Midway Supported Services Warwickshire

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 requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The provider was previously in breach of the legal regulations in relation to safe care and treatment. Not enough improvement was found at this assessment, and the provider remained in breach of this regulation.

The provider continues to need to make improvements around the safe management of medicines, and staff knowledge of the Mental Capacity Act.
 

This service scored 56 (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. However, improvements were required in relation to lessons learned.

Internal investigation reports did not always contain information on lessons learned and actions taken to reduce the risk of reoccurrence. For example, we found a number of incidents relating to staff working patterns and the impact this was having on them. When an incident had been concluded, mitigating circumstances were identified such as the number of hours the staff member worked, or gaps in the induction process. However, the mitigating circumstances were not explored to reduce the risk of reoccurrence, or any lessons learned.
 

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 had hospital passports containing personalised information about them. A hospital passport is a document designed to provide healthcare professionals with essential information about an individual's specific needs and preferences, especially when receiving care in a hospital or other healthcare setting. Staff said any new information was shared with them during handover.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They did not always concentrated on improving people’s lives while protecting their right to live in safety, free from harassment, abuse and neglect.

We found gaps in staff knowledge around the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) practices. For example, staff told us some people would not be allowed to access the community on their own due to being vulnerable. As a result, they would accompany them when they wanted to access the community. We found no MCA assessment or best interest meetings had taken place in relation to accessing the community. However, records indicated people had not been restricted as they had not asked to go outside alone.

The provider was open to feedback and had started to make the required improvements to ensure there was a better understanding around the requirements of the Mental Capacity Act and Community DoLS so that people would not subject to restrictions associated with their care without agreement or the correct authorisations being in place.

The provider shared concerns where appropriate with the relevant agencies to enable them to take any required actions to keep people safe. People told us they felt safe with the staff. One relative told us, “When I do visit, carers are with [name of person], I feel they are kept safe.” Staff received training in safeguarding people and knew what to do if they suspected abuse including how to contact the police or the local authority to keep people safe.

Staff we spoke with confirmed they had received safeguarding training and were able to state what action they would take in response to witnessing or suspecting abuse, including contacting the local authority’s safeguarding team. When safeguarding concerns were raised, the management team dealt with these appropriately and recorded all actions taken. Staff knew how to recognise abuse and protect people from the risk of harm. People and their relatives told us they felt safe with care staff who were kind, caring and good at their jobs.

The provider did not work well with people to understand and manage risks. Risks to people's individual health and wellbeing were assessed; however, improvements were required in how safety issues were managed and recorded. For example, some behaviour incident reports were not sufficiently detailed to show how the incidents had been managed to keep the person safe.

For example, medicine was administered to 1 person following an incident to help with their anxiety, but the records did not reflect this. It was therefore not clear that this intervention was appropriate or effective.
 

The provider detected and controlled potential risks in people’s homes.

People did not express any concerns in relation to the environment and were able to access communal areas and equipment they needed to support their needs to keep them safe freely.

The provider completed environmental risk assessments to check if it was safe for staff to carry out care in a safe environment. This included checks around fire safety. We saw detailed instructions for staff within care plans stating how to ensure kitchen utensils were put away safely.

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.

People and relatives told us they thought there were enough staff to support their needs. One person told us, “When I visit there is enough staff.”

We observed there were enough staff to support people. One staff member told us, “There are enough staff on duty, we try and keep the same staff supporting people.”

Staff received an induction and regular training which included mandatory training. A staff member told us, “My induction included shadowing experienced staff members. After my induction, I felt comfortable to support people, and I was given the option of extending my induction if I needed to.” Supervision and appraisals were in place to monitor performance and development. Staff participated in monthly staff meetings where they were able to share information and receive important updates about the service.

The service ensured staff had the knowledge and skills required to meet people’s needs. The provider followed safe recruitment practices and had ensured appropriate pre-employment checks were completed before staff were employed. During our visits we saw staff were not rushed and had the opportunity to respond to and converse with people in a relaxed manner. We observed staff being attentive and supportive of people’s needs.
 

The provider assessed and managed the risk of infection. However, some areas of people’s living spaces were not always kept clean.

People and relatives told us that staff attending to them would wear appropriate personal protective equipment (PPE) such as gloves and disposable aprons.
Staff confirmed they had completed training in infection prevention and control and always had access to supplies of PPE. However, we found 1 person’s bedroom had significant dirt accumulation on the bed frame. The management team told us it was due to be cleaned the following day.
 

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

National Institute for Health and Care Excellence (NICE) guidance was not always followed as several Medicine Administration Records (MAR) charts that were handwritten did not have two staff members check and sign next to the medicine. This meant if there was an error it would not be identified. In addition, we saw examples of MAR charts that had medicine handwritten on them, but no dose was present or how to give the medicine. This could put people at risk of receiving incorrect doses of medicines.

When required medicine protocols were in place however they did not always include clear guidance on how to give the as required medicine, with some missing the dose to give. Some protocols also did not explain how to assess the effectiveness of the medicine or the next steps to take based on the outcome. This lack of detail increased the risk of inconsistent care and made it difficult for staff to make informed decisions.