The Grange Supported Living Service

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 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff and leaders told us that they understood their responsibilities and that they worked together to reduce the risk of incidents being repeated. Staff told us they felt able to speak up about concerns relating to people’s care. We found a management team which took our findings on-board to address minor areas we identified during the inspection. One member of staff told us, “If someone hurt themselves, [we look at] how we can minimise the risk happening again.”

We found the service had systems in place to learn from events. This included learning from incidents, ensuring there were systems in place to report ‘duty of candour’ incidents, monitoring of medicines and healthcare products regulatory agency (MHRA) alerts, reporting of injuries, diseases and dangerous occurrences regulations (RIDDOR) notifications and reporting to other relevant bodies such as the local authority and the Care Quality Commission. The ‘duty of candour’ requires registered providers and registered managers to act in an open and transparent way with people receiving care or treatment from them. Staff had completed accident and incident reports which included the action taken in response. The management team undertook an accident and near-miss incident analysis to look at lessons learnt and future recommendations.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff understood their responsibilities in relation to safeguarding and had completed relevant training. Staff were able to explain the signs and what they would do if they suspected abuse. One member of staff told us, “Unexplained bruising - I would report it to my line manager. I would go to safeguarding myself.”
Leaders understood their responsibilities in relation to reporting incidents to the relevant bodies, such as the local authority’s learning disability and autism services. Staff knew how to access the provider’s whistleblowing procedure and relevant policies. Staff received relevant training and understood their responsibilities under the Mental Capacity Act and in relation to consent. One member of staff told us, “Their decisions are their decisions. If they say they don’t want to do something, then they’re adults and they have the capacity to make that decision.”

We found the service had systems in place to protect people from abuse and neglect. The service had whistleblowing and safeguarding policies and processes in place which were available in different formats. The provider shared concerns appropriately with the relevant authorities. The provider worked with the local authority and other agencies when concerns were raised.

We found risks in relation to people’s care were managed effectively whilst empowering people to make choices about their care and maintaining their independence. People told us they were involved in the management of risks and this had positive outcomes for them, including maintaining their independence and dignity. One relative told us, “Staff use reasoning and skill to pursue with [person] what [person] wants to do. [Person] is not very verbal. [Staff] are clever at presenting material in a non-pressured way. They don’t say ‘no’. They explain reasons why.” Another relative commented on the impact of a person’s risk management strategy which they had been supported with by staff, “This has improved access, maintaining [person’s] independence and dignity”.

Staff had worked with people and their relatives to understand and manage risks in relation to their care. Staff told us they had time to read and contribute to people’s care records, and that they reviewed people’s goals regularly. One member of staff told us, “Risk assessments are sent out for us to read quite often. [People] are involved in the process. If they want to keep the same goal.” Another member of staff commented on how they had managed risks to people’s care whilst supporting them to undertake a work experience, which meant that the person was able to become more independent, “[Person] is now being left to do [their] work experience. [Person] was left for thirty minutes on [their] own.” We found that staff were working with people and holistically considering people’s independence, safety and wishes when supporting them to take risks.

People’s care records included information on how to reduce risks related to their care and showed that people were at the centre of their care. This included risks when accessing the community, the risk of seizures and financial risk assessments. People’s records were personalised and included other information such as where a person was affected by a change of staff and how this should be managed. There were processes in place to empower people to take risks in order to maintain their independence and meet goals which they had set with the support of their relatives and staff.

People told us they felt staff knew how to keep people safe in their environment. This included works which had been undertaken to ensure that the environment was safe for people with a visual impairment. People told us there was a maintenance team on-site who responded to environmental issues in a timely way. One relative told us, “The facilities team are sensational.” Another relative commented, “[Person] has an enclosed environment. [Person] was afraid when the fire alarm sounded, so now [person] checks the alarm weekly with the maintenance staff.”

Staff had undertaken fire safety awareness training and were able to tell us what they would do in the event of an emergency. Staff knew how to report concerns in relation to the premises and told us these were addressed in a timely way. “We just call our facilities [team] and they get things sorted out very, very quickly.” Leaders understood their responsibilities in relation to maintaining safe environments for people.

The service had a fire alert panel in place which covered all premises on-site and people had individual personal emergency evacuation plans in place. We found relevant equipment, such as fire extinguishers, were in place and had been checked appropriately to ensure they would work in the event of an emergency. Equipment such as mobility hoists and wheelchairs were stored safely and had been checked to ensure they were in acceptable working condition. The premises were accessible for people’s needs and included relevant adjustments.

We found there were effective arrangements to keep people safe in an environment that met their needs and supported them to maintain their independence. Where people wished to move to a different home in order to become more independent, there were processes in place to try out the new environment to ensure it was suitable prior to moving permanently. The provider had effective systems in place to monitor the safety and upkeep of the premises. For example, regular checks were undertaken in relation to the maintenance and fire safety of premises.

People told us there were generally sufficient staff who understood people’s needs well. People commented that this had improved following conversations with staff. One person who used the service told us, “If I have a problem, I will find staff and discuss it.” A relative commented, “The staff support each other and can always call on someone from their own bank who are familiar with people.”

Staff told us that there were sufficient staff deployed to meet people’s needs. Staff told us they had undertaken training and competency checks in order to be able to support people effectively. Staff told us supervisions were undertaken regularly between them and their line manager. They told us supervisions were a dialogue where training needs could be discussed and that there was further training available should they need it. One member of staff told us, “We are constantly on training courses. They make sure we keep our training up to date.” Another member of staff commented, “We’ve done training around equal opportunities, not discriminating against people or lifestyles. We are open-minded and we work together.”

We reviewed records which showed that staff had completed relevant training, including specific training to support people with a learning disability and/or autistic people, emergency first aid at work, Equality Act training, oral care training and health and safety awareness. The provider followed safe recruitment practices. The provider had completed relevant checks prior to a prospective employee starting. This included requesting and receiving references from previous employers, identification checks and Disclosure and Barring Service (DBS) checks. DBS checks are carried out to confirm whether prospective new staff had a criminal record or were barred from working with people at the time.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.