Aspens Supported Living & Outreach (Kent)

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. 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.

The service was in breach of legal regulation in relation to assessing potential risks and the ways people’s medicines were managed.

This service scored 47 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was not a consistently positive culture of safety throughout the service. This meant lessons learned had not always been identified to embed good practice.

Staff felt confident to report incidents or accidents which were reviewed by managers. Relevant people were informed of these events such as the person’s social worker and family members. However, lessons learnt about best practice in assessing potential risks and medicines management had not been shared and implemented consistently. For example, the provider was aware of shortfalls in recording people’s medicines when they went on social leave as this had been highlighted at an assessment of another of their services. However, there continued to errors in this area showing that good practice in medicines management had not been embedded throughout the service.

Some people had anxieties which they may present verbally or physically. People’s presentations were closely monitored and reviewed to develop and make changes to the ways staff supported them. Records showed people were given reassurance, redirection and praise by the staff team. These positive staff interactions helped to ensure people and staff’s safety.

Staff told us lessons learned about people’s individual safety were shared with the staff team. When incidents or accidents had occurred, they had been fully looked into to establish what had happened. Discussions had taken place to assess the most appropriate actions to take to minimise the chance of the same thing happening again.

There was inconsistent practice in how the provider worked with people and healthcare partners to help ensure continuity of care, including when people moved between different services.

Healthcare partners gave mixed feedback about how the provider worked with them to help ensure continuity of care when people moved between different services. One healthcare partner told us about a young person, “When they initially transitioned there were considerable challenges. Staff at Aspens listened to advice and adapted”. Another healthcare partner said, “There were concerns the service didn’t have swallow guidelines in place for them and they weren’t transferred from his previous placement”. These guidelines were in place at the time of the assessment.

The service had been involved in successfully supporting young people with anxieties to move from their family home and during their transition from school to college. This involved working with a range of health and social care partners, visits to the person’s home and school and observations and modelling of staff interactions. All these actions helped to ensure as smooth a change as was person for the young person involved. One family member told us, “When she first came to Aspens it was a struggle due to her behaviour and needing to know staff. As soon as it settled down it’s been pretty much okay and much smoother because she knows the staff and they are all very good”.

Hospital passports were in place to support people when they needed to go to hospital or attend clinic appointments. However, some records did not contain all the necessary information for external professionals to know about the person’s health or medical appointments.

Some people attended the provider’s day service. People’s care plans and risk assessments were shared with them, so they knew how to support people in the right way.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. However, the provider had not always shared information appropriately.

The provider had reported safeguarding concerns to the local authority who is the lead agency for safeguarding. When directed the service had carried out an investigation and taken actions to help keep people safe. However, the provider had not notified CQC of a recent safeguarding concern and were not aware of this omission or able to explain the reason for it.

For people who needed support with their monies, records and receipts were kept of financial transactions. Some people were paying for their own personal protective equipment, although it was the providers’ responsibility to provide this equipment. Family members with legal responsibility for people’s finances were not always being provided with the necessary information. We fed this back to the provider who gave assurances they were making the necessary changes.

People told us they felt safe and knew what to do if they had any concerns about their safety. Comments from people included, “I would tell staff if I was abused or if I was not happy. They would listen” and, “I would tell (named member of staff) if someone stole from me. (Named member of staff) would listen to me”. Personal safety was discussed at resident meetings and people had been supported to understand about personal boundaries.

Relatives told us that even though sometimes there were situations when people become unsettled, their family members were safe. One relative commented, “Both the physical environment and the staff make me happy she’s safe.” Another relative said, “They always make sure she’s safe day and night and do everything they should and she is well looked after.”

Staff had received training in how to recognise and report abuse. They knew how and to whom they should report concerns both internally and also to external agencies should they not be listened to. The provider had a safeguarding lead who gave advice to staff and had oversight of safeguarding concerns. Safeguarding was discussed at team meetings, staff supervision and monthly safeguarding meetings.

Some people were subject to deprivations of liberty (DoLS) for their own safety. DoLS applications had been submitted to the appropriate authorising bodies where required. There were systems to monitor deprivations of liberty (DoLS) to ensure people were only deprived of their liberty to receive care and treatment when it was in their best interests and legally authorised under the MCA. There was a record of any conditions in people’s DoLS to ensure they were met.

The provider did not always understand and manage potential risks to people. Staff did not always provide safe care to meet people’s needs.

Potential risks to people in their daily lives had been assessed with regards to their health and social care. These included encouraging people to pursue their interests, maintain relationships and to be a part of their community through positive risk taking. Where risks had been identified there was detailed guidance of the steps staff needed to take to support people and keep them safe. However, some risks which could potentially place people at risk of harm had not been identified. Therefore, there was no guidance for staff to follow to help ensure people’s safety.

One person had had a procedure to enable them to pass urine or stools more easily. There was no guidance for staff about the specialised care and support this person needed. Nor were staff informed of the potential risks and how to recognise them, such as the risk of an infection. The person was also not able to digest certain foods but this information had not been contained in a care plan or risk assessment. Other people had diabetes and there was inconsistency in the staff guidance about how to support people with this condition. Some people’s care plans and risk assessments contained step by step guidance about how to recognise and what to do if people had too much or too little sugar in their bodies. However, one person did not have any information for staff to follow to meet their health need.

A restrictive intervention risk assessment (RIRA) tool had been used to evaluate the potential risks associated with using restrictive interventions that limit people’s freedom of movement. RIRA promotes using the least restrictive intervention as set out in NICE guidelines. It is intended the risk assessment sets out the proposed type of physical restraint but, for one person, the RIRA only contained the level of training staff needed to have undertaken. The regional manager told us there should be a link to the strategy agreed in the assessment. Also, a photographic guide of the type of physical intervention agreed, available for staff in the service. Although staff received training in this type of physical intervention neither of these guides were in place to advise staff of the assessed level of intervention should it be required.

Risks relating to the management of constipation were not always well managed which put people at risk of harm. People with a learning disability are at significantly higher risk of constipation than the general population. One person at risk of constipation did not have risk guidance for staff about how to manage their condition. Some people had been prescribed medicines to be given when they had not had a bowel movement for a specific number of days. There were gaps in people’s bowel charts so it could not be certain when people had last had a bowel movement. Although people had not come to any harm there was a risk of potential harm as their medicines prescribed to effectively reduce the risk of constipation were not being administered as required.

People’s assessments of risk were reviewed on a regular basis to ensure they remained up to date. The exception to this was for a person who had moved from one of the provider’s services to another. Although there had been a change in the person’s environment their risk assessments had not been reviewed to reflect this change.

Relatives told us that people were protected from risks when they went out as they had staff to support and protect them such as when crossing busy roads. People who were able to call for assistance had lifelines and the services on call number in case of an emergency.

The provider did not always detect and control potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Staff carried out checks of people’s homes to ensure they lived in a safe environment. This was because people may not always be aware of potential safety risks where they lived. This practice had not been consistent and we found some areas of concern. In one person’s home a window restrictor to prevent them from falling from a height was broken. At another person's home, the lock was broken on a cleaning cupboard door so they could have access if unsupervised. These shortfalls were reported to the maintenance team after they were brought to the provider's attention.

Relatives said that people’s homes and the environment had been adapted to people’s needs and to keep people safe. One relative said about their family member’s home, “It’s clean and well maintained”. People told us their homes were decorated to their own taste. One person said, “It is nice having my own place”.

The provider made sure there were enough staff who received effective support, supervision and development. Staff had not always received the specialist training they needed to provide safe care that met people’s individual needs.

Staff had undertaken training relating to the wide range of strengths and impairments that people with a learning disability and autistic people may have. Some people had specialist needs such dementia, epilepsy, anxieties and bowel management. The provider told us staff had received the necessary training to meet people’s complex needs. However, we found that staff had not been provided with training for one person who required specialist support with 2 medical protocols for their bowels. Although there was clear guidance in place for staff to follow, staff were training and assessing the competence of each other without specific management oversight. The regional manager was not aware staff were supporting this person with these specialist procedures. After our visit, the provider told us their training provider was designing a structured course for staff to complete and gave an anticipated date for its completion.

New staff completed a comprehensive induction, including shadowing experienced staff, completing essential training and the care certificate before working on their own. The care certificate are the standards employees working in adult social care need to meet before they can safely work unsupervised. Staff told us their induction was comprehensive. Relatives told us that staff had the right skills and training to support people. One relative told us, “She’s so complex and they manage her well. A lot of her behaviours don’t have triggers so it’s difficult – they’ve got the measure of it.”

Staff had received accredited training in supporting people where physical interventions had been identified in their risk assessments and positive behavioural support plans. The training focuses on managing people’s anxieties and promoting a positive and safe environment for everyone involved.It equips staff with skills to assess, prevent, and manage people who are communicating a need, expressing feelings or an emotional reaction. It emphasises positive behaviour support and strategies to improve quality of life. Staff had also been encouraged to further their development through studying for management qualifications.

The staffing levels required for each person were assessed with the local authority before people moved to their home. Relatives told us there were enough staff available to support people although we did receive feedback that some people’s one to one hours could be managed more effectively. Staff teams were arranged for a group of people to ensure staff cover and aid consistency. The majority of relatives told us their family member received support from staff who knew them well. One relative commented, “Yes absolutely, staff are quite consistent and there are regular faces.” Another relative told us, “If they use agency staff who don’t really know the people they do make sure there’s always 1 permanent staff member.” The service employed a dedicated bank and agency coordinator. They endeavoured to ensure there was as minimal movement as possible for these staff between people’s homes so they could get to know people and people could get to know them.

The provider had undertaken all necessary checks for new staff to ensure safe recruitment decisions. There was a dedicated worker to support the recruitment of staff on sponsorship from overseas. This included obtaining work references, explanations for any gaps in people’s employment history and Disclosure and Barring checks (DBS). DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

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.

The provider had systems and processes in place to assess and manage the risk of infection. There were cleaning programmes for each person’s home which people joined in according to their abilities. Relatives told us people’s homes were always clean when they visited.

There was sufficient personal protective equipment (PPE) at each person’s home to provide safe care. This included gloves and aprons. Staff had received infection prevention and control training and understood what to do to mitigate infection risks. We observed staff using PPE appropriately throughout people’s homes.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Medication administration records (MAR) instructed staff of the name of the medicine, the medicine strength and how much medicine to administer to each person. When staff had handwritten this information onto the MAR they had not always done so accurately. One person had an agreed protocol for giving medication for their anxiety initially in a small dose. Then if their anxiety continued for a set amount of time, to give another small dose. However, staff had incorrectly written on the MAR that the full dose should be given at the outset of the anxiety. Although the person had not needed this medication, if this error had not been identified, the person may have received more medication that was prescribed by their GP.

There were not always directions for staff when people had been prescribed topical creams which needed to be applied to a specific area of a person’s skin. For example, one person’s cream needed to be applied in a thin layer, on their toes, once a morning. However, their MAR stated, ‘apply as directed’ and there was no corresponding body chart to indicate where the cream should be applied. A relative told us, “They don’t apply creams to him properly”.

Relatives told us that medicines were well managed when their relative came to visit them at the family home. One relative said, “His medicines have to be accounted for so I’m happy with that. When he comes to stay with me there’s always a medication handover as well.” However, we found that there were not always accurate records when people went on social leave. Medicines records did not always include the time people left the service, how many medicines they took with them or how many medicines were returned to the service. Some social leave forms did not provide staff with the space to add all this necessary information. This meant staff could not be assured people had been given their medicines as prescribed nor ensure a clear audit trail of medicines. After the assessment visit the provider told us they had implemented standardised social leave forms across people’s homes to enable all necessary information to be recorded.

Medicines were stored in locked cabinets in people’s rooms. The temperature of medicines was checked to make sure they were at the correct temperature. This is because some medicines are not effective if they are stored at too high a temperature. We found that one person’s medicines were unlocked, although their risk assessment identified that they needed to be locked for the person’s safety. People were enabled to administer their own medicines when it had been assessed they were competent to do so.