Stable Lives

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 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 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.

Accidents and incidents were recorded and analysed to ensure trends and themes were identified. Actions were taken to mitigate future risks, and learning was shared to drive improvement at the service. Staff knew what action to take to report incidents and were confident that action would be taken. The management team were knowledgeable about their duty of candour and ensured they were open, honest and transparent when things went wrong.

Regular audits were completed to allow oversight and monitoring of the service. We recommended the management team review their monthly audit system to provide easier tracking of themes and trends from month to month. The management team agreed to action this immediately.
 

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.

Information in care records provided sufficient guidance to staff to allow them to support people safely and allow effective information sharing if shared with other parties.

Detailed assessments were completed prior to support commencing with input from people, family and other professionals.
 

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.

Effective systems to provide oversight of accidents and incidents including safeguarding’s were in place. Records showed safeguarding concerns were reported promptly to the local authority and notifications submitted to CQC.

Staff had completed safeguarding training and the provider’s safeguarding policy guided staff about different types of abuse and how to raise a concern to ensure people were protected. One staff member told us, “We have a whistleblowing policy that we follow. Firstly, I would follow the safeguarding procedure, reporting it immediately to my line manager or safeguarding lead, recording the concern accurately and escalating if needed to external agencies such as social services.” Another staff member commented, “Recognise the signs of abuse they might be facing. Then act on it by responding calmly and sensitively and report concerns to my safeguarding lead or manager or the police if its immediate danger on 999.”
 

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 to people's health, safety and well-being were well managed. There were processes in place to identify risk, which then led to detailed plans being put in place for staff to follow to reduce or remove risk.

People's risk assessments were reviewed regularly or as required, such as in response to their changing needs or after a significant event.

Staff had completed a range of training including positive behaviour support training to support with managing risk. One staff member told us how they supported people with behaviours of distress, “Providing general emotional support to service users especially when they are feeling stressed, anxious or agitated. Offering them a listening ear, reassurance and encouragement. Finding out what could make them better and how best they would want to be supported. Using the best methods to deescalate and redirect them when agitated.”
 

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

Safety checks of supported living properties and equipment were completed which included daily checks for hazards and repairs as well as routine checks for fire. Maintenance logs were kept of repairs reported to the landlord with records of follow up when needed. People were supported to be involved in managing risk in their home including taking a lead in scheduled fire drills.

People had personal emergency evacuation plans [PEEPS] in place to ensure they could evacuate their home safely in an emergency. We asked the provider to seek guidance from the fire service regarding types of locks on exit doors to assist with safe evacuation.

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.

Recruitment procedures were in place, so people were cared for by suitably qualified staff who had been assessed as safe to work with people. However, it was noted that employment history for some candidates did not always provide sufficient detail or include all information from leaving school. On occasions where references were not provided by previous employer’s, risk assessments were in place but required more detail around how the risk was to be mitigated. The provider agreed to action this immediately.

People, relatives and staff raised no concerns about staffing levels. One relative told us. “Never not been without. Reasonably consistent with some staff turnover, which is natural but have shadowing.” Another relative commented, “Always has two people with [person] at all times.”

Staff told us they received a comprehensive induction when they commenced employment which included training, discussions and shadowing. One staff member told us, “It was a detailed discussion of the techniques and methods that I was to use to support individuals that I was working with. Every detail of the care plan was discussed, and I had the opportunity to ask questions. The induction also came with days spent working with more experienced staff members who helped me gain practical experience.

People were supported by staff who were trained and competent to deliver safe care. Staff working with adults with a learning disability or autistic people had completed training in learning disability and autism which was in line with the Oliver McGowan Code of Practice.
 

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.

Audits were in place which checked the cleanliness of the environment and equipment.

Staff received training on Infection Prevention and Control (IPC). One staff member told us, “I have learned lessons on infection control. It taught me to sanitise surfaces, wash hands, wear protective clothing and keep things clean at all times.”

No concerns were raised by staff about the availability of personal protective equipment (PPE).

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.

Staff were trained in medicines administration, and their competency had been assessed. People were supported by staff who followed systems and processes to administer, record and store medicines safely.

Where people had been prescribed medicines on an ‘as and when’ required basis, often referred to as PRN. PRN protocols were in place to ensure they were administered safely.

We noticed recording for one PRN medicine recorded on a record sheet for Homely Medicines as a Medication Administration Record (MAR) was not available. We discussed this with the provider who actioned it immediately and put revised systems in place to prevent this happening in future.

Care records were person centred and evidenced medicines being reviewed by prescribers in line with the principles of STOMP (stopping over-medication of people with a learning disability, autism or both).