed. Staff told us communication about any changes was timely and effective. An electronic support planning system was used to share updates and alert staff to changes in risks.

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

The accommodation was set out on the ground floor, with a spacious layout that promoted people’s privacy and independence. Corridors and communal areas were clear of obstacles, supporting safe movement throughout the service. A range of health and safety checks were carried out regularly to ensure the premises and equipment remained safe. The provider used external contractors to complete essential servicing and compliance checks. Staff demonstrated an understanding of fire safety procedures, including what action to take in the event of an emergency. The business continuity plan identified what to do in an emergency.

The provider ensured there were enough suitably qualified, skilled and experienced staff to meet people’s needs. Staff received appropriate training, support, supervision and opportunities for development.

People and their relatives told us they felt there were enough staff available to support them. Staff said they had enough time to support people safely. When agency staff were required, the provider used consistent staff to maintain continuity of care. We also saw evidence that some agency staff had been successfully recruited into permanent roles within the service. Staff had accessed sufficient training to be effective in their roles, and this included specialist training to support people with a learning disability and autistic people.

All staff had up-to-date Disclosure and Barring Service (DBS) checks in place and 2 staff files we reviewed had recruitment records in line with legislation. However, we reviewed 1 staff member’s recruitment records which were not robust and we shared this with the registered manager. The registered manager told us all the records were not available because the staff member had worked for the service for several years and had transferred from another service when the provider took ownership of the business.

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.

Relatives told us they felt the service was clean and well maintained. Communal areas were clean and free from odours. People had access to their own bedrooms with en-suite bathrooms, which we found to be spacious and clean.

Staff had access to appropriate personal protective equipment (PPE), which we observed them using in line with current guidance. Staff had also received training in infection prevention and control (IPC), supporting their understanding of safe practices.

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 had access to their medicines in their rooms as required which was in line with Right support, right care and right culture guidance. Medicines were booked in appropriately and when we checked people’s stock, we saw people had the right amount according to records. There were no gaps in medicines administration records (MAR) and staff had receive training in medicines and completed competencies. There was an effective ordering of medicines systems in place. People had medicines support plans which clearly highlighted any allergies. Body maps showing the application of creams were available and risk assessments were in place for flammable based creams.

The provider was signed up to STOMP (Stopping over medication of people with a learning disability and autistic people). This is a national initiative to stop over prescribing of psychotropic medicines.

We identified that some ‘as required’ (PRN) protocols did not consistently provide clear guidance on dosage. For example, one person was prescribed a variable dose of Laxido, recorded as 1–2 sachets per day; however, the protocol did not clearly specify the circumstances in which 1 or 2 sachets should be administered. This lack of clear protocols could lead to inconsistent administration and increase the risk of the person receiving either too little or too much medication, which could impact the effectiveness of their treatment. However, we identified no harm had come to people. When we raised this with leaders, they took prompt action and rectified the protocols.