SM Voice Advocacy 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 69 (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. Lessons were learnt to continually identify and embed good practice.
Relatives and staff felt confident in raising safety issues and told us senior staff would address their concerns about people. The provider had used incidents to make improvements and embed good practice such as updating care and support plans. Staff were informed of these through supervisions, team meetings or updates via their care application. The registered manager told us they looked at incidents individually and not overall as an analysis of trends or thematic review.
However, one of the incident reports was incomplete and did not show that it had been reviewed. it wasn’t clear if the registered manager had reviewed all the incident reports as one of the 2 supplied was incomplete. The provider was working on reviewing all incidents across both their home care and supported living services to ensure any trends or patterns could be identified and acted upon.

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.
The provider assessed people prior to starting their package of care. The provider ensured care was organised flexibly, with adjustments made to meet people’s changing needs. This included when people attended appointments, when their health needs changed or when they were admitted to or discharged from hospital. Staff told us they were always informed when people started with the service, or people came out of hospital with different needs. Information was available on people’s care plan and via messaging on their mobile care application. There was evidence of communications by the service with various organisations and professionals including hospitals, speech and language therapists (SaLT), social workers, district nurses and GPs. This helped to ensure a safe transition and coordinated care for people.

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 shared concerns quickly and appropriately with external agencies.
A person told us they felt safe with staff. A relative told us the person felt safe receiving support from staff, and they were able to raise issues if there were any. The provider had effective safeguarding policies and procedures in place. Senior staff demonstrated a thorough approach to investigating safeguarding concerns, to help reduce the risk of people suffering abuse or coming to avoidable harm.
All staff were trained in safeguarding adults and children and knew what signs to look out for and who to report this to. Staff told us it was important to make sure no abuse, or neglect was experienced and they would call the manager or on-call if they had any questions. Staff knowledge of the Mental Capacity Act 2005 (MCA) was good. This meant staff understood the importance of ensuring care was as least restrictive as possible.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.
The provider considered risks to people as part of their assessment, when the person started with the service.
Relatives told us they had been involved in creating their care plans, although one said they would like to be more involved.
Risk assessments included relevant information and guidance for staff to keep people safe. Positive behaviour support (PBS) plans were detailed and included actions for staff to take in different scenarios to de-escalate certain heightened behaviours. This promoted positive outcomes for people around their safety. Staff told us there was enough information for them to follow in people’s care and support plans and any new risks would be reported to management.

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 carried out assessments of people’s home environments to identify and reduce any risks related to the delivery of care. Staff had completed fire safety training and were aware of the procedure to follow if there was a fire.
When people’s needs changed and they required equipment to support them, the provider worked with occupational therapists to obtain suitable equipment. The provider monitored equipment including inspection frequency to maintain safety. Staff were aware of the need to check equipment prior to use.

The provider made sure there were enough qualified, skilled and experienced staff. Relatives told us consistent staff supported people. The registered manager confirmed staff retention was good.
However, some recruitment practices needed to improve. We reviewed 4 recruitment records during the inspection. Recruitment records did not always record all the required pre-employment checks to show how the provider ensured only suitable staff would support people. The provider’s recruitment policy did not detail all the checks recruiting managers were required by law to undertake. The provider started to address these concerns during the inspection.
There was limited evidence of oversight of training. Appropriate mandatory training was in place, but it was not clear when or by whom this had been completed.
New staff received an induction and worked alongside experienced staff to develop their skills and confidence. Staff did not always have an opportunity to undertake further adult social care qualifications. The registered manager told us they were working on improving this and some staff had already signed up for further qualifications.
The provider could describe the training staff were required to complete but these were not always evident on their training record to support them to monitor training requirements.
Staff we spoke with were knowledgeable and knew people they supported well.
The registered manager told us staff received extra knowledge briefings and knowledge checks during team meetings . The registered manager had organised suitable training on people with a learning disability and autistic people in line with current guidance.

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 or relatives did not raise any issues about infection prevention and control (IPC). Staff were knowledgeable about keeping people’s homes clean and reducing the risk of infection. Staff knew when to use PPE and how to dispose of it correctly. They were also clear on the benefit of good hand hygiene. There was a suitable IPC policy in place.

Although the provider endeavoured to make sure that medicines and treatments were safe and met people’s needs, capacities and preferences, they were limited by the clarity of their medication administration records (MAR) and policy. Staff involved people in planning, including when changes happened.
The provider’s medicines policy did not make it clear to staff what to do if people missed their medicines. This is needed to ensure people do not suffer harm when they might miss their medicines .
In people’s care and support plans medicines were clear, however people’s medicine administration records were not always clear on the dosage or strength of medicines.
The provider had a ‘when required’ medicine support guidance policy in place. However, individual guidance for each occasional medicine prescribed for people were not in place to inform staff how people were to be supported to take these medicines. This increased the risk of medicine errors occurring.
People had capacity assessments in place for medicines including the relevant best interest decision and guidance. The provider completed appropriate competency checks for staff to administer medicines safely. Staff were clear on the checks they needed to make to administer medicines to people safely.