Cumbria Supported Living

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 78 (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. Where incidents occurred, these were logged as ‘events’, investigated by senior staff and learning identified to prevent recurrence and improve practice. Lessons were shared with staff at ‘huddles’, and meetings to share learning and best practice.

Staff knew people well and were able to identify early signs of distress or triggers which might lead to unwanted outcomes. This allowed staff to respond proportionately and in a timely manner to reduce the need for restrictive interventions, offer support and promote emotional wellbeing.

Reporting systems and referral pathways were in place, and staff demonstrated a clear understanding of when and how to notify partners of untoward events.

The provider always worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored.

The provider had an extremely effective transition procedure into the service. Staff spent a bespoke period of time with people in familiar settings, prior to any introduction to the service, to get to know them and their families, lay foundations of trust and develop relationships. This collaborative process could often take weeks and months to allow staff to assess risks, understand needs and develop safe systems for transition into the service.

The registered manager explained how “one size does not fit all” for the safe transition of people into the service and how they ensured each person had their own plan to successfully and safely integrate into their new home.

One family member told us, “They were in such a bad place after a horrible experience. Staff spent a lot of time to get to know them, worked so hard to regain their trust and support them to settle into the service. They have made such a difference.”

This was supported by a healthcare professional who reported, “[They] had a particularly bad experience and were absolutely lost. They had been badly let down. Staff were nothing short of brilliant in supporting them through this transition to give them back their confidence and a new lease of life.”

The provider worked with people, families and health and social care partners to maintain safe systems to ensure these continued to meet people’s needs. Staff prepared detailed personal information for people when moving between services to ensure they received the right support to safely meet their needs.

The provider worked with people, their families and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff supported people to live safely whilst protecting their rights to make independent decisions and engage in positive risk-taking and challenging activity.

Where safeguarding concerns arose, staff were aware of their responsibilities to support people, report to partners and take reasonable steps to understand how an incident occurred and implement measures to prevent recurrence.

It was clear during visits, people were comfortable engaging with and being in the presence of staff. Staff had taken time to really understand people and build strong trusting relationships to provide a safe and homely environment. Staff were able to intervene sensitively in situations which involved escalating and heightened behaviours, which helped to de-escalate concerns and prevent potential safeguarding incidents.

One family member told us, “They are absolutely in a safe place, I have full confidence in them and now don’t worry about her.”

Some people were subject to a deprivation of liberty authorised by the Court of Protection. These arrangements were clearly reflected in people’s care and support plans to ensure they were safe and protected from potential harm or abuse.

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.

Care plans showed evidence of risk assessments, risk mitigation strategies and discussions with people about care and support needs. Where people wanted to engage in positive risk-taking activity, staff supported them to do so. Where assessed risk was considered excessive or may put people at risk of harm or abuse, staff worked with people, their families and health and social partners to discuss alternative approaches or opportunities.

People took part in various external activities including attending football matches, playing contact sports, going on independent outings at home and abroad, using public transport, attending educational establishments and occupational opportunities where risk and safety were a consideration.

Staff approached risk management proactively to safely support people to engage in meaningful and fulfilling activity through enriched life experiences. Care and support plans detailed outcomes from positive risk-taking activity.

One person was proud to show off all the activities they had taken part in and explain how they really looked forward to their drink at the match.

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

Staff were respectful of people’s personal environment and how they wanted their homes to be. Where potential environmental risks were identified, these were discussed with people.

Transitional thoroughness allowed staff to uncover potential environmental triggers, ahead of admission into the service, which may cause distress to people. This allowed staff to prepare for and anticipate potential safety issues within their home.

People were actively involved in home and environmental safety discussions. At one location, people were involved in an environmental safety project to better recycle and dispose of waste. This gave people a sense of ownership and belonging by contributing to the local community and environment.

Personal Emergency Evacuation Plans were in place to support people to safely leave their home in the event of a fire or untoward event.

The provider made sure there were enough qualified, skilled and experienced staff to safely support people.

Recruitment checks were completed to ensure staff were fit and proper to work with people. There was a thorough induction programme including corporate welcome, requisite learning, meeting people, supervised shifts and competency checks. There was an effective programme of ‘You Can’ supervision and appraisals.

One staff member who was two weeks into the role told us, “The induction is very good. I am shadowing for four weeks to give me time to get to know people and them me – this has been really helpful. I’ve attended a lot of internal and external training – it’s very good, more detailed and specialised to what I’ve done before.”

One family member observed, “Staff are well trained and patient. They know people well and can adapt to everyone.”

In addition to core training, there was a learning and development programme called ‘GROW’. Staff also received bespoke training linked to the individual needs of the people they supported. This included training in autism, positive behaviour support and safe approaches to managing distress. This helped ensure staff had the right skills and confidence to support those people they cared for.

Staffing rotas were well managed to ensure people received safe and timely care and support in accordance with their needs. Some staff covered days and nights with sleep-in shifts which saw them work long periods on occasions. However, this was planned and monitored to ensure staff remained fit to work and people’s safety was not compromised.

Where agency staff were used, relevant checks and inductions were completed. There was an on-going and focused recruitment drive to strengthen care continuity across all locations.

Staff were trained in infection prevention and control (IPC) and assessed people’s individual infection risks which were recorded within their care and support plan. Staff sought assistance when they had concerns about a deterioration in a person’s condition which may be due to an infection.

Systems were in place to detect and control the spread of infection, and the communal environment was clean and well maintained. Staff supported people to carry out housekeeping tasks and dispose of waste appropriately to keep their homes clean and well maintained. This promoted ownership, responsibility and independence.

People took a pride in their environment and during visits were keen to show-off their homes.

The provider ensured that medicines and treatments were safe and aligned to people’s needs, capacities and preferences.

During the visit, some shortfalls with medicines recording were identified and shared with the registered manager. These were not related to any harm or missed medication and were immediately addressed. This responsive approach supported safe medicines management and demonstrated a commitment to continuous improvement.

The service adopted the principles from STOMP (Stopping Over-Medication of People with a Learning Disability, Autism or Both) initiative. Staff had worked with people and their healthcare team to reduce reliance on ‘as required’ medication and had seen some positive outcomes. By carefully stopping medicines and using positive strategies to support behaviour, staff were able to respond to people’s needs, reduce distress and avoid the need for medication whenever possible.

A healthcare professional reported, “Progress has been nothing short of brilliant – from frequent restraints in hospital, this is now few and far between and there has been a significant reduction in PRN (as required medication).”

The provider conducted medicine audits to ensure safety, reinforce best practice and monitor outcomes for people.