Archived: Alderwood L.L.A. Limited - Cransley

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• 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

We identified 3 breaches of the legal regulations in relation to safeguarding, safe care and treatment, and staffing. These were continued breaches of regulation.

This service scored 31 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People were not protected from abuse or avoidable harm and staff did not always report concerns to relevant safeguarding authorities. Staff did not always understand what constituted a safeguarding concern, and there had been a lack of analysis to learn from the causes of incidents. At the time of the assessment the Service was part of a large scale enquiry and colleagues from the provider were working with partner agencies to address the concerns regarding the previous high level of safeguarding events

Staff we spoke to were not always clear about where they could find information related to safeguarding in the home. We were not assured that some incidents of self-injury were not triggered by inappropriate support to people from staff. Staff we spoke with told us; they had not always felt safe and had not been able to keep people safe from each other. They said, “Everyone seemed panicked in their own home. It was not a homely environment”. As people moved to other care services staff stated that the home was much safer and calmer.

We observed staff working to keep people safe in the environment whilst they were waiting to be moved to other providers. We saw improvements in medicine processes from a previous high level of safeguarding concerns in this area.

Not all safeguarding incidents been reported to LA and or CQC in a timely manner. We identified incidents between Aug-Dec 2024 on providers RADAR incident report which had not been reported.

The information staff completed in a person’s bowel monitoring chart did not contain enough detail required to assess if they were constipated. We also found a note in the person’s daily diary that they had not drunk enough fluids, but there were no further actions about what staff should do. Management and staff told us and records showed the person had recently experienced extreme distress and self-injury to their head which required paramedics to attend, resulting in a prescription to manage constipation. Records showed the service supported people to access health care appointments and a care plan and risk assessment was in place in relation to a person’s food allergy. Records showed a person had been assessed for their swallowing needs in February 2024 and a risk assessment was in place to reduce the risk of choking.

The service told us they did not use restrictive physical intervention; however, they could not demonstrate how this approach met people’s individual assessed needs. One person had a known risk of head injury when they were distressed. There was no risk assessment documented about the use of physical intervention when the person was in crisis to prevent them causing themselves serious harm. The provider confirmed that for this person the team did not use, and were not trained in any specific physical interventions, but that other strategies and a range of interventions were in place to manage the risk of injury.Staff we spoke to also told us no restrictive practices were in place, and we were not assured they understood the meaning and rationale of these.

We observed staff supporting all people preparing for bed at 19:10 and everyone was in bed at 20:30. One person appeared unready to sleep and was followed by staff between their bedroom and the staff office looking at YouTube on their iPad until we left at 22:45. The deputy manager told us the person regularly doesn’t sleep until 2am and wakes between 12 noon 13:00. They said the waking night staff supports the person to access their iPad or snacks from the kitchen and the service had implemented a sensory light to be set at red and dim at night to promote sleep. We saw this light system was also in place for another person who was in bed but not asleep when we checked at approx. 20:30. The deputy manager told us that people were used to getting ready for bed as part of their routine directly after their evening medicines. They told us people had not been asked what they would like to do and said there were no communication pictures about this to offer people different opportunities or choices.

The service did not work well with people to manage risks. Although people had some risk assessments in place we were not assured that these were sufficient to prevent people experiencing avoidable harm.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We looked at 5 staff files in relation to recruitment and staff supervision, and the training matrix. The provider had not ensured there was safe staffing in place, and risks to people had not been identified through recruitment practices. Staff had limited knowledge of how to communicate with people, which could be used to improve their quality of life and help to deescalate incidents of harm. Staff were not always sufficiently skilled or experienced to meet people’s needs. We asked a member of night staff to describe a person’s sensory needs, but they did not understand what we meant by sensory needs. This demonstrated a need for further training for some staff in relation to autism and potential sensory needs. We informed the manager who told us they would take action to address this with the staff member. Managers knew that staff needed to improve their skills to communicate with people.

The provider had failed to ensure staff were suitably qualified, competent, skilled and experienced. This had also been reported in the previous inspection, but limited action had been taken until September 2024. The covering manger advised us that: “An audit was completed by our on-boarding and HR team on 24/09/2024, at this time it was identified multiple staff files had discrepancies........”. The provider had now acted, and risk assessments were in place for staff who had been identified as not having adequate recruitment paperwork on file.

One member of staff we spoke to was pleased with the training they had been offered.

Another staff member advised us the previous manager had not been approachable or helpful, but now they felt they would be listened to if they had any concerns.

Staff did not receive support in the form of continual supervision, appraisal and recognition of good practice. Supervision did not take place regularly. The provider had not checked staff's competency to ensure they understood and applied best practice in their support. We saw the terms Learning Disability and Learning difficulty used interchangeably in people’s care records by senior staff.The provider informed us the staff who used these terms in this way were no longer employed by the service.

Provider processes had failed to recognise a breach in recruitment which had caused people who lived at the service to be at risk. Whilst policies were in place these had not been adhered to. We saw the steps which the provider now had in place to offer some assurances this could not happen again.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Medicines used ‘when required’ (PRN) to alleviate anxiety or agitation were used infrequently and always in combination with de-escalation techniques. Protocols to support staff when making decisions about using these medicines were available and person centred.

Staff understood people’s preferences on how they liked to take their medicines. People had regular review of their medicines by psychiatric services and annual health checks were completed.

Staff understood people's needs and how to support them when they became distressed. Staff told us that they felt supported by their senior leaders.

People were supported by staff who had been trained and assessed as competent in medicines administration. The service shared a sample of their medicines related incidents, and we were assured that appropriate actions had been taken share learning and prevent incidents from recurring.

Staff told us there was an open reporting culture for incidents and they understood duty of candour.

Medicines were stored securely and safely. Room temperatures where medicines were stored were monitored. People were given their medicines on time and as prescribed.

Care plans contained information about how people liked to take their medicines, what medicines they were taking and what they were for.

Medicines related audits were completed monthly and issues identified were actioned in a timely manner. A medicines policy was available and accessible to staff.