Imagine Act and Succeed

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 84 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice and ensure people were safe.

Staff understood how and when to report accidents and incidents. There was an open culture where staff were encouraged to report any issues of concern. The management team investigated incidents, accidents and near misses to take actions to keep people safe and learn lessons where required.

People and their families told us they felt staff were well trained and knew how to support them. One relative told us, “There is a culture of continuous learning… every time we have things happen to (relative), they are always very committed to helping [relative] and in [relative] best interests.”

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

Robust arrangements were in place for transitions into the service. Care and support plans and risk assessments were discussed and individually planned with the involvement of people, their relatives and professionals and were paced at an appropriate level for the person. Transitions plans could take as long as six months, where required, to ensure people received the right support and the placement was suitable. People were invited for dinner visits and sleepovers to test out the suitability of the placement for example.

We received positive feedback from people and families about the transition into the service. One person told us it was, “Good, we had various meetings with staff in the service, I met co-tenant prior to moving in, good process. Yes, they were very forthcoming and any questions we had they were very responsive”. Family told us, “They (IAS) supported [relative] at home first so [relative] would get used to them”. Another parent told us, “Family were involved in the transition process organised by (the Local Authority). A meeting was carried out. All our family were included in having a say in his requirements”.

When people did leave the service, or transitioned between the supported living homes, this was always supported with careful person-centred planning and consideration of their needs and any risks. Professionals advised us that a recent transition had incorporated compatibility with peers, a lessening of restrictions and a reduction of formal support.

Hospital passports were accurate, concise and clear. Referrals to external agencies were always made in a timely manner and were clearly documented. Where required, preparation work was completed with people for any upcoming meetings. Staff understood the Equality Act 2010 and supported people with reasonable adjustments. These actions ensured professionals had the best possible opportunity to provide people with the correct support.

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 promoted a safe environment and a positive culture. People and families told us they felt safe. People and families were provided with safeguarding information and tenant’s meetings supported people to understand safeguarding and the importance of boundaries between people and staff. A parent wrote to us to say, “IAS provide a safe, well managed environment, which always has [relative] safeguarding at its heart. The home is a well-managed, safe environment for all of the residents.”

The provider shared concerns quickly and appropriately with the local authority, other professionals and families. During the assessment we had identified a small number of safeguarding cases had not been submitted to CQC. These were all submitted during the assessment and measures taken to ensure future compliance. The provider had a strong and effective relationship with the local council safeguarding team. People had not been harmed, and appropriate actions had been taken by staff after each incident to keep people safe.

Staff had access to policies and procedures in safeguarding. Staff were supported through their induction and training to understand their safeguarding responsibilities. We discussed safeguarding with 16 staff and checked their learning in practice. They understood their responsibilities and how they should report concerns. Professionals who worked with the provider were confident in the organisations ability to recognise and manage safeguarding matters. They informed us work was carried out to a high standard with detailed protection plans put in place when required.

People’s rights were upheld, and staff training included the Mental Capacity Act and Equality Diversity. There was a clear understanding of the Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act. Restrictions were kept to a minimum and best interest decisions were made to support people safely.

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

Risk assessments were person centred and developed in partnership with people, their families, staff and professionals. Peoples wishes and views were clearly reflected in all the documentation we reviewed. Effective risk management and tailored support meant that people had achieved their goals. People had been supported to go on holidays, a cruise, independent travel, gain employment and increased levels of independence.

One staff team identified distress as a potential side effect of one person’s medication. The staff team worked closely with the person to support them through changes to their care plan. The medication was initially reduced and then eventually discontinued. This led to improved health and well-being for the person along with a reduction in distress and a reduction in the restrictions to support the person’s distress. The person’s life has been transformed. Previously, access to the kitchen and food had been restricted. This had been removed and they were now able to dine in the community when they had not been able to before.

People and families were happy with risk management plans. One person told us, “They do have risk assessments for everything they do with [relative], if something is new there’s a risk assessment, I’ve seen a folder with all of them in it…They do risk assessments to manage his safety.” A professional told us, “I feel confident that any recommendations that I make will be carried out and that staff will contact me in a timely manner should they have any concerns. For example, when working with person who is at risk of choking the home contacted me quickly after another choking episode and we have worked together to reduce the risks of the person choking again”.

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

The provider had systems in place to check the home environment was safe. They had a robust annual assessment of people’s homes and liaised closely with housing providers. This included up to date safety certificates for gas, electric and regular checks of fire safety equipment. People and staff told us they had fire drills day and night, and appropriate equipment and evacuation plans were in place.

The provider sometimes depended on housing associations to complete work and measures were needed to ensure any outstanding work was escalated when it had not been completed. Any issues identified were followed up during the assessment.

The provider had worked closely with people to ensure their home environments remained safe and habitable. People homes were well maintained, clean and provided a safe and comfortable environment.

The provider made sure there were always enough qualified, skilled and experienced staff, who received excellent support, supervision and access to development opportunities. They worked together well to provide safe care that met people’s individual needs.

Staff were recruited safely and had the appropriate pre-employment checks in place before employment commenced. The provider used a specialist reference agency that utilised technology as a further aide in the vetting process and staff made an annual declaration of their continued safety to work.

The providers values were promoted throughout the recruitment process. Staff vacancy levels were low, and staff retention was very high. There were a significant number of employees who had worked for the company for more than a decade. Staff retention was a key strength and helped to ensure people received consistent support form staff they were familiar with and who knew them well.

The impact of values-based recruitment was evident throughout the entire organisation. Staff were positive about their roles, the people they supported and the management team who supported them. Staff told us they felt valued, and they were treated with care and consideration by senior managers. They said they ‘loved’ their jobs and focused on the impact they were able to have on people’s lives. Staff told us, “I love working here. I am valued and they focus on my strengths. They give me additional support if needed. I feel listened to. It is like a family… I enjoy coming to work.”

Training was completed before staff worked with people and was maintained throughout the course of their employment. Staff and people were matched on their skills, personalities and their cultural needs. There were opportunities for additional training and career progression. All the management within the organisation had started as support workers. This also meant they had real insight into the role of the staff they managed and the people they supported.

People and the families we spoke with were overwhelmingly positive about the staff. They told us the homes were staffed, with kind, experienced and consistent staff. One person told us their family member, “Feels safe around staff. They are all open and honest. [Relative] looks to them as friends”. Another told us, “Staff have a lovely attitude and great communication skills” and “When I observe them, they appear competent, I have no worries about them”. A family member of another person told us that, “They (staff and managers), really try to help us, I think it’s important for families like us to have cooperation with all parties involved. They engage with all the people in (person’s) life. There is always management cover, I get a response quickly, the office staff are great.”

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.

People were supported by staff who had received training in infection prevention and control. Where one outbreak had occurred, appropriate contact had been made with professionals, and we observed that measures had been put into place and were followed through.

Overall, the properties we visited were clean and equipment was maintained appropriately. Cleaning schedules were tailored to the abilities of the people who lived in each house. When staff cleaned there was not always a system to identify when the cleaning had been carried out. One property had a couple of minor issues that were rectified during the assessment. A second property had a fridge that was above the accepted temperature range. The temperature had been recorded but action was not taken to rectify this. Managers had plans to meet to discuss these shortfalls further and to ensure processes were reviewed and any required changes made.

Medicines were managed safely. People were supported by staff who followed systems and processes to prescribe, administer, record and store medicines safely. Staff who administered medicines had been trained to do so and staff had regular competency checks to ensure procedures were followed.

People were encouraged and supported to self-administer medication where possible and staff completed checks to ensure compliance. Medicines were accurately recorded and audits ensured they were administered as prescribed.

The provider followed the principles of STOMP (stopping overmedication of people with a learning disability, autism or both) and had evidenced their involvement in this practice.

Systems were in place to ensure lessons were learned in response to any errors.