Disability Supported Accommodation Service North Network

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 service 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.

Systems for reporting and investigating incidents, such as safeguarding alerts were present and we found that safeguarding concerns had been identified and escalated by staff appropriately. There was timely communication with external agencies when referring such concerns and staff demonstrated a clear understanding of their responsibilities.

Complaints had been handled with transparency and respect and people supported by the service had been encouraged to express concerns in ways that suited their communication needs. Complaints were handled promptly and in line with their guidance.

The service recognised the importance of learning from incidents and complaints, however, systems used to monitor these did not consistently record outcomes or lessons learned. Records we reviewed did show appropriate action was taken by managers when dealing with incidents and accidents to keep people safe and a dedicated performance team had been established by the service to analyse trends. However, this was not fully embedded at the time of the assessment. As a result, analysis of trends and root causes lacked sufficient depth to drive meaningful change.
 

The service 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.

A comprehensive assessment of people's needs was completed by appropriate healthcare professionals, such as social workers and managers at the service, prior to admission. These assessments included relevant details about people’s health, communication, mobility, emotional well-being, and daily living skills. People, their relatives and representatives were involved in this process to ensure support plans also reflected their preferences, goals, and aspirations. Risk assessments were also completed, and where appropriate, people's capacity was assessed in accordance with the Mental Capacity Act.

The pre-assessment process had considered the needs of people with learning disabilities and developed specific guidance for staff to ease the transition of people into the service. This included considerations for gradual introduction and emotional support, where appropriate. The service had also developed, ‘placement profiles’, that enabled people to view the accommodation remotely, including its accessibility and adaptations, helping accommodate people’s needs and expectations along the journey.

The service also demonstrated good planning and coordination when people moved between settings. The service had embedded a process which increased staffing hours for new admissions and those re-admitted to the service following a stay in hospital. This process avoided unnecessary delays and ensured people had access to an increased level of support immediately.
 

The service 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 service shared concerns quickly and appropriately.

People and their families told us they felt safe when supported by staff at the service. One relative told us, "Since moving from a previous private run company, where (person) experienced a lot of traumas…. (person) really is living her best life, I have to say they are amazing.” People and their families were aware of how to report any concerns and told us they would be confident to raise concerns with management if they needed to.

Staff demonstrated a good understanding of safeguarding policies and procedures. Staff told us they were supported through the induction process and received ongoing training to understand their safeguarding responsibilities. The service had a clear process to record concerns which staff followed, and a clear escalation process was in place to ensure safeguarding concerns were referred to the local authority, when necessary.

Person-centred planning, consent and capacity assessments, and Deprivation of Liberty Safeguard applications were also in place to ensure people’s human rights were met. Where assessments concluded a person had been deprived of their liberty, relevant authorisation was sought and tracked appropriately. The service had safeguarding policies aligned with best practice and staff completed specific training to understand the Mental Capacity Act (MCA).
 

The service 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.

Risks were communicated by the service in ways that were accessible and understandable to people, including those with communication needs. The service had worked collaboratively with other services including Speech and Language Therapy (SALT) teams to produce and distribute easy read materials to people, when needed. People’s support plans included their preferred communication methods, such as Makaton, visual aids, and simplified language, and we observed staff using shortened language and gestures, demonstrating an understanding of people’s individual communication plans.

Staff supported people to take positive risks, such as trying new activities or increasing independence, in line with their preferences and assessed capacity.

Positive Behaviour Support (PBS) plans were in place and used by staff to help support people who may show behaviours that challenge, such as self-harm. These plans included details about why behaviours that challenge might happen. They contained clear information to help staff avoid triggers and respond to behaviours that challenge using the least restrictive methods. Staff completed mandatory training in learning disability and autism, including the Oliver McGowan programme, to improve their understanding and communication.

People were consistently involved in their own risk assessments, ensuring that plans reflected their personal goals, preferences, and capacity. Plans we reviewed were up to date and had been reviewed annually or when a person’s needs changed. Where people lacked capacity to make specific decisions, staff followed the principles of the Mental Capacity Act to ensure decisions were made in their best interests.
 

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

Regular audits were conducted by the managers of each property to assess fire safety, infection control, and general cleanliness. Staff were trained in infection prevention and control, and cleaning schedules were followed consistently. Personalised fire risk assessments were in place and up to date for each person, and regular checks of alarms, extinguishers, and emergency lighting had been carried out and recorded. Personal Emergency Evacuation Plans (PEEPs) included details about each person’s mobility, understanding, and support needs, and staff had participated in fire drills and understood their roles in an emergency.

The service used call bells and other technology, such as real-time monitoring sensors, to help people live more independently. Staff checked these devices were in working order routinely to ensure they remained functional. All communal and private areas were accessible and adapted to meet the individual needs of people using the service for example, for people who use wheelchairs. Security arrangements were also proportionate and person-centred. External doors were secure but did not restrict people’s freedom unnecessarily and access codes were known to people, where needed.

Properties we visited were safe and well-maintained, even when the property was managed by external landlords. There were clear systems for reporting and managing environmental risks and where staff had raised issues with landlords, we observed that repair work had commenced. While environmental risks were generally well managed, communication about the status and timelines of property maintenance could be improved at the service to ensure people and staff remain informed.
 

The provider did not always make sure there were enough experienced staff and did not always make sure staff received effective support, and development.

We received mixed feedback from relatives, with some telling us that the quality of care was inconsistent when agency staff were used. One relative told us, “The (permanent staff) work on separate days and are absolutely fine, no problems with them at all, but the agency staff are a bit unwilling to talk to you for whatever reason." However, people and relatives spoke positively about permanent staff, describing them as reliable and approachable. The registered manager acknowledged these concerns and shared plans to reduce reliance on agency staff by increasing the number of permanent staff to improve consistency.

Not all staff training was up to date at the time of the assessment. However, staff told us they received training relevant to their roles, and managers carried out competency checks for tasks such as medication administration and moving and handling. The service had booked all overdue training during the assessment.

While support and development systems were not always consistent across the team, staff received regular supervision and annual appraisals to support their development and ensure safe practice. New staff also completed a structured induction programme, including shadowing and competency assessments, before working independently.

Recruitment documentation was not always complete, particularly in relation to interview records. However, staff were recruited safely and had the appropriate pre-employment checks in place before employment started, including right to work and disclosure and barring service (DBS) checks.
 

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Designated staff were responsible for cleaning communal areas, and the service had embedded person-centred cleaning routines, encouraging people to participate in the cleaning of their own flats. One member of staff told us “We encourage (person) to be as independent as possible and support [person] when he needs it." Cleaning logs detailed specific tasks and the frequency with which each area should be cleaned by staff, and regular audits were carried out by managers to ensure standards were maintained.

The service managed personal protective equipment (PPE) stock effectively, verifying availability on a weekly basis. We observed appropriate PPE in people's flats and rooms were clean and equipped with separate waste disposal bins. People and their relatives confirmed staff had access to and used PPE when required.

The service had infection control policies and procedures that were regularly reviewed by the service and included protocols for managing outbreaks. The service arranged clinics for people to attend and receive vaccinations, such as influenza and Covid-19. These clinics had been communicated to staff and people in advance to allow effective preparation.
 

The service had systems in place to support safe medicines management, but these were not always effective.

We found some inconsistencies in medicines-related documentation and internal processes, though we found no impact on the safety or wellbeing of people using the service. One person’s medication administration record (MAR) included a dosage amendment that had not been initialled or dated, which was not in line with the service’s own policy. This had not been identified through internal audits, indicating that governance systems required improvement. Another person’s records lacked consistent documentation of medication-related risks, such as bleeding, across their support plans and MAR. The service updated these records during the assessment, but this reactive approach suggested that systems for ensuring thorough and consistent recording were not yet fully embedded.

We also found that one person’s records did not include a body map to show where medicated patches were applied. While staff had received guidance and the person was supported by a consistent team of staff, the absence of a formal record could have affected continuity of care. This was addressed during the assessment. In another case, a person’s support plan referred to both self-administration and staff support with thickener use, but the information was not clearly presented. When the person self-administered, the use of thickener did not appear to be consistently recorded on the MAR, as required. Although this did not result in harm, it highlighted the need for clearer documentation and more consistent recording practices.

However, we found that people were involved in decisions about their medicines, and staff understood and supported individual capacity and consent. Medicines were stored securely, with safe handover practices in place. Staff were trained in safe handling of medicines and had built strong relationships with people over time. Hospital passports contained relevant information for transitions, and no concerns were found regarding the use of controlled drugs or medicines to manage behaviour.