Active Support Service Ltd

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 changed to requires improvement.

At our last assessment we rated this key question as good. At this assessment the rating has changed to 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.

This service scored 59 (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. We saw that feedback and day-to-day practice was discussed and used to strengthen the quality of care. People’s relatives told us there had not been any adverse events but that they had confidence in the management team to address any issues quickly and effectively. Staff spoke positively about the support they received from managers and described a culture where continuous improvement was encouraged. One staff member said, “incidents are dealt with quickly, keeping me well informed by calling me or an email.” The systems in place supported a consistent, good learning culture across the service.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care

The management team and people’s relatives told us they worked closely with other stakeholders involved in people’s care to maintain safety and ensure continuity when people moved between services. This included engaging with health professionals, social workers and specialist teams to share information and coordinate support. However, despite these positive working relationships, we did not see evidence that competency checks had been completed for delegated healthcare tasks. These are clinical activities normally performed by a registered professional but formally assigned to a trained, competent care worker to carry out under the professional’s guidance and accountability.

This meant the provider could not demonstrate that staff had been assessed as competent to carry out specific clinical tasks safely and in line with relevant guidance. The absence of documented competency assessments increased the risk of inconsistent or unsafe practice and limited the provider’s ability to assure themselves that delegated tasks were being performed appropriately. We did not see any evidence that people had been harmed because of these shortfalls. Staff and relatives told us they felt people were safe, and there was nothing indicating that the lack of documented competency checks had led to unsafe practice or negative outcomes.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

Staff understood how to keep people safe and were confident in recognising and reporting any concerns if they arose. They were aware of safeguarding procedures and described how they would escalate issues to ensure people were protected from abuse, neglect and avoidable harm. One staff member told us, “I check for signs and changes during all of my visits. I write my concerns in my notes and report straight away.” Relatives also told us they felt staff promoted people’s safety and acted quickly if they identified any changes or concerns. One relative said, “[they are] absolutely safe. I have complete trust in them (the staff).”

However, where there was reason to believe that people lacked mental capacity to make specific decisions, there was insufficient evidence that decisions had been made, reviewed or recorded in line with the requirements of the Mental Capacity Act 2005. Records did not consistently demonstrate that the decision in question had been clearly identified, that a capacity assessment had been completed, or that any subsequent decision had been made in the person’s best interests involving appropriate representatives. This lack of documentation reduced the provider’s ability to evidence that people’s rights had been upheld in line with the legislative safeguarding framework. However, feedback from relatives indicated that in practice decisions were being made in a way that protected people’s rights. One relative said, “the staff know if [person is] not in the mood. If [person is] resistant to care they will put on music and dance with them. Staff do whatever [person] wants to do.”

The provider did not always work well with people to understand and manage risks.

Staff understood how to manage risks and described the actions they took to keep people safe. People and their relatives told us they felt safe, and we did not see any evidence that anyone had been harmed. People and relatives also told us they were involved in discussions about risks and how these should be managed, and they felt staff listened to their views.

However, the documentation did not always support this. Risk assessments did not consistently identify all risks posed to people or reflect the steps staff took in practice to mitigate these. In several cases, the records did not show how people or their relatives had been involved in the risk assessment process, despite their feedback indicating they were actively engaged. This meant the provider could not fully evidence that risks were being managed in a personcentred way or that people’s preferences and insights were routinely incorporated into written assessments.

The provider did not always detect and control potential risks in the care environment. Environmental risk assessments were not documented within people’s care plans, meaning there was no clear written guidance setting out the environmental risks relevant to each person or how these should be managed. This reduced the provider’s ability to demonstrate that risks within people’s homes had been formally considered and reviewed.

Checks of equipment were in place to ensure items were in good repair and serviced regularly. However, there was a strong reliance on staff using their common sense to identify environmental concerns and feeding these back to office staff when issues arose. While staff told us they felt confident to raise concerns and we did not see any evidence that people had been harmed, the absence of structured, documented environmental risk assessments limited the provider’s assurance that all risks were consistently identified and managed.

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. Evidence showed that safe recruitment processes had been followed, ensuring staff employed were suitable and had the necessary checks completed before working with people. Staff told us they had received the right training and felt they had the knowledge and skills required to provide safe and effective support. They said they felt well supported by the management team, who were approachable and available when guidance was needed. One staff member said, “training is good and we have plenty of it. I learn new things every time.” People and their relatives told us staff were reliable and arrived on time, which helped ensure continuity of care. One relative said, “[staff] are knowledgeable. The personal relationship with [person] is good. [There is a] good balance between being professional and supportive.”

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.

Staff understood how to prevent and control the spread of infection. They were knowledgeable about safe infection prevention practices. People and their relatives told us staff used personal protective equipment (PPE) appropriately and followed good hygiene procedures.

The provider did not always make sure that medicines and treatments were supported by clear guidance to ensure they were administered safely and consistently. There were no PRN (as required) protocols in place to guide staff on when PRN medicines should be offered, what signs or symptoms to look for, or what nonmedicinal interventions should be tried first. This increased the risk of inconsistent practice.

Despite this, people and their relatives told us they received their PRN medicines when they needed them, and staff were able to recognise individual signs that indicated when support was required. For example, staff were familiar with one person’s specific body language that signalled when they needed their “as required” medicines, demonstrating staff’s knowledge of people’s needs in practice. One relative said, “they can see on [person’s] face and can recognise when they need PRN medication.”

However, we did not see evidence that competency checks had been completed for medicines administered through a PEG tube. Without documented competency assessments, the provider could not demonstrate that staff were suitably trained and skilled to carry out this clinical procedure safely and in line with best practice. It was rare that medicines needed to be administered via this route and no evidence that people had been harmed because of the lack of competency checks.