Total Health Support and Training Services Limited

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 75 (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 promoted a positive culture of safety, openness and learning. There were systems in place to record, review and monitor accidents, incidents and safety concerns. Records showed incidents were reviewed by the registered manager and actions were identified where required. People and their relatives told us they knew who to contact if they had concerns about safety and said they would approach the care manager for support. Staff understood their responsibilities for reporting accidents, incidents and safeguarding concerns. The provider encouraged learning following incidents and concerns. Lessons learned were shared with staff through team meetings, handovers and training sessions. Records of staff meetings demonstrated staff discussed case studies and scenarios, including occasions when people communicated distress, to encourage reflective practice and maintain safe, consistent approaches to supporting people. This supported a culture of continuous learning and improvement across the service.

The provider worked with people and relevant healthcare professionals to help establish and maintain safe systems of care. Processes were in place to support continuity of care when people moved between services, including during hospital admissions and discharges.

Before care commenced, assessments were completed to ensure the provider could meet people's needs safely and effectively. Staff told us they received sufficient information to enable them to support people safely and understood their individual needs and risks. The care manager described how they worked collaboratively with people, relatives and external professionals to help ensure care remained coordinated and responsive to changing needs. Records showed professional recommendations were incorporated into people's care and support arrangements where appropriate.

The provider demonstrated an understanding of the importance of partnership working and continuity of care to support safe transitions and positive outcomes for people.

The provider worked with people and partner agencies to understand what being safe meant to them and how best to support this. Staff promoted people's rights to live safely and free from abuse, discrimination, avoidable harm and neglect. The provider shared safeguarding concerns promptly and worked with relevant agencies when risks were identified.

Staff demonstrated a good understanding of safeguarding and were able to describe the different types of abuse people may experience. Staff had completed safeguarding training and were confident in recognising and responding to concerns. One staff member told us, "The training covered different types of abuse and neglect, recognising signs and indicators of abuse, reporting concerns, safeguarding procedures, whistleblowing, professional boundaries and the importance of protecting people from harm." Staff were familiar with the provider's safeguarding and whistleblowing procedures and told us they would report concerns to a manager or external agencies where necessary.

The registered manager understood their responsibilities for responding to safeguarding concerns, undertaking investigations and making referrals to the local authority and other relevant agencies when appropriate. People told us they felt safe receiving support and knew who to contact if they had concerns about their care or wellbeing.

The provider worked with people to identify, understand and manage risks in a holistic way. Staff delivered safe, supportive care, enabling people to pursue activities and routines important to them.

Risks were assessed with people wherever possible, and measures were implemented to reduce identified risks while promoting choice, independence and positive outcomes. Personalised risk assessments reflected people's individual needs and circumstances. Appropriate arrangements were in place to ensure equipment and the environment supported the delivery of safe care.

Relatives told us staff had a good understanding of people's individual risks and took appropriate steps to manage these while supporting their independence. One relative described staff as having an excellent understanding of their daughter's complex needs and behaviours. They explained staff carefully assessed risks and adapted their approach according to changing circumstances. Another relative told us activities and outings were risk assessed and said staff were "very accommodating" in supporting their loved one and understood the best way to interact with them when their mood was low.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. They took appropriate action to ensure equipment and technology used to support people remained safe and suitable for their needs. Environmental risk assessments were completed to identify potential hazards to people and staff within people's homes. Where risks were identified, measures were implemented to reduce the likelihood of harm and support safe care. Records demonstrated environmental risks were reviewed and acted upon appropriately.

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 tailored to people’s individual needs. Staff received appropriate support, supervision and opportunities for development to help them carry out their roles effectively.

Records confirmed staff completed a structured induction and received regular supervision and appraisal to support their performance and professional development. Staff told us they had regular 1-to-1 meetings with their line manager and access to training to keep their skills and knowledge up to date.

People were supported by staff who had been recruited safely. Recruitment records showed the provider carried out appropriate pre-employment checks, including criminal records checks, verification of employment history and obtaining references before staff commenced work.

The provider had systems and processes in place to reduce the risk of infection and support the delivery of safe care. Staff received infection prevention and control training and were provided with guidance to carry out their roles safely. Records demonstrated infection prevention and control practices were monitored through spot checks. People told us staff used appropriate personal protective equipment (PPE), including gloves when providing personal care.

The provider ensured medicines and treatments were managed safely and in line with people's needs, capacities and preferences. Staff involved people in planning their care and support, including when changes were required.

The provider ensured medicines were managed safely through staff training, medicines audits and medicines administration records (MARs). These showed staff had the knowledge, skills and oversight required to support people safely with their medicines where this formed part of their support arrangements. Medicines governance systems were in place to monitor practice and support the safe management of medicines.

One relative described staff as "very on the ball" regarding their relative’s healthcare. They explained they managed the person’s medicines well and carefully coordinated medicines by ensuring medicines administration records were completed appropriately.