Flourish Healthcare and Support Limited

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 66 (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. The provider had systems in place to review and investigate accidents and incidents. Systems were in place for recording and analysing any trends and changes were implemented in response to any lessons learned.The senior team were open and transparent and demonstrated commitment to driving improvement at the service.

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. People’s needs were assessed prior to receiving support. Information gathered from professional assessments, along with input from individuals and their relatives, was used to inform people’s support plans and risk assessments and ensure transitions into the service were person centred, well planned and coordinated.

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. However, they were not fully aware of the requirement to notify external partners of the full range of notifiable incidents. As a result, some incidents although managed and followed up internally, had not been reported to CQC or safeguarding. This was addressed immediately and revised systems for notification implemented. Overall people and their relatives told us they felt safe with the support provided by the service. One person when asked if they felt safe told us, “Yes.” Staff received training in how to safeguard people. Staff we spoke with were confident to report concerns and satisfied that action would be taken to investigate them. One staff member told us, “I would follow safeguarding procedures and report any concerns immediately to my supervisor. I work closely with management regarding safeguarding matters and would ensure concerns were escalated appropriately to protect the individual.” There were processes in place to review people’s capacity in line with the MCA.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.People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). We found the service was working within the principles of the MCA.

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 were assessed and mitigated to keep people safe and risk assessments provided guidance for staff ensure people received safe and responsive care and support. Staff knew people well and were able to explain how they minimised risks. One staff member told us, “I manage risk by following care plans and risk assessments, remain observant to changes in people’s needs, reporting concerns immediately and following company policies and procedures while promoting individual independence.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Apartments were tidy, well maintained and safe. Systems were in place to ensure regular health and safety checks were completed. Staff had received training in fire safety, but some staff were yet to participate in a fire drill practice. We discussed this with the senior team and received reassurance that this would be addressed immediately to ensure all staff had participated in a drill and had the knowledge and confidence of what action they would need to take in an emergency.

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. Staff overall told us they felt supported in their roles and received regular support and supervision. A few staff felt support could be improved. We discussed this with the senior team who were willing to explore and ensure all staff felt supported. Staff completed an induction on commencement of employment and ongoing training and refreshers to enable them to carry out their role effectively. This included training on learning disability and autism and areas such as positive behavioural support and communication. However, some relatives felt that some staff would benefit from further training or support in areas such as autism awareness, learning disabilities, and cooking skills. They felt this could help strengthen knowledge and confidence for these staff and promote greater consistency in the support provided. This feedback was discussed with the senior management team, who agreed to investigate and review, whether any additional training, support or development opportunities were required for staff. Recruitment procedures were in place, so people were cared for by suitably qualified staff who had been assessed as safe to work with people. No concerns were noted with staffing levels and people and staff felt that staffing levels were safe and where necessary short notice cover was provided. Records showed that staffing issues were reviewed and addressed with learning used to improve support for both people and staff.

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 training on infection, prevention and control (IPC). No concerns were raised by staff or families about the availability of personal protective equipment (PPE) or management of infection.

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. Staff were trained in medicines administration, and their competency had been assessed. People were supported by staff who followed systems and processes to administer, record and store medicines safely. However, although no harm to people was identified, improvements were required in the management of creams, liquid medicines and homely remedies to ensure medicines were administered safely and consistently. The provider acted promptly to address these issues and agreed to strengthen their audit processes by introducing additional checks in these areas. These revised systems now need to be embedded into everyday practice to provide effective oversight and assurance of safe medicines management.Medicines related incidents were reviewed and used to improve practice. Action taken included additional staff support, refresher training and closer monitoring where needed. Medicine related incidents were reviewed and used to improve practice. Action taken included additional staff support, refresher training and closer monitoring where needed. The provider had a medicines policy, and this included the principles of STOMP (stopping over-medication of people with a learning disability, autism or both). We saw evidence of reviews taking place for people and reductions in medicines being administered since moving to the service.