TLC Support 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 72 (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 and leaders listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Systems were in place to record accidents and incidents and share learning. The service had not had any accidents and incidents reported in the last 12 months. However, staff were aware of systems to report these and confirmed learning was shared with them, through meetings or email correspondence.
 

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Staff and leaders made sure there was continuity of care, including when people moved between different services.

The service liaised with health professionals and other care providers to support people’s needs. Emergency care records were being implemented to support people if they required transfer to hospital.

People and relatives said staff always attended and followed pre agreed times, with rotas shared in advance.
 

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff and leaders 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.

Staff understood safeguarding and whistleblowing procedures and training was provided. They were confident to report concerns and escalate if needed. Staff described a culture where they could raise concerns and be heard, helping maintain a focus on safe standards of care.

Safeguarding was discussed in staff meetings. Leaders demonstrated awareness of restrictions and when these might require authorisation and provided examples. Although there had not been any safeguarding concerns reported in the last 12 months, the management team had systems and processes in place to deal with these in the event they arose.

People and their relatives consistently said they felt safe with staff, with comments such as, “I feel safe with them very much so” and “I feel [person] is safe… they are considerate and kind”.
 

The provider worked with people to understand and manage risks by thinking holistically. Staff and leaders provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People were involved in decisions about their care and risk management. Care plans were agreed with people and their relatives. These included details about personal preferences, routines and some risk measures. Risk assessments covered areas such as moving and handling, medication, nutrition and hydration and environmental safety. Staff encouraged independence while mitigating risks. For example, a person was supported with positive risk-taking related to a health condition they lived with.

Some information provided to staff in care documentation needed strengthening, such as including how a person presented when their health condition fluctuated and support required to maintain skin integrity for another.

Staff and leaders knew people very well and they were supported by a small consistent team. The minor improvements required had no impact on people’s care.
 

The provider detected and controlled potential risks in the care environment. Staff and leaders made sure equipment, facilities and technology supported the delivery of safe care.

People’s home environment was assessed before the care package commenced and risks such as fire safety were identified. Risk assessments for infection control, fire, and the control of substances hazardous to health (COSHH) were in place and regularly reviewed. Lifeline systems, where used, were tested monthly to ensure emergency support was accessible.

Environmental risks were escalated when required, including referrals to the fire services for people at increased risk due to mobility or sensory impairments. Staff were familiar with people’s homes and supported them safely during moving and handling tasks with appropriate equipment and training.
 

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff and leaders worked together well to provide safe care that met people’s individual needs. However, some improvements were needed to records related to safe recruitment processes.

Staffing levels were sufficient to meet people’s needs, and rotas were planned to ensure continuity.

Systems were in place to ensure staff received training suitable for their role and that they have the required qualifications or experience. This included mandatory training on learning disabilities and autism in line with legal requirements. Staff were receiving supervisions and their practice and competencies were checked.

Staff received induction, robust shadowing and competency checks when they commenced employment. Recruitment checks were completed before staff started work, and the provider ensured staff were appropriately supervised until all checks were received and they were assessed as competent to work on their own. However, we identified that recording of safe recruitment processes required some strengthening. Some records did not evidence reasons for leaving previous roles involving children and vulnerable adults, and records of Disclosure and Barring Service barred list checks were incomplete. One staff record lacked a full employment history, and risk based decisions for staff working while pre employment checks were outstanding were not consistently documented. The registered manager told us they had already taken action to improve recruitment records for future staff following our feedback.

People and their relatives were positive about staff skills and reliability. Comments included; “I think they know what they're doing. If they are new, they shown what to do by an experience carer.” and “The staff are competent. I have learned very much from them. They've definitely had training. I am a 100% happy with what they do.”
 

The provider assessed and managed the risk of infection. Staff and leaders detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The provider followed infection prevention and control (IPC) procedures, including personal protective equipment (PPE) use, disposal of clinical waste and sharps handling. IPC risk assessments were in place for people, and staff were observed to be following safe hygiene practices during spot checks.
 

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff and leaders involved people in planning, including when changes happened.

Medicines management systems were safe. Medicines administration records were completed without gaps, with regular audits and alerts generated if tasks were missed. Staff received medicines training, shadowing and competency assessments before administering medicines.

Care plans included information about how people preferred to take their medicines. Staff were confident in describing the processes they followed to safely support people with their medicines and knew what action to take if someone refused their medicines.

Records related to the rotation of transdermal patches and their application required some strengthening to ensure staff had the required information to apply these correctly.

Risk assessments related to flammable creams and ointments where in place for most people who were using these, however missing for one person.

A person’s relative told us; “[Person] is very independent and they let [person] do things. They're [staff] not interfering. For example, [person] has a dossett box for [their] medication, and they give it to [them]. But [person] does some self-administration. But there’s some prompting also. It's all written down.”