Salisbury Support 4 Autism

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 72 (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 promoted a learning culture, and improvements were made when things went wrong. The provider had systems for investigating and responding to incidents, accidents and complaints. People who used the service, relatives and staff were involved in investigations. One relative explained, “If there is an issue, they are really good at responding.” The provider apologised when things went wrong. People were given strategies and support to express themselves in a positive way. This helped reduce incidents.

Staff told us they discussed incidents with each other and their managers. They had regular meetings to learn together. The managers had good oversight of the service. They had systems to identify any trends and to make sure staff had the right support to understand about best practice. Records showed that staff were given additional training and information when needed. Comments from staff included, “We face challenges together, head on” and “The work can have challenges, but the team work well together to overcome these.”

The provider had systems for identifying and dealing with closed cultures. The provider’s operations lead told us they had responded to practice at another service when they had identified a potential closed culture. They had used the learning from this to support staff teams across the organisation to ensure they were open and transparent. They had provided information for all staff and people using the service (in an easy-to-read format) to help them understand about positive cultures and why these were important.

The provider supported people to have safe transitions between services. At the time of our assessment, 1 person was in the process of moving to the service. Staff had worked closely with the person, staff from the place they were currently residing, other professionals and the person to develop a person-centred plan for the transition. Staff had visited and supported the person in their previous setting. The person had visited and spent over night stays at the service. They had worked together to develop a support plan and to assess risks.

Relatives of people who were using the service told us the transitions had gone well, and people were happy and settled. Their comments included,"[Person] is more settled and happier now [at the service]”, “This is the longest placement [person] has had. This has worked because of the support [they] have received” and “The staff stayed in touch and spoke with me when [person] was moving in.”

People were supported to access external healthcare services. The staff developed easy to access information for other professionals. This helped to make sure these professionals knew and understood about people’s needs, particularly how they communicated and made choices.

People were supported to move on to new services when this was right for them. The staff helped make sure others who were involved in their future care knew and understood their needs.

The provider had procedures to help safeguard people from abuse. People living at the service felt safe. Their families felt they were safely cared for. Their comments included, “The staff know [person] well and [they are] definitely safe”, “The staff seem brilliant, and [person] is safe” and “Staff understand [person’s] needs and I feel [they are] safe there.”

There were procedures for responding to allegations of abuse. The staff understood these. They undertook training and had regular discussions with managers about recognising and reporting abuse. They demonstrated a good understanding about this. The provider had responded appropriately when there had been suspected abuse. They had worked with the local safeguarding authority and others to investigate concerns and protect people from harm.

The provider had requested legal authorisations where restrictions amounted to a deprivation of liberty for people who did not have the capacity to consent to these. Decisions around these were made in people’s best interests and for their safety.

The use of any form of restraint was closely monitored. There was clear guidance for staff on how to support people without using any medicines or physical restraint. Staff were trained to understand about safe physical interventions. They only used these as a last resort and in line with training and guidance. All incidents of restraint were investigated to make sure these were safe, appropriate and the least restrictive way to manage the situation in each instance.

The provider supported people to understand positive risk taking. The staff assessed the risks involved with different decisions and regarding people’s support, wellbeing and individual needs. Other professionals, people’s representatives and people were involved in discussions about these risks and together they planned strategies to help keep people safe. Risk assessments and management plans were person-centred and showed how people could be supported in the least restrictive ways. Some people led independent lives and were working towards greater independence. This was regularly reassessed to make sure people were safe.

Some people became anxious and could potentially cause harm to others or themselves.The provider employed specialist professionals who worked with the staff at the service to assess people’s individual needs. They involved people in managing risks and developed plans to help them express themselves in a positive way.Staff demonstrated a good understanding of how to deescalate situations to help people make positive choices. Any incidents were investigated and discussed with the specialist staff so that plans could be reviewed. Relatives told us they thought risks were well managed. Their comments included, “Staff understand [person’s] behaviours and calm [them] down quickly”, “They have a behavioural support specialist who helps staff to understand [person’s] needs” and “[Person] can sometimes get agitated. The specialist staff know how to support [them] and [they] are never restrained.”

The provider made sure people lived in a safe environment. The supported living properties were managed by a different company. However, the provider worked with the landlords to assess risks in the environment and to identify any improvements that were needed. People were able to personalise their homes. They had their own private rooms and communal spaces to relax. There was good signage and information for people to help them understand and orientate themselves within their homes. Risks relating to fire safety were assessed and planned for. The staff made sure equipment was regularly serviced and checked. Comments from people’s relatives included, “The house is safe and well maintained, there are no problems”, “[Person] has everything they need and the home is safe and clean” and “[Person] has a lovely living room, big bathroom and bedroom. There are also big communal spaces.”

The provider deployed enough staff to meet people’s needs and keep them safe. Staff, relatives and external professionals told us they thought staffing levels were appropriate. People were assigned an individual key member of staff who oversaw the coordination of their care. People knew the staff well and had good relationships with them. There was good staff retention. Comments from relatives included, “I think there are enough staff to support [person]” and “I would say there are enough staff. If anything, they are overstaffed.” A staff member told us, “I think there are enough staff on duty, and we are very supportive of one another.”

The provider worked with other professionals to assess people’s individual staffing needs. The staffing structure reflected these assessments. Some people needed individual staff support at home or when out of their homes for safety. This was appropriately managed, and the provider made sure staff supporting people were well matched to reflect people’s personalities and interests.

The provider had procedures to help make sure staff were suitable when recruited. They carried out interviews, undertook a range of checks and provided new staff with a thorough induction. Managers regularly assessed staff skills and competencies.

The staff were able to take regular breaks. They worked well together to plan and meet people’s needs. Staff told us they felt well supported. They completed comprehensive inductions, had their skills and knowledge assessed and had opportunities for supervision from managers. There was good communication between staff, and they provided a consistent approach which helped ensure good quality of care. Relative’s comments included, “I think the staff are well trained” and “As far as I know the staff are well trained. They certainly do a lot of training.”

The provider had procedures to help prevent and control infection. The staff undertook training about these. The staff followed schedules to help make sure the environments were clean and well maintained. They had supplies of Personal Protective Equipment (PPE) to use when needed. People using the service were involved in helping to keep their homes clean and manage their own laundry. The staff supported people when needed. They carried out regular checks and audits to help maintain cleanliness. People and staff were given information about managing infections, including information about good hand hygiene, vaccinations for seasonal illnesses and good kitchen hygiene. One relative told us, “[Person’s] home is lovely and clean.”

The provider made sure people received their medicines safely and as prescribed. However, some of the systems for managing medicines were not being followed and this meant there was an increased risk of errors. For example, we found improvements were needed to some medicines records and storage arrangements. We discussed these with the staff, they made improvements and sent us evidence of these during the assessment.

People’s relatives told us they thought medicines were well managed. Their comments included, “[Person] sometimes comes home for overnight stays. The staff always explain about the medicines and make sure we know what to do”, “Staff support [person] effectively with medicines and make sure this is kept locked safe” and “[Person] has a lot of medicines, and I know this is safely managed, checked and recorded.”

The provider worked with people using the service, their families and other professionals to monitor whether they were prescribed the right medicines. This included working with others to follow the STOMP (stopping overmedication of people with a learning disability, autism or both) principles.

People were supported to manage their own medicines if they were able and wanted to. The staff assessed the risks relating to this and helped promote people’s independence when possible.

The staff undertook training to understand about safe medicines management. The provider regularly assessed their knowledge about medicines and competencies relating to this. The provider responded appropriately when they identified medicines errors and following medicines incidents. They investigated these and supported staff to understand what went wrong and learn from these.

There were audits of medicines management which had helped to identify when improvements were needed.