Rotherham Regional Office

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. Action was taken to understand why a person had become distressed, or why an incident occurred and what could be changed to prevent further occurrences.

Risks associated with closed cultures were identified. A closed culture is a poor culture that can lead to harm, including human rights breaches such as abuse. People had access to professionals, family and friends outside of the service they could raise concerns about their safety with.

The management team placed emphasis on creating a culture of honesty, openness, and learning, rather than blame. Staff confirmed this. They told us they were encouraged to raise concerns and were confident they would be listened to and supported. Staff were aware of changes made to the service as a result of lessons learned from incidents, accidents and concerns.

The provider worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was managed and monitored. They made sure there was continuity of care, including when people moved between different services.

One relative told us their family member had lived in a shared house for several years. They said, “[My family member] shares their bungalow. It works quite well. The transition was done carefully, meeting in the pub beforehand. It worked like a dream.”

The electronic care planning system was used to generate key information to accompany people to hospital and care planning documentation was kept under review to make sure up to date information was passed on to partner professionals.

Care plans were in place to support people to have a good day, and strategies were in place to prevent distress. Reactive strategies were available and followed by staff This helped make sure people were consistently supported when they were distressed.

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 with relevant professionals, where necessary. Staff were aware how to raise concerns if they felt people were at risk and told us they felt confident to do so.

People were supported to develop skills to protect themselves from harassment and abuse in the community in a way that didn’t infringe on their independence. The provider worked with people to help make sure they had the tools and skills to keep themselves safe and recognise risk. People were supported to build healthy friendships and relationships, access work and education opportunities, use public transport and have a mobile phone.

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). When people receive care and treatment in their own homes an application must be made to the Court of Protection for them to authorise people to be deprived of their liberty.

We found the service was working within the principles of the MCA.

The provider worked well with people to understand and manage risks by thinking holistically. Staff provided care that met people’s needs and was safe, supportive and enabled people to do the things that mattered to them.

The service supported people to effectively manage known risks. People were supported and empowered to take risks in areas they wanted to and to enhance their lives. People’s needs were clearly identified, assessed and risks were mitigated. When people’s need changed, they were reassessed. For example, where staff picked up changes in a person’s mood and communication style, they worked to understand what had happened and how their support might be adapted.

Staff understood there were times when people became distressed and took steps to understand why and what support they needed to express their emotions. There was a focus on understanding what caused people distress and planning to facilitate positive change. Staff received training and support in the use of positive behaviour support (PBS). This is a person centred framework for providing support to people with a learning disability, and/or autism, including those with mental health conditions, who have, or may be at risk of developing, behaviours of distress.

People felt risks were well managed without overly restricting their freedom. People who had health conditions such as epilepsy, were supported effectively to protect them from the risk of avoidable harm. Best practice guidance was followed, and the risks were identified and mitigated whilst ensuring the person was able to maintain their independence and dignity.

One relative said, “[My family member] is prone to falls, so handrails have been fitted in various places. Most staff observe [my family member] getting up and follow them around to keep them safe.”

One relative told us of an incident that had shaken their confidence in the team’s management of risk. We discussed this with the management team and saw evidence of good practice and of lessons learned shared throughout the service to further strengthen and improve risk management.

The provider detected and controlled potential risks in the care environment. They made sure the equipment and technology used in the provision of the service supported the delivery of safe care and support.

Staff supported people to liaise with their landlord about housing related issues. Regular checks were carried out with people to make sure their environment was safe, and meetings held included discussion of potential risks and how they could be managed. Maintenance records were up to date and any actions addressed in a timely way.

Care plans were in place to help make sure safe care was provided and people had personal emergency evacuation plans (PEEPS) which were kept under review. A PEEP is a plan for a person who may need assistance, for instance, a person with impaired mobility, to evacuate a building or reach a place of safety in the event of 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.

We received positive feedback about the staffing of the service. One relative said, “It works. [My family member] lives with 3 other people. [My family member] has 1:1 staff during the day. Overnight there is 1 waking and 1 sleeping staff. This ratio meets [my family member’s] needs."

People told us they had good relationships with the staff. We saw interactions where people were relaxed and very much in control of their day. When people receive 1 to 1 support, the staff’s skills and experience matched to the needs of the person. This enabled people to work towards and achieve their aspirations and their potential.

Staff were recruited safely. The provider completed pre-employment checks such as references and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. This information helps employers make safer recruitment decisions.

People were supported by staff who had undertaken training in how to support them as an individual. New staff received a comprehensive induction. They had time to shadow existing, experienced staff until they got to know people and became familiar with and confident in their role. All staff received ongoing training and support to carry out their roles effectively. Staff had undertaken training in how to support autistic people and how to support people with a learning disability, and their competency was assessed to make sure they had the skills to support each person. Staff had a very good understanding of people’s individual needs and care plans. They told us they felt very well supported and said they worked well together as a team.

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 supported people to keep their homes clean and managers undertook regular infection prevention and control (IPC) audits to make sure staff were working within IPC good practice guidance. Personal protective equipment, such as gloves and aprons (PPE) was readily available to staff.

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. Processes were in place to make sure people received their medicines as prescribed. Medicines were administered and stored safely. Some people were prescribed medicines on an ‘as and when’ required basis, often referred to as PRN. Protocols were in place to help make sure people received their PRN medicines appropriately.

The provider worked in line with STOMP, which is national best practice guidance on stopping the over-medication of people with a learning disability and or autistic people. There were systems in place to make sure people’s distressed behaviour was not inappropriately controlled by medicines. The team worked with others to protect people from the risk of over medication. The team’s approach to medicines reflected current best practice and professional guidance. People’s medicines were administered in line with the Mental Capacity Act 2005 and staff were trained to support people and meet their needs without overuse of medicines. Staff were able to speak up if they had a concern that a person was being controlled by excessive or inappropriate medicines.

Overall, relatives provided positive feedback. For instance, 1 relative told us their family member had recently been to the GP. They told us staff in the home kept them up to date saying, “Sometimes staff phone if they are concerned about [my family member]. If staff think they are in pain, they give [my family member] paracetamol.”