United Support Services

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 outstanding. This meant people were protected by a strong and distinctive approach to safeguarding, including positive risk-taking to maximise their control over their lives. People were fully involved, and the provider was open and transparent when things went wrong.

This service scored 88 (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.

There was an exceptionally strong learning culture which was well embedded within the service. Leaders demonstrated a professional curiosity and reflective practice. They were open and transparent about any mistakes, including any they made in their own practice, seeing these as learning opportunities and sharing any lessons learned with the wider team. The registered manager told us, “We and staff need to be honest then we can learn from it, if they're dishonest we can’t.” They described an incident where things had not gone well. They told us; “We are all human, and even with the best intentions, we may all get things wrong from time to time. It is so important that leaders within United Support Services champion openness and share and reflect on what goes wrong just as much as what goes well. From my perspective, as the registered manager, if I expect the staff to open and reflective, I need to model this on a daily basis.”
This approach of continually reflecting on how support was provided had enabled staff to tailor their approaches so they could support people more effectively. As a result, the number of incidents when people had been distressed had dramatically decreased.

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. They made sure there was always continuity of care, including when people moved between different services.

People had been supported to move from long-term residential care into supported living settings. The registered manager and provider had recognised this model of care would better suit the individuals concerned while being aware of the risks associated with changes to people’s living arrangements. The moves had been carefully planned over several weeks to enable a smooth transition. Some staff had worked with one of the individuals for several years prior to them transferring to United Support Services. When the person had moved into their new home these staff had chosen to change their jobs, so they were able to continue working with the person. This meant the person continued to receive support from staff who knew them well and had built positive relationships with them.
One person had several restrictions in place in their previous living arrangements. The registered manager and staff had worked with a behavioural analyst to plan how these restrictions could be reduced without causing the person distress and confusion. This had been very successful, and the person was now living a much more independent life where they had greater choice and control.
Staff worked closely with other agencies to help ensure people received consistent and joined up care. An external healthcare professional commented; “The service worked with a range of professionals including learning disability nurses, behaviour analysts, the community learning disability team, epilepsy services, GPs and other specialist healthcare professionals. There was evidence of information being shared appropriately and care being adapted when people's needs changed.”
Hospital passports were regularly updated to ensure information remained current and relevant.

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 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). In supported living services this can be done through the Court of Protection (COP). We checked whether the service was working within the principles of the MCA and how they managed Community DoLS and COP orders within the service. We found that staff and management worked within the MCA. Authorisations were appropriately applied for and overseen. People were not subject to unlawful or excessive restrictions, they had choice, control and freedom over their lives. Where possible restrictions had been removed giving people greater independence and autonomy in their own lives.
Staff displayed a thorough understanding of their safeguarding responsibilities. They were confident any concerns would be dealt with internally. Staff had access to information about how to raise safeguarding referrals if they needed to. An external professional commented, “They deliver a very safe service.”

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.

Leaders and staff had a positive approach to risk taking and supporting people to do the things that mattered to them. An external professional commented, “I also saw evidence of the service taking a positive approach to risk rather than allowing risk management to unnecessarily restrict people's lives.”
Risks were clearly identified and action taken to mitigate those risks, both in advance and in the moment. For example,1 person had sometimes reacted to members of the public in a way which may have caused them alarm. This had resulted in the person’s opportunities to go out and take part in day-to-day activities being severely limited. Staff had worked to identify how the foreseeable risks could be minimised. When supporting the person in the community they took a dynamic approach to risk, continually assessing the environment and responding quickly and calmly to any changes. The registered manager told us, “We can’t control the world for [Name] but we can control how we support them.” The person was now being supported to regularly go out in their local community. The registered manager said, “The team work together, they are very well connected so together we can make it work.”

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

Leaders recognised the importance of ensuring people’s environments were safe and enabling. We visited one person and they clearly demonstrated a sense of ownership within their home. We observed staff encouraging the person to complete a check of the smoke alarm and make their bed. The premises were decorated and furnished according to their own taste.

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.

The provider told us it was particularly important to them that they employed staff who reflected the organisation’s values and were compatible with the people they supported. Interview records evidenced candidates had been asked value-based questions as well as questions about their employment history and experience.
People were supported by small teams of staff who they had built trusting relationships with. All staff knew the people they worked alongside well and had a sound understanding of how to support them safely while enabling them to live meaningful lives. A behaviour analyst was contracted to work weekly alongside staff trained in Positive Behaviour Support (PBS) to provide advice and guidance. A member of the PBS team was always on shift to provide additional support if needed.
Staff were well supported through induction, training and supervision. Staff told us the induction had been thorough and had equipped them to provide support confidently. One commented, “I had a bunch of training, and then shadowed other staff for several weeks until I was fully confident. It was a really informative induction.”
Training was focused on the needs of people using the service. For example, staff had completed the Oliver McGowan training, the governments preferred learning disability and autism training. In addition, staff had completed training in learning disability awareness and Level 3 autistic spectrum disorder training.
When leaders identified additional skills were required this was arranged. An external professional commented, “We arranged a training session with the team. The session was a pleasure to deliver. Every member of the team spoke highly of the people they support. They all spoke up in the session and asked relevant questions in regard to the implementation of Intensive Interaction and using pictorial resources.”
Staff told us they were well supported and encouraged to develop professionally. One member of staff told us, “[Leaders] were informative about everything, I got information about the different roles and responsibilities. They showed a lot of trust and belief in me which was very motivating.”
This approach to supporting staff throughout their journey with United Support Services meant staff were confident and felt empowered to deliver support which had positive outcomes for people. One member of staff told us, “I love my job, I am helping [Name] live life in the way they want to. We are giving them opportunities and then get to witness them take them.”

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 were trained in Infection Prevention and Control (IPC) and were provided with Personal Protective Equipment (PPE) when carrying out personal care. They supported people to be involved in maintaining a clean environment.

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.

The service worked in line with stopping over medication of people with a learning disability and autistic people (STOMP); a national initiative aimed at reducing the inappropriate use of medicines used to manage behaviour. Staff and the registered manager had worked with involved health care professionals to reduce the amounts of these types of medication people took regularly. Some people were prescribed ‘as required’ (PRN) medications to help with the management of anxiety. These medicines were used very infrequently, and records of why the medicines were used and their effectiveness had been completed. The registered manager spoke of the need to only use these medicines as a last resort. They commented, “Why would you go straight to that without trying other things first?”
People and staff had access to easy read information about these PRN medicines. Easy read information can be an effective tool for staff to use when sharing complex information with people.