Nottingham DCA

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 changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff consistently told us they were supported to learn lessons when things went wrong and were confident incidents would be actioned by managers. Staff said learning lessons was done through a variety of methods such as retraining, practical demonstrations and team meetings. The provider had policies in place to support people and staff when an incident arose. However, paperwork and actions taken were not always completed or documented fully. Where incidents had happened, follow up actions did not clearly show an outcome or how future risks had been mitigated. We raised this with the registered manager who immediately took steps to upskill staff with management oversight in this area.

People received mixed experience with safe systems, pathways and transitions. Some people had clear documentation to support them moving into their own flats which included easy read documentation and aims and goals to ensure they were comfortable with this process. However, other people’s care and support plans lacked details on how to support people with pathways between services such as day centre support. For example, one person attended a day service 4 days a week, there were no details on how this person was to be supported to achieve this, what equipment or medicine they would need to take with them, or who to contact in an emergency. However, staff were knowledgeable about these processes, and no one had been limited in their access to other support or services and had attended regularly and safely.

The provider worked with people and healthcare partners to understand what being safe meant to them and how to achieve that. The provider and management team shared concerns quickly and appropriately with relevant authorities such as the local authority and CQC. Staff were knowledgeable about people’s risk through the relationships they developed. However, care plans lacked people’s social history and did not fully document potential risks people faced such as emotional or financial abuse from people known to them. Care plans did not contain any guidance on how people were supported to develop skills to protect themselves from harassment and abuse in the community in a way that did not infringe on their independence.

People we spoke with told us they felt safe with staff. Staff we spoke with demonstrated an understanding of how to manage risks by thinking holistically about how best to meet people’s needs and how people communicated their needs. However, care plans did not contain the level of detail described by staff or guidance to ensure people remained safe. Some staff we spoke with stated they were reluctant to support people to take positive risks even when they had capacity to make the decision. For example, we saw evidence that a person with full capacity had stated they wished to go out into the community alone, but staff did not feel this was safe. Rather than seeking appropriate guidance and support around making decisions in people’s best interest, staff followed the person discreetly from a safe distance. This meant the person was not supported safely or appropriately to manage their risk or improve their independence.

We visited 4 of the 13 locations offering supported living by United Response. Although the maintenance of the homes were outside of the providers control, staff and leaders escalated any concerns about the environment to the relevant agencies and adapted their support to keep people safe. People had been supported to design and decorate their own room in a person centred way that promoted their safety. For example, one person who was at risk of falls had been supported to purchase new bedroom furniture so items could be better placed to prevent falls. Additionally, the provider had replaced sliding doors that were unsuitable for some people to walk through independently which increased their safety whilst also promoting positive outcomes for people.

We received a mixed response from people and staff regarding safe and effective staffing levels. While the provider had a robust matrix in place to ensure staffing levels kept people safe, some people felt the levels restricted activities. One relative said, “There are 2 staff for 5 people so obviously they can’t all go out at once and even a visit to the shop has to be planned.” Another relative said, “I have 2 family members here and sometimes they want to go out together, obviously it needs more than 1 staff member so they can’t always support it.”

Some staff told us that shift pattern changes had impacted people’s wellbeing. We raised this with the registered manager who took immediate steps to review shift patterns and assess people and staff experiences and preferences.

Hygiene and cleanliness was to an extremely high standard within the locations we visited. We saw evidence of staff taking responsibility to maintain these levels whilst supporting people to engaged in domestic tasks if they chose to. Staff were knowledgeable about infection prevention and control (IPC) and the provider had appropriate policies in place to keep people safe. However, some staff wore excessive amounts of jewelry whilst supporting people. This meant people were at risk of harm from cuts and grazes whilst staff supported them with personal care. This was also an IPC risk as people were at the increased risk of harm from the spread of infection. We raised this immediately with the management team as staff were also at risk of harm. For example, some staff wore necklaces whilst supporting people who had known behaviours that at times included physical aggression. This meant that staff were at risk of harm from choking.

People and their relatives told us they were safely supported with their medicine and administration needs. One relative said, “Medication is always correct. One day a week [name] visits here and I get the medication to give at a set time from staff, it has never been wrong or missed.” However, record keeping did not always keep people safe. For example, body maps were not consistently used to identify where to apply topical medicine such as creams. Some managers told us the forms needed were not available while another stated it was due to lack of access to a printer preventing the use. Additionally care plans did always contain up to date medicine information. For example, we saw 1 person had a repeated stock count of 0 for a prescribed medicine, we enquired about this and was told the medicine was stopped by the GP ‘some months’ ago. This meant staff were not given clear guidance and information of people’s medicines which placed them at risk of harm. Despite this, we found no evidence that anyone had experienced any hurt or harm because of this and the registered manager provided assurances on immediate actions that would be taken to improve care planning and recording.