Bolton 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 requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

The provider was previously in breach of the legal regulation in relation to safe care and treatment. Improvements were found at this assessment and the provider was no longer in breach of this regulation.

This service scored 72 (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 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.

The service worked in partnership with other professionals such as GP's, dietitians and speech and language therapists (SaLT) to support people to access healthcare when they needed it.

The management team and staff demonstrated how when a person's needs had changed, they had promptly engaged with several services to ensure the person's needs were fully met and understood. Case studies were documented by the service about how people had transitioned between services and work done with other multi-disciplinary teams.

Initial assessments were completed when people first began to use the services of Bolton Supported Living, so that staff could determine the level of care they required.

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.

The service worked in partnership with other professionals such as GP's, dietitians and speech and language therapists (SaLT) to support people to access healthcare when they needed it.

The management team and staff demonstrated how when a person's needs had changed, they had promptly engaged with several services to ensure the person's needs were fully met and understood. Case studies were documented by the service about how people had transitioned between services and work done with other multi-disciplinary teams.

Initial assessments were completed when people first began to use the services of Bolton Supported Living, so that staff could determine the level of care they required.

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.

People who used the service had a range of risk assessments in place regarding the support they received. These covered areas such as accessing the community, finances, participation in activities, eating/drinking and mobility. Where any risks were identified, there were control measures in place to keep people safe.

Our assessment had been prompted in part by a serious incident where a person had choked and sadly passed away. We looked at the systems in place and actions taken to prevent this from happening again. Staff spoken with during the assessment displayed a good understanding about people who were at risk of choking, and we found appropriate referrals had been made to Speech and Language Therapy (SaLT) if people were at risk.

We saw people’s food being served in correct textures and staff observed sitting with people if this was required for their safety by ensuring they were sat upright or eating more slowly. Staff had also received additional dysphagia training to support their understanding in this area.

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.

People who used the service had a range of risk assessments in place regarding the support they received. These covered areas such as accessing the community, finances, participation in activities, eating/drinking and mobility. Where any risks were identified, there were control measures in place to keep people safe.

Our assessment had been prompted in part by a serious incident where a person had choked and sadly passed away. We looked at the systems in place and actions taken to prevent this from happening again. Staff spoken with during the assessment displayed a good understanding about people who were at risk of choking, and we found appropriate referrals had been made to Speech and Language Therapy (SaLT) if people were at risk.

We saw people’s food being served in correct textures and staff observed sitting with people if this was required for their safety by ensuring they were sat upright or eating more slowly. Staff had also received additional dysphagia training to support their understanding in this area.

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

Individual supported living houses were managed by separate landlords and housing providers, therefore Bolton Supported Living were not responsible for the maintenance and upkeep of the living environment. Where any repairs were required, we saw these were raised with landlords who then scheduled for any work to be completed. Health and Safety audits were also undertaken where building maintenance could be monitored.

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.

Staffing rotas were in place, these demonstrated how many staff were available to care for people. A dependency tool was used to determine how many staff were required. The feedback we received from people who used the service and relatives was that staffing levels were sufficient.

Staff told us they felt numbers were sufficient to care for people safely. One member of staff said, “We have enough staff, and they are very flexible in meeting people’s needs.” Another member of staff said, “There are enough staff, and we have bank staff available for cover too.”

Staff were recruited safely with the necessary pre-employment checks carried out. People who used the service had been involved with recruitment processes when interviewing potential new staff.

Staff told us they received enough training to support them in their role, with a training matrix in place showing which courses had been completed. Staff supervisions and appraisals took place where staff could discuss their work in a confidential way.

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.

Infection control checks formed part of the health and safety audits which were carried out at each of the supported living houses.

An infection control policy and procedure and cleaning schedules were in place, and we observed domestic staff carrying out their work during the assessment. Areas such as bedrooms, communal areas at Supported Living houses were seen to be clean and tidy and staff had completed infection control training, which was recorded on the training matrix.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Staff we spoke with confirmed that they completed medicines training, and annual competency checks to help ensure that medicines were safely managed. Additional training was provided where care staff needed to administer medicines using more specialist techniques for example, using injection pens. However, the actual dose of medicine given to one person using a specialist technique was not recorded, to evidence administration as prescribed. The manager was actively seeking a solution to an identified concern about the lack of healthcare professional delegation of specialist tasks to care staff to support oversight of the overall management of people’s care.

People were supported to attend medicines and heath reviews with their GP and specialists. Staff also supported people to buy non-prescribed medicines for minor ailments, if needed. People’s medicines needs were considered when they were away from the home for example on day trips or holidays. However, the accompanying medicines paperwork supporting both these activities was not always completed. Similarly, although staff could describe how they prepared thickened fluids record keeping was not always completed in line with the provider’s policy. Hospital passports were used to help support people to receive any support they need if they were admitted to hospital.

Written medicines information within people’s care plans was not always kept up to date. For example, we saw two examples where care plans referred to the use of ‘when required’ medicines that were no longer prescribed for that person. A care plan for another person included clear information about how they could be supported should they become distressed. However, although infrequently used, clear records of events leading to the administration of a ‘when required’ medicine and the outcome was not always recorded.

The service was piloting the use of electronic medicines administration records (eMAR) at one of the locations we visited. Staff had completed eMAR training, and service managers were identifying areas where existing policy and approaches to medicines audit did not align well with the new processes.