ASL 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 newly registered service.

This key question has been rated 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.

Following an accident or incident staff recorded what had happened and what immediate actions were taken. Incident forms were reviewed by the provider, potential triggers or causes were identified and actions taken to resolve and prevent a reoccurrence. People’s Positive Behaviour Support (PBS) plans were reviewed to ensure these were being followed by staff and areas for learning identified. One staff member told us, “We record and report, why and what's happened.” They also said that this was reviewed by the provider. If any changes to people’s support was needed this was implemented and all staff were made aware.

Staff were updated about incidents and any changes to the person’s support at handover and through the electronic system. Where appropriate the local authority safeguarding team and CQC were notified of any incidents.

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.

There was a procedure in place to ensure when people started using the service, the transition was as smooth as possible. This was to ensure people’s needs could be met. It was also to ensure people felt comfortable with decisions that were being made about the transfer. Relatives told us that their loved one’s transition into the service was managed well. One relative said, “[Name] moved there on my request because the last placement was failing [name]. Staff knew [name] very well and problems, so it was very smooth. They went through home visits and introductions teas etc. It was all done properly.” A social care professional told us, “The staff have been consistently supportive throughout the transition period and continue to provide high quality care.”

A pre-admission assessment was completed. This gave the provider an opportunity to meet the person and their family and discuss their needs and choices. It also helped identify if staff would require additional training to support the person.

People were invited to visit the service, spend time meeting other people and staff. This helped ensure people would get on with others that already used the service. As far as possible transitions were managed at the person’s own pace. Health and social care professionals were included in admission plans to ensure people’s needs continued to be met.

Transitions plans were completed so the person and staff knew what they were doing each visit and the transition could be safely monitored.

The provider collaborated 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.

Systems were in place to ensure people were protected from the risk of harm, abuse or discrimination. There was a safeguarding policy which was accessible to staff. Staff received safeguarding training and understood their responsibilities about identifying and reporting any concerns. People and their relatives told us their loved ones were safe at the service. One person said, “It feels safe here.”

Staff told us they would speak to the most senior staff member on duty or the provider. If it was not appropriate to discuss concerns with staff, they would contact the local authority safeguarding team. Staff told us they knew where they could find this information.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

Where people were deemed not to have capacity, Mental Capacity Assessments (MCA) care plans had been developed and demonstrated the involvement of people, their relatives and how decisions were made in people’s best interests.

Some people made decisions that may have been considered as ‘unwise.’ Mental capacity assessments demonstrated people had capacity to make these decisions. Care plans and risk assessments provided guidance for staff, about keeping people safe when ‘unwise’ decisions were made. Staff were clear how they continued to support people safely.

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.

Risks to people were well managed and supported people to live as full a life as they wished. Staff knew people well and were able to tell us about the risks associated with the people they supported. Where people, with capacity, chose to take risks that may be considered ‘unwise’ they were supported by staff to take these risks as safely as possible. There were a range of risk assessments in place to guide staff with guidance for staff to follow.

Some people had Positive Behaviour Support (PBS) plans in place which instructed staff about how to support people safely, for example if people were becoming anxious or displaying signs of distress. They included details of how the person may appear, what actions staff should take to prevent the distress escalating. There was also guidance about what steps staff should take if this did escalate and how to support the person to recover. Staff showed a good understand of people’s PBS plans and how these were implemented. Staff were consistent in what they told us which demonstrated risks to people were managed and mitigated. Staff spoke highly of the PBS training. They told us it enabled them to, “Identify changes of level (of mood) and prevent it escalating.”

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 provider worked with people and the landlord to ensure the environment was safe. Staff completed regular checks to ensure the environment was safe and well maintained. This included fire and water temperature checks. Staff received fire safety training and fire drills were undertaken to ensure staff knew what actions to take in an emergency. Each person had a personal emergency evacuation plan to guide staff in case an evacuation was required. Staff told us if any maintenance was required this was addressed promptly. One staff member said, “We are lucky, if anything needs doing here, it will be done.” The landlord had employed maintenance staff who undertook regular checks and works at the properties.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

There were enough staff working each shift, with the appropriate knowledge and skills to support people safely and ensure their choices and needs were met. People had been assessed as requiring 1 to 1 support at times throughout the day. There was a system in place that ensured this was provided.

When staff started work at the service they completed a period of induction. This included training, policies and a period of shadowing where they worked with more senior staff to meet with people and understand the support they required. Staff received training that was appropriate for their role to ensure they had the knowledge and skills to support people safely. Training included, learning disability, autism, positive behaviour support. Where people had specific and complex needs staff received the relevant training and support to meet these needs. One person had complex communication needs. The provider had developed a video, with the person, demonstrating their method of communication. This was used as part of staff training.

One staff member explained how they were due to undertake further training to support one person. Relatives told us staff had the knowledge and skills to support people. One relative said, “Yes, it’s always difficult because everyone is so different so they do really well and I can’t fault them.”

There were processes in place to ensure staff were recruited safely. This included references, employment history and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer.

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 received infection prevention control training and had access to essential personal protective equipment (PPE). Staff told us there was always PPE available and appropriate handwashing facilities. Systems were in place to support people to keep their home clean and tidy. People told us this was part of their weekly routines. Staff explained where people were unable to maintain the cleanliness of their own rooms themselves staff were responsible for ensuring this was met. The provider told us measures were in place in case of any outbreaks of infection. Regular checks and audits were completed to ensure appropriate cleaning had taken place and procedures had been followed.

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.

Medicines were managed safely. Only staff who had received medicine training and had been assessed as competent supported people with their medicines. People told us they were supported to receive the medicines they needed. Medicine administration records (MAR) were completed when people had taken their medicines.

Some people were able to manage their own medicines. Care plans and risk assessments had been completed, to demonstrate where they may need support, for example a weekly check of the medicines. Care plans and risk assessments contained detailed information about how people liked to take their medicines and why they had been prescribed. There was guidance for staff to ensure these were given safely.

Some people had been prescribed medicines to take ‘as required’ (PRN), for example pain relief. There was guidance for staff about why these medicines were needed and how they should be taken.