ASLN

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 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.

There was a positive learning culture within the service. The registered manager told us about the processes in place to investigate incidents and understand what had happened and why. They said, “We send a message to everyone detailing what’s changed and we have read receipts, so we know it’s been seen.” Records showed that incidents were reviewed promptly and appropriate actions were taken to reduce the risk of reoccurrence. Learning from incidents was shared with staff in team meetings, through supervision, and via written communication where relevant. Staff told us they felt supported to report concerns and understood the importance of reflection and learning to improve the quality and safety of care people received.

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 experienced safe and well‑planned transitions when moving between services or properties within the provider. We saw that transfers were managed smoothly and with consideration for the person’s needs, preferences and wellbeing. Information about people was shared appropriately to ensure continuity of care, which helped minimise disruption and supported people to settle into their new environment.

The service had effective systems in place to respond to unforeseen events. Emergency grab sheets were readily available and contained clear, up‑to‑date information about people, such as health needs, communication preferences and risks. This meant staff could respond promptly and safely if people became suddenly unwell or required emergency support, including transfer to hospital.

The provider worked proactively with people to plan for the future and consider potential changes or transitions in their lives. This included discussing aspirations, anticipated changes in needs and how these could be supported over time. People were involved in these conversations and their views were respected, which helped them feel prepared and supported.

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 and their relatives told us they felt safe using the service and were confident that staff would take action to protect them if they had any concerns. One relative said, “Generally the care is pretty good, so I’d say [they] are safe in that way.” Staff understood their responsibilities in relation to safeguarding and knew how to recognise and report concerns.

We saw that there had been some incidents involving one person and other people they lived with. The provider responded appropriately to manage the situation and reduce the risk of harm. This included reviewing support arrangements and working with relevant professionals. The person was supported to move to a different property where they were more compatible with the people they lived with. This resulted in improved outcomes for everyone involved and demonstrated that safeguarding concerns were managed in a person‑centred way.

Staff had received safeguarding training, which included information about the Mental Capacity Act and Deprivation of Liberty Safeguards. We saw that mental capacity assessments had been completed where people may lack capacity to make specific decisions. Whilst these were mostly of good quality, some would benefit from more clearly identifying the decision being assessed and the outcome of the assessment. Where people had restrictions on their liberty, these had been appropriately recognised and escalated to the local authority, and applications had been made to the Court of Protection to seek the required authorisation. This demonstrated an understanding of the importance of promoting people’s rights and acting within the law. One staff member gave us examples of restrictions that might be in place and said, “These must be lawful, proportionate and authorised.”

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.

We saw comprehensive risk assessments in place for all identified risks. People were actively involved in discussions about their risks and how these would be managed. The registered manager told us that staff worked closely with people to talk through risks and support them to make informed decisions. Staff used communication techniques tailored to everyone’s needs, which helped ensure people understood their choices and were involved in decisions about their care and support.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The environment was not always managed in a way that ensured people were protected from harm. We found that window restrictors were absent in some supported living properties, which increased the risk of falls or injury to residents. The provider had not ensured that appropriate measures were in place to reduce these risks.

In addition, we saw an unlocked cupboard containing a lawnmower and garden shears that residents could have accessed. These items posed a potential risk to people’s safety. There was no risk assessment in place to identify or mitigate the risks associated with residents accessing this equipment. This demonstrated that environmental risks were not consistently recognised or managed to keep people safe.

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 found there were enough suitably qualified staff available to meet people’s needs safely. Appropriate recruitment checks had been completed before staff began working at the service, which helped ensure people were supported by staff who were suitable for their roles.

Staff told us that staffing levels could at times feel stretched when there was sickness; however, they explained that they worked together as a team to ensure shifts were covered and people’s care was not compromised. People’s relatives also commented on the impact of staff sickness. One relative said, “There’s a lot of sickness for staff so [person] is not getting out and about as much as before.” However, one person said, “There’s always staff around when we’re at home day and night.” We did not see evidence that people’s wellbeing was impacted by this. People were happy with the frequency they went out.

Staff felt supported to manage their responsibilities. One staff member told us, “I balance my time to ensure all my delegations as part of my role are completed. If I require an extension on anything and can’t meet a deadline, I speak to either the manager or assistant manager, who are happy to extend this for me when needed.”

This demonstrated a positive and supportive management approach, which helped staff manage their workload effectively and maintain safe care for people.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

Infection prevention and control practices were not always effective in minimising the risk of infection. We saw hand towels being used in bathrooms rather than disposable paper towels. This increased the risk of cross‑contamination and did not follow best practice guidance for reducing the spread of infection.

We found out‑of‑date food items in one property, which posed a risk to people’s health. While most environments were visibly clean, we observed some kitchen appliances that were dirty in two properties, indicating that cleaning processes were not consistently effective. In one property, we saw ants in the kitchen and conservatory areas, which increased the risk of contamination.

We also found medicated creams stored in a fridge used for food. This presented a risk of cross‑contamination and showed that medicines were not always stored safely or in line with infection control principles.

However, people’s support plans included guidance to remind staff about the appropriate use of personal protective equipment (PPE) where required. Staff we spoke with were aware of this guidance and people told us that staff used PPE appropriately when supporting them. This helped to reduce some infection risks despite the shortfalls identified in environmental and storage practices.

There was no evidence that people had been harmed by these shortfalls.

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.

Medicines were mostly managed safely; however, improvements were needed to ensure medicines were consistently optimised for people. We found that some ‘as required’ (PRN) protocols did not contain sufficient detail about people’s symptoms or clear guidance on when these medicines should be administered. This meant staff may not always have had the information needed to ensure people received PRN medicines consistently and in response to their individual needs. However, the PRN protocols were supplemented with information in people’s support plans and positive behaviour support documents.

We did not see any evidence that PRN medicines were administered excessively or when they were not required. This included the use of psychotropic medicines. Records and discussions with staff indicated that medicines were generally given appropriately and with consideration of people’s wellbeing.

People told us they were happy with how their medicines were managed. One person said, “Staff look after and give me my tablets. I like staff helping my medicines because I sometimes get confused.”

We saw that some medicated creams had been opened but the date of opening had not been recorded. This increased the risk that creams could be used beyond their recommended period after opening. In addition, temperatures of medicine storage areas were not being monitored, which meant the provider could not be assured that medicines were being stored within safe temperature ranges.

Despite these shortfalls, MAR charts were completed accurately and in full. Regular audits were undertaken, and there was no evidence of medicine errors. This demonstrated that there were some effective systems in place; however, further improvements were needed to ensure medicines were fully optimised and always managed safely.