Hounslow Supported Living 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 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.

There were systems to learn when things went wrong. Staff reported all accidents, incidents and adverse events. They worked with managers to investigate and learn from these. Staff involved people using the service to help them better understand what had happened and be involved in any changes. Relatives told us they were well informed. Staff explained they discussed lessons learnt during team meetings. Managers ensured care plans and risk assessments were updated and staff received additional training, when needed.

An external professional told us that incidents of distress had reduced which was a positive outcome for people using the service. They told us the provider shared information with them and was always transparent.

The provider worked with external professionals to help make sure people had safe and successful transitions between services. Managers assessed people’s needs and planned personalised transitions before they started using the service. For example, 1 person was anxious about moving to a supported living scheme. Staff supported them to take part in different trips to the scheme and social events to help them become familiar with the idea. They decorated and furnished the person’s new room in a way that was familiar to them and felt safe and comfortable. Staff offered the person choices to take things at their own pace and recognised the complex emotions they felt about moving. The transition was successful and the person became settled and happy at the service. The person’s relative explained, “The thought of transition for [person] moving homes was verytraumaticand[manager] gave us amazingly wise guidance and support.” The relative of another person commented on a successful personalised transition. They said, “The transition was done slowly. It was the right pace for [person]. The service was sensitive to [their] needs.”

Staff also supported people to move on to new homes and more independent environments when this was what they wanted and this was safe for them to do so. They worked closely with the person developing their skills. They worked with other professionals to make sure the person was safe. Some people’s needs had increased, and they had been supported to move into other care settings. Staff shared information about the person to help new staff understand their needs.

When people spent time in hospital, staff visited them and helped provide support when needed. This included helping to advocate for people, helping with meals and supporting with personal care. Relatives explained that staff had stayed with people providing reassurance and ensuring they were well cared for.

An external professional told us they found transitions were very well managed. Their comments included, “I have confidence that when 1 of our residents moves to a Certitude home, they will be safe and that it will be a positive experience.”

There were systems to help safeguard people from abuse. Staff undertook training and were familiar with policies and procedures. Staff were able to tell us how they would recognise and report abuse. The provider shared information with the local safeguarding authority when they had concerns. The provider worked with others to investigate these concerns and protect people from avoidable harm.

The provider shared information with people using the service and their relatives about abuse. Some people being supported took part in panels to discuss best practice and improvements around safeguarding.

People using the service told us they felt safe and would speak up if they had concerns. Their comments included, “I am safe and if I had any problems I would talk to my keyworker” and “Before I moved here, I was scared. But now they help me.” Relatives also felt people were safeguarded from abuse. Their comments included, “[Staff] make [person] feel so special. [They] have a wonderful sense of safety and security”, “I have peace of mind knowing that [person] is safe, healthy and happy” and “I have no worries about [person’s] safety. Staff keep [them] safe.”

Where people were identified as being unable to make informed choices about their care, the provider requested legal authorisations to make these decisions on their behalf and in their best interests.

The use of any restrictions was only carried out when this was part of a person’s planned care and when this was the only option to keep them or others safe. Restrictions were closely monitored to make sure people were safeguarded from abuse. Staff undertook relevant training.

The provider supported people to make informed choices and take risks when appropriate. They planned care which helped people to try new things in a safe way to develop their independence. For example, supporting people to be confident travelling independently and accessing different community services. Staff found innovative and creative ways to provide personalised plans to manage risks.

Some people expressed anxiety or distress regarding aspects of care and support. Staff worked closely with specialist teams of professionals to develop individual plans to help reduce anxiety. Staff provided support in the least restrictive way. All restrictive practices were assessed and regularly monitored. Staff used personalised communication techniques to support people. The provider was able to demonstrate how a consistent approach from staff had improved outcomes for people.

Staff assessed risks to people’s safety and wellbeing. They worked with the person, their representatives and other professionals to make sure plans were appropriate. There were risk assessments and risk management plans relating to different health conditions and the activities people took part in. Staff regularly reviewed and updated these. Staff undertook training to ensure they knew how to safely care for people.

When we were invited into some people’s homes, we saw people being supported appropriately, including supporting people to eat and drink, as well as moving around.

Relatives explained risks were well managed. Their comments included, “Staff minimise risk as much as possible and know what [person] likes”, “Staff understand [person’s] complexities. I am kept in the loop with risk assessments” and “Staff know [person] well and know when [they] need to use different techniques.”

Whilst the provider ensured environments were generally safe, we identified a small number of potential risks when we visited some of the schemes. These included an unlocked boiler room and electrical cables stored haphazardly. We discussed these with staff who took immediate action. The registered manager assured us that checks would improve to avoid a repeat of these risks.

The individual schemes were designed to meet the different needs of people who lived there. People had personalised the environments with different décor, pictures and belongings. People had the equipment they needed, and this was regularly checked and tested.

The homes where people with mobility needs lived were fully accessible for them. People were able to access their kitchens and were supported to be as independent as possible. Everyone had their own rooms which reflected their personalities and there were communal spaces which met people’s needs. When needed, there was additional signage and information on display.

People told us they liked their homes and bedrooms. A relative commented, “It is a very safe environment with locked doors, and the heating is a perfect temperature.”

There were enough staff to keep people safe and meet their needs. The provider assessed people’s individual needs. Staffing levels were based on these assessments. People using the service, relatives and staff felt there were enough staff. A staff member commented, “We have enough staff and I never feel rushed. If someone has an appointment or an activity, we get additional staff. It is flexible.” Staff were provided with reasonable time off and had information about shifts in advance. Staff were assigned to each supported living scheme and knew people well. People had a good relationship with the staff.

Staff retention was good. Comments from relatives included, “There is a stable, consistent staff team”, “Any agency staff are regular and known by [person]” and “There is good ability to retain staff. This is a huge credit to the management team.”

Recruitment processes included a range of checks on staff skills, knowledge and suitability. Potential staff were required to spend time with people using the service. This enabled people to share their opinions during recruitment and allowed managers to observe how these staff interacted with people. New staff completed an induction, and managers assessed their competencies at regular intervals. There was a comprehensive programme of training available for staff. Staff told us they felt there were good training opportunities. Staff regularly met with their line managers to discuss and appraise their work.

There were systems to help prevent and control infection. Staff understood and followed procedures. Staff undertook relevant training. Managers carried out audits of cleanliness. People using the service and relatives told us that the schemes were kept clean. Their comments included, “The service is clean and well maintained” and “The home is always spotless.”

People received their medicines as prescribed. However, we identified concerns relating to some medicines related records. This increased the risk to people’s safety and wellbeing. We were assured by the provider’s response to these findings.

In a small number of cases, staff had not accurately recorded changes to people’s medicines, the amount of stock medicines held or the methods of administration. We discussed these findings with the registered manager who investigated these and took steps to ensure records were updated and accurate. We received assurances these were recording issues only and there had been no adverse impact for people.

Some people were prescribed medicines to be administered on a when-required basis for health conditions such as constipation and pain. Guidance was not always detailed enough to ensure these medicines were administered consistently. We discussed our findings with the registered manager. They liaised with the prescribing doctors and pharmacists to ensure the information was updated and available for staff.

Following our visits, the registered manager arranged audits of medicines management in all the schemes. They sent us the completed audits which included robust actions where they identified improvements were needed. They arranged for a medicines expert within the organisation to attend staff meetings and work with staff to ensure medicines were safely managed.

Staff did not use medicines to control people’s behaviour. Staff worked closely with healthcare professionals to review people’s medicines and to make sure these were right for them. They supported people to reduce medicines when appropriate in line with the principles of “Stopping over medication of people with a learning disability and autistic people (STOMP)”. This is national programme to stop the inappropriate prescribing of psychotropic medications. Relatives confirmed this. Their comments included, "Staff work with the doctors to review the dose of a medicine and this has now been reduced" and "Staff manage [person's] medicines well. [Their health condition] had stabilised as a result of this."

There were suitable policies and procedures relating to medicines management. The provider investigated incidents and errors. They took appropriate action when they identified concerns. Staff undertook training to understand how to support people with their medicines. Managers assessed their competencies and knowledge.