London Borough of Hillingdon

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.

The last rating for this key question was requires improvement. At this assessment the rating has changed to 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 enabled a learning culture. There were improvements when things went wrong. Relatives told us staff had been responsive following accidents and that staff had worked with them to assess risks to help keep people safe. Staff kept records of all accidents, incidents and concerns. Managers reviewed these to see if any lessons could be learnt. They discussed these with staff to help them reflect on the situation. When needed, care plans and risk assessments were reviewed and updated.

The registered manager told us they were reviewing the way records of adverse events were recorded. They had a new format for recording which would improve staff understanding of factors leading to and following accidents and incidents. They were also developing improved recording of lessons learnt. These records would help staff with their reflection and enhance a consistent approach to care.

Staff told us they worked well as a team, discussing incidents to learn from each other’s experiences.

The provider worked with external professionals to help ensure safe transitions between services. Staff created hospital ‘passports’, a document which included key information about people’s needs and how they communicated. These were shared with healthcare professionals to help them provide safe and person-centred care to people using the service.

Staff assessed the needs of people before they started using the service to ensure these needs could be met. They considered the different personalities of everyone using the service. A relative commented, “[The provider] always knows who would fit in well at the home.”

Staff planned personalised transitions to the service. A relative told us that the transition for their relative had been quick because of their personal circumstances, but that this had been managed well. For another person, the staff had organised a series of visits and overnight stays before their move. This had helped them become familiar with the service. The registered manager commented, “Staff are very good at encouraging people to ensure they feel settled. When [person] moved to the service, they worked hard to make sure [person] felt valued and part of the group.”

In 2024, a person was admitted for a hospital stay following an accident. They returned to the service with reduced mobility. Staff worked closely with other professionals to ensure their transition home was safe and well managed. They supported the person to reduce risks and to help improve their mobility and confidence.

The provider had systems to help safeguard people from abuse and improper treatment. Staff undertook training to understand how to recognise and report abuse. Staff were able to tell us about these processes. There were systems to safeguard people’s money. Staff had worked with the safeguarding authority to investigate allegations of abuse and protect people from harm.

Relatives told us people felt safe. Relatives trusted staff. Their comments included, “[Person] always wants to come back [to the service] after an outing. [They] would not want to do this if [they] didn’t feel safe”, “[Person] is always safe” and “Staff absolutely keep [person] safe and make sure [they are] comfortable."

The provider had requested legal authorisations where restrictions amounted to a deprivation of liberty for people who did not have the mental capacity to consent to these. Decisions around these were made in people’s best interests and for their safety.

Staff did not use any form of physical restrain or seclusion. Some people needed medicines to help them cope with distressing or worrying situations. The use of these medicines was closely monitored to make sure people were safeguarded from abuse.

The provider had systems to assess, monitor and mitigate risks. Staff carried out comprehensive assessments and developed plans to reduce the likelihood of harm. Staff encouraged people to be independent and try new things. They planned for potentially risky activities and helped people find ways to keep safe. For example, when people accessed the community, and when people learnt new practical skills. A staff member explained, “Trying new activities can be stressful for people. We look at ways to minimise the stress they may feel.” Another member of staff commented, “Safety comes first, always. Little things have changed as people have got older. We need to consider this because they are less mobile. We discuss with them extra steps to keep them safe.”

Some people expressed anxiety and distress in ways which they found hard to self-regulate. External professionals had developed guidance for staff to help make sure they responded appropriately and helped to reduce risks to people’s wellbeing. A relative commented, “Staff can de-escalate situations by distracting [person]. They know [person] well. They never use any physical restraint.”

The provider had systems to help prevent, detect and contain fires. Staff and people using the service took part in fire drills. There were personalised evacuation plans which described the support each person needed to safely evacuate in the event of an emergency. Staff regularly tested fire safety equipment. A staff member told us, “This is a safe place to work, and all the residents are safe. We rehearse safety drills.”

The provider made sure people’s home environment was safe and well-maintained. At the time of our assessment, the service was being operated in 1 supported living setting. People living there had helped to choose the décor. The service was comfortable, clean and appropriately decorated. Everyone had their own space. Comments from relatives included, “I see [person] every week and it is a good environment. They redecorate every 2 years” and “It is a nice environment; everything is fine there.”

People had the equipment they needed to stay safe. Staff carried out checks on the environment, equipment and health and safety. Risks within the environment had been assessed and planned for.

The provider ensured enough staff were deployed to keep people safe and meet their needs. There was good staff retention. People using the service and their relatives knew staff well. Comments from relatives included, “They are always well staffed”, “A lot of the staff have been there longer than [person]” and “There are always loads of staff and they know [person] so well.” We saw people were relaxed and happy with staff.

The provider had systems to ensure the safe recruitment and selection of staff. These included checks on their suitability and identity. Staff undertook a comprehensive induction and regular training to help ensure they understood about best practice. Managers assessed staff competencies and skills. Staff had regular individual and group meetings with managers to reflect on their work and discuss the service.

The provider had systems for preventing and controlling infection. They employed housekeeping staff who worked at the service daily. The service was clean and there were appropriate systems for waste disposal. People using the service were supported to take part in cleaning their rooms and managing their laundry. Staff provided appropriate support and guidance. All staff undertook training about infection prevention and control. They had a good understanding about this. Staff had the equipment they needed to help manage infections. There were regular audits of cleanliness as well as checks on water safety.

At our last assessment, we identified improvements were needed in the way medicines were managed. At this assessment, we found the provider had made the necessary improvements.

The provider ensured people received their medicines safely and as prescribed. There were appropriate systems for obtaining, storing, administering and disposing of medicines. Staff were aware of these. Staff had training to understand how to safely manage medicines. Their competencies and skills were assessed to check they followed procedures.

Some people were prescribed medicines to be taken when required (PRN) for pain, constipation or anxiety. There were clear protocols for staff to identify when these were needed. Medical professionals had helped staff develop and review these protocols.

Staff kept records to show when medicines had been administered. They recorded the application of medicated topical creams and patches. There were appropriate systems for managing these. The provider audited records to ensure medicines were managed appropriately.

People’s medicines needs and health were regularly reviewed by their doctors. Staff alerted doctors when they had concerns about people’s medicines. A staff member described how they had recognised a change in 1 person’s needs. The person was unable to use words to describe what was wrong. The staff worked with the doctor to identify possible causes. They tried new medicines and monitored the effect of these. The result was the person became more settled, and the medicines appeared to be helping them.

The provider worked with people using the service, their families and other professionals to monitor whether they were prescribed the right medicines. This included working with others to follow the STOMP (stopping overmedication of people with a learning disability, autism or both) principles.