Leicester & Leicestershire Supported Living

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 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.

Staff understood their responsibility to report any incidents or accidents. They had access to reporting systems and used body maps to record any injuries. Staff recorded all accidents or incidents on an ‘event tracker’. These were analysed by managers to ensure action was taken to reduce further risk. Risks along with lessons learned were discussed at team meetings. For example, an incident where a medicine error was not identified straight away and opportunity to seek medical advice missed was discussed. Staff were encouraged to consider how this could be prevented to reduce reoccurrence. Also, following a fall, medical advice was sought and a referral made to the ‘falls team’ in order to reduce further risk.

A staff member said, “We have an accident form we use to record this information; we also have to put it on event tracker for managers to follow up. We record any witnesses, how the incident happened, it’s a summary and it's also used as a form of clarity."

Event tracking records prompted staff to consider all eventualities such as what action they must take and who should be informed. Actions to reduce further risk and support the person were recorded. Monthly audits were carried out at each property, and this included an audit of all ‘events’ and actions taken to promote safety and reduce risk. Audits had identified staff had not followed correct procedure when a person went missing (the person had not come to any harm). Staff were reminded of the correct procedure to follow during a team meeting and why this was important to ensure peoples were safe and protected from harm.

Lessons learned were shared at team meetings and at regional conferences. For example, a local authority contract monitoring visit identified some shortfalls in record keeping for medicines and the use of language which was not always professional or supportive to people using the service. Managers made changes to address these concerns and provided additional support to staff. A positive behaviour trainer was employed to support people and staff with effective strategies to promote safety and wellbeing. Expectations were discussed in staff team meetings along with support available to staff

Staff gave us an example of an incident shared at a conference that occurred at a different provider’s service. Staff were able to learn how things had gone wrong and how to prevent this.

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 told us how they were supported when they began using the service. Transition plans and thorough needs assessments were carried out.

A staff member told us, “We do have meetings prior to people moving in, talk about any changes coming up, updates on people we support, and receive emails reminding us. Its compulsory to read the care plan before supporting a new person so we can understand their needs. We take turns, go in to introduce ourselves, spend some time to get to know them because they all have preferences.

Key information was available in the event of a person requiring a hospital admission. Staff supported the person and attended with them. A staff member said, “There is always a support worker that goes to the hospital with a service user. At the hospital, I contact my manager every hour to update them, we also have a text group to communicate so everyone is aware of what's going on. We also update electronic care records.”

Team meeting minutes showed that staff were carefully preparing for a person to return to their home from hospital. Staff had assessed their changing needs including the use of mobility equipment.

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 told us they felt safe and were confident speaking with staff if they had any concerns. One person said they would speak with the service leader or the registered manager if they were not happy about anything. Another said they would speak with the staff.

Staff had received appropriate safeguarding training and understood their responsibilities to identify and report any safeguarding concerns. Staff we spoke with were able to explain the correct procedures to follow and demonstrated a good understanding of how to recognise signs of abuse.

Managers promoted an open culture and encouraged staff to raise concerns through a clear ‘speak out’ process. Confidential systems were in place to support this, including dedicated telephone numbers and email reporting methods, which staff were aware of and confident to use.

A staff member described their responsibilities to protect people, they said, “It's protecting the people we support from any harm or abuse. I would inform my line manager, we also have a speak up policy and whistleblowing policy. If the safeguarding involved my manager I would definitely not go to them, I would go to someone else."

Another staff member said, “It means trying to protect people from getting harmed. Examples of abuse are emotional, physical, verbal and financial. If I saw someone being abused I would report it, we have a policy on who to report to. I would speak to my manager and take further action if needed, and there is a policy."

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 people’s freedom to take informed risks was respected and upheld. This meant people were not prevented from following their chosen lifestyles and activities and had their human rights to do so upheld.

Risk management plans were in place for all identified risks. For example, staff knew about each person’s individual risk. One person had an identified risk of developing pressure sores; staff knew what to do to prevent this from happening. Another person had seizures and staff knew what to do in this event. They used assistive technology to monitor and manage risk and knew when to seek healthcare support. Another person had swallowing difficulties and staff followed healthcare advice to reduce any risk of choking or aspiration.

Positive behaviour support (PBS) plans were developed where required. PBS is a person centred approach to supporting people with a learning disability. This meant staff understood how people communicated their needs and emotions and knew how to respond in the most effective way.

PBS plans included the person’s likes and dislikes, protective strategies and how staff should communicate. Environment and structure were considered along with a sensory analysis and what a ‘good day’ should look like. Potential triggers that may cause distress were identified along with how staff should respond if distress escalated to crises point. The function of behaviours was analysed and explained so staff had a better understanding of the person, their needs and how to reduce risks and promote quality of life. PBS plans were comprehensive and provided detailed information to involve people in managing risk.

A staff member told us how they used PBS plans when supporting people and were able to describe real life examples of how this supported people. A staff member said, “I would look at the behavioural management section of the care plan, look at the person's triggers, what I need to do when they are distressed, we have that in our knowledge, their crisis prevention too is there for us to make sure we manage effectively.

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

People had their own tenancy agreements which they managed independently or were supported by staff to manage and meet their tenancy requirements. The properties ranged from small 1-4 person shared houses to larger properties of apartments ranging from 6-14 people.People lived independently in their own flat with which was personalised to their individual needs and tastes. There were shared communal areas if people chose to come together socially for an event such as a birthday party.

People’s homes were well maintained and risks were managed. The provider assessed the physical environment people lived in. This was included in care and support plans along with specific risks in the environment staff were required to manage.

We spoke with a housing manager who told us, “They (staff) are on the ball with housing needs, the standout amongst other care providers.” They told us staff were quick to report any issues that required maintenance or repair and always completed fire risk assessments.

Staff carried out health and safety and fire safety checks. They had access to a maintenance support for repairs.

Managers carried out monthly audits for each property. These included checks of fire safety, evacuation plans and staff knowledge of fire procedures in the event of an emergency. Gas safety, electrical safety and equipment maintenance dates and certificates were checked to ensure they were completed and in date.

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.

People we spoke with told us there were always staff available when they required care or support. Some relatives felt they would like more staff but this was outside of the providers control because required staffing hours had been reviewed by and funded by the local authority. The provider ensured all commissioned hours were fulfilled and staff teams were consistent. The provider told us agency use had reduced to zero usage. The service was fully recruited with no staff vacancies at the time of this assessment.

Staff we spoke with told us there was enough staff to meet people’s needs. A staff member said, “We always have enough staff. That’s something we are proud of. Since I started here, we've never used any agency staff”.

Staff had time to spend with people and to meet their needs. There was always an on-call service available outside of office hours. Staff were encouraged to contact the on-call service to cover any staff shortages or if they had required any support or advice.

Staff had the skills, training and support they required to provide safe care and support.. Recruitment practices were safe; processes were in place to carry out pre-employment checks to ensure staff had the right skills and experience. People told us staff understood their needs and how to meet them. A relative said, “There is a consistent team of well-trained staff. I watch them and they are competent.”

Staff told us they had the training and support they required. They were proud of all the training they had attended and qualifications earned. A staff member told us, “My training is fully updated and excellent.” Training opportunities included nationally recognised training within the sector and specific learning disability and autism courses. This included nationally recognised training supported by people with lived experience in line with regulatory requirements. Staff had specific training from external clinical staff where health tasks had been delegated.

The provider told us their staff training compliance figures were at 96% which was about their expected benchmark.

Staff had ‘supervision’ with their service leaders at least every 3 months. This provided opportunities to discuss staff performance and any learning and development needs. The supervision process (known as UCAN) was comprehensive. A staff member described the supervision process, they told us, “Every UCAN (supervision) focuses on aspirations, wellbeing resources. Staff were asked to describe a positive impact they have had on people they support, this promoted a holistic approach.” Another staff member said, “Supervision is every 3 months, but I have constant communication with my manager.

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.

People told us they were happy with how they were supported to keep their homes clean and hygienic. We observed people’s homes were visibly clean, fresh and tidy.

Staff checked weekly cleaning schedules. The provider had a comprehensive infection prevention and control policy which complied with all best practice national standards and guidelines. Staff had received training and understood the providers policies. Managers audited infection prevention and control practice at each property monthly.

A staff member told us, “We use personal protective equipment (PPE) when delivering personal care. I also use PPE when giving medication to prevent contamination.”

Staff knew the correct way to dispose of different categories of waste.

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.

People told us they were supported to manage their medicines or managed their own medicines. A relative told us, “My family member has epilepsy and takes medicine for that, the staff are on the ball with that.”

Each person had a risk assessment and care plan in place which identified their support needs regarding medicines. Medicines were stored correctly and records were maintained to ensure a clear audit trail of medicine stocks and medicines administered.

Records we looked at were accurate and up to date. Medicine care plans were person centred and set out in details how the person preferred to take their medicine. For example, a care plan for medicine stated, ‘my support team will get my medication prepared and a drink for me to have after before they tell me it’s time to take my medication. One of my team will entertain me while the other will prepare my medication for me they will then either bring it to the table or I will stand up and come next to the kitchen counter. I like to take my medication either at the dining table or standing in the kitchen. I need to be calm and settled before I take my medication.’

People had their prescribed medicines reviewed to ensure it remained effective or if any changes were required. Staff followed ‘STOMP’ principles (Stopping Over-Medication of People) to reduce the use of unnecessary medication. Any person prescribed anti-psychotic medication had proactive and preventative strategies developed within positive behaviour support plans. The was checked during monthly audits in order to reduce any risk of over medication and to ensure alternative approaches were explored.

A medicine profile was in place to support staff regarding why the medicine was prescribed and any potential side effects. Staff made sure time critical medicines were administered at the correct time. Medicines to be given on an ‘as required basis had a clear protocol for staff to follow.

The provider had a medicines policy and staff had training and competency checks. Staff we spoke with were knowledgeable and knew how to safely manage people’s medicines. They confirmed they had received training and had their competency assessed. A staff member told us, “We have online courses and also have face to face training for medication administration, after that there is a competency assessment to assess if you're confident. We also have a person-centred approach, each client differs, they asses you based on the individual person you're supporting so you're confident with that person. We also have a monthly medication audit. [Service leader] comes in every month to audit every and go through it. But as soon as any errors or issues arise or if anything is unclear, staff raise it and we communicate within our teams group if we are unsure."

The provider carried out monthly medicine audits to check people received their medicines in a safe way. Where audits had identified medicine administration recording errors, these were discussed with staff during a team meeting and staff were reminded of the correct procedures to follow and why this was important to ensure safe medicines management.