Opportunities for Adults and Children

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 requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

The provider was previously in breach of the legal regulations in relation to safe care and treatment, and staffing. Improvements were found at this assessment, and the provider was no longer in breach of these regulations.

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 listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The provider investigated all incidents and reviewed records to help identify any trends or action to reduce the risk of recurrence. Senior staff followed up incidents with people and relevant stakeholders, ensuring people’s care plans were reviewed and updated in response. One person told us, “If anything happens, I’m supported.” Relatives generally felt they would be notified of incidents, although some told us they were not always confident this happened consistently. Some relatives also commented the timeliness of updates and responses from the provider could vary. Despite this, there was an overall view that communication had improved since the last assessment.

Since the last assessment the provider had implemented a clear lessons‑learnt framework to support reviewing and learning from accidents, incidents and complaints. This included, conversational debriefs, competency assessments, spot checks and targeted training updates. Leaders told us how they had worked to move the service away from a previous culture of blame and towards a transparent, learning-focussed approach. They had established an open-door culture where staff were supported to discuss and explore emerging themes, with learning routinely shared to reduce the risk of reoccurrence. Staff mostly told us they felt listened to and that action was taken when they raised concerns. Comments included, “I feel [registered manager] takes on board what we are saying. She gives feedback” and “Communication is excellent.”

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.

Comprehensive initial assessments were completed with people and those important to them. These assessments were holistic and informed a structured and person‑centred transition period, designed to help people feel comfortable and ensure the service could meet their needs. They included identifying what was important to the person and what was important for them.

People had opportunities to meet others living at the service, spend time with staff, visit the supported living service and share social experiences. The provider considered everyone’s support needs and compatibility. These steps supported positive relationships and ensured people were well matched with their environment and housemates before moving in. This helped to optimise a positive transition experience for people.

Safe transitions also took place at other points in people’s care journey. For example, when people experienced hospital admissions. Staff liaised with healthcare professionals and shared essential information, supported communication, and provided reassurance and emotional support to people during their stay. On discharge, staff worked with healthcare professionals to ensure up‑to‑date information was received and incorporated into care planning.

People and relatives described receiving emotional and practical support both during hospital stays and when attending medical appointments. One person told us, “They go with me. If I find it hard to talk or communicate to someone, I give permission for staff to talk to them about me.” A relative said, “[Person’s name] was in hospital not long ago and the staff were going in every day … shows you how caring they are.”

Care plans were updated regularly to reflect changes in people’s health, mobility, or mental wellbeing. Professionals were positive about the continuity of care.

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.

People told us they felt safe and knew who they could talk to if they had any concerns. Comments included, “If I need to talk to someone … always loads of people I can talk to. They [staff] are brilliant.”, “If I say anything about my feelings, or if asking questions about anything, I feel I’m listened to” and “I think I’m pleased with everything really, if I’m not happy I can talk to either manager or staff. They would do something about it.”

People were protected from abuse and neglect while still being treated with dignity and having choice and control. Staff and the registered manager knew how to recognise the signs and what to do if they suspected someone was at risk of abuse or neglect.

The provider had effective policies and procedures in place to promote people’s safety. These included procedures around handling people’s money, supporting safe internet use, Easy Read safeguarding information (a clear, simple format designed to help people understand important information) and named safeguarding leads.

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.

Staff were able to demonstrate a good understanding of people’s risks and the actions needed to reduce them. There was a culture of supporting positive risk‑taking, which enabled people to maintain and develop their independence and pursue what was important to them. Whilst records did not always detail the level of input people had had in assessing risks, people told us they felt informed and involved in decisions about their safety. For example, 1 person described how staff supported them with a new activity they wished to pursue. Staff helped them research the activity, understand what it involved, compare different options and costs, and consider any potential risks. The person told us they felt fully involved and supported throughout the process.

Staff and leaders also shared examples of how they had helped people enhance their quality of life through positive risk‑taking, including supporting people to build independence and confidence in daily living. For example, staff worked with a person who wanted to develop their skills to access the community independently. Together a plan was agreed which included increasing independence in stages, while reducing support gradually until the person was confident to travel and shop independently.

People had individual risk assessments in place; however, some of these lacked the level of detail needed to guide staff effectively. Important information about how risks should be monitored or mitigated was not always clearly documented, for example in relation to epilepsy. Although staff could verbally describe the actions they took to keep people safe, the lack of detailed guidance increased the risk of people not being supported consistently. The provider had identified some of these shortfalls through their internal governance processes, and action to address them was in progress at the time of the assessment.

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

People had the equipment they needed to support safe care and staff had a good understanding of how to use and maintain it. The registered manager understood who to contact whenpeople may benefit from additional aids or equipment. One person told us, “I have things that make my life easier, like my armchair and 4-wheel stroller … I don’t have to worry anymore about going to places with no benches or seats, I can go wherever I want.”

Health and safety and fire safety risk assessments were completed and checks made of equipment to ensure it was safe to use. Any concerns were reported to the management team or appropriate person for further action. Maintenance and servicing schedules were tracked and monitored by the provider, and we saw evidence that required servicing had been carried out as expected.

We found the servicing frequency for some moving and handling equipment had been recorded incorrectly in people’s care plans. For example, equipment requiring six‑monthly LOLER servicing (lifting equipment safety) was recorded as needing annual servicing. The provider told us this was a documentation error, and records showed servicing and maintenance had been completed in line with regulatory requirements. This meant people remained safe, although improvements were needed to ensure care planning records were fully accurate.

Staff attended regular fire training to ensure they could safely support people out of their homes in the event of a fire.

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.

People told us, which records and feedback from staff confirmed, there were enough staff. Comments from people included, “Always have staff available”, “Much better now we have more staff” and “Yes, always staff here.”

Staff received training relevant to their role and systems were in place to promote their ongoing learning and development, including regular supervision, checks of their competency and shared learning through team meetings. This included training on learning disabilities and autism in line with latest legislation.The provider incorporated ‘lived experience’ perspectives into their training, enabling staff to learn directly from people who had personal experience of disability or health conditions. This enhanced staff understanding, empathy and insight into the impact of their practice. One person told us, “I think they are trained and know what they are doing.”

We received some mixed feedback from relatives about newer staff and agency workers. A small number of relatives did not always feel confident that newer or temporary staff had the information they needed to fully understand people’s support needs or communication preferences. Leaders and staff described the induction and support processes in place for new staff and felt these provided the necessary information, training and shadowing to prepare staff effectively. This feedback highlighted an opportunity for the provider to continue strengthening communication with relatives about how new staff are supported to get to know people well.

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 confirmed they were supported to maintain the cleanliness of their homes. Arrangements were in place to ensure shared spaces were cleaned regularly, and during the assessment we observed people being supported with household tasks in a way that promoted independence and good hygiene.

People told us staff wore appropriate personal protective equipment (PPE) when providing care. The provider had effective infection prevention and control policies and procedures in place, which reflected current guidance. The service carried out spot checks on staff to ensure correct infection control practices were being followed and that PPE was used safely. Staff confirmed that appropriate PPE supplies were always available, enabling them to follow good hygiene practices and reduce the risk of infection.

The provider did not always make sure that medicines and treatments were safe or that they fully met people’s needs, capacities and preferences. Staff did not always involve people in planning how their medicines should be used to support person‑centred care.

We identified shortfalls in medicines management that could impact safe and person‑centred practice. Records relating to variable‑dose medicines did not always contain sufficient detail to guide staff in determining the appropriate dose. For example, some people’s PRN (as‑needed) protocols lacked clear guidance for staff to support safe and consistent decision‑making when administering prescribed medicines with variable doses. This meant there was an increased risk of medicines not being administered in line with people’s assessed needs.

The provider had identified these areas for improvement through their internal governance processes prior to the assessment. They provided assurances action was underway to update PRN protocols and improve documentation relating to homely remedies and PRN medicines. Some of these improvements were in progress at the time of the assessment and required further time to become fully embedded across the service.

People’s medicines were stored securely, and staff we spoke with understood their responsibilities in relation to medicines and were committed to supporting people safely.