Autism East Midlands Supported Living

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 regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the behaviours of others in the home had a physical and emotional impact on some people using the service.

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 did not always have a proactive and positive culture of safety based on openness and honesty. This meant that lessons were not always learnt to continually identify and embed good practice.

Relatives knew how to raise concerns or make a complaint, but some told us they were not confident that the actions taken always addressed their concerns. This related to the behaviours of some people using the service, which impacted on the well-being of their loved one.

The use of communication aids, visual prompts, and one-to-one support was available to support people to raise any concerns they had.

Improvements were needed to ensure the management team provided a culture of openness to enable discussions about, incidents, and provide opportunities to discuss any actions required.

The provider did not always work well with people to maintain safe systems of care. They did not always manage or monitor people’s safety, with regard to the compatibility of those they lived with and the behaviours of others to ensure people were safe.

Where people had a diagnosis of a specific health condition, there were clear risk assessments in place to enable staff to support them safely.

The provider did not always work well with people 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.

Some people’s relatives told us they did not feel their loved ones were safe living with other individuals. One relative said,” My relative is bullied by a person they live with. The staff working with them do their best to protect them.”

Staff had access to local safeguarding procedures and confirmed they would report any concerns to the management team. The provider has reported concerns to the local authority, but we were not confident that all incidents that may constitute abuse were shared with the local authority safeguarding team. The provider took action to address this following our assessment.

We were made aware by the local authority that some incidents that should have been reported to the police by the provider had not been. We asked the provider to take action to address this.

The provider did not always work well with people to understand and manage risks within their home due to the behaviours of other people. This meant the staff could not always ensure people were safe.

Relatives felt their loved ones received safe care from the staff team, but some were concerned about their safety with some of the people they lived with.

People were supported to spend their time doing things they enjoyed, and staff were consistently engaging with people in a positive and respectful manner.

The provider identified and managed potential environmental risks within people’s homes to help ensure the service remained safe for people living there.

Relatives told us they had no concerns about the environment which was well maintained.

The environment was tidy and free from unnecessary trip and slip hazards. Health and safety audits were in place and regularly carried out to ensure potential environmental risks to people were monitored and managed.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support,

supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

Although staff had received training in how to manage people’s behaviours. We were not confident that all staff had a clear understanding of how to put this training into practice.

This impacted on the support provided to people when incidents occurred. The provider said in their PIR that, ‘All staff are trained to use a variety of physical intervention and restraint techniques.’ A PIR is information providers’ send us every year, including any changes they have made and how they ensure their service is safe, effective, caring, responsive and well led. The provider agreed that the records of one incident we reviewed could have been managed more effectively. Although the physical intervention techniques were only used as a last resort, we saw from the information recorded that the incident impacted on the other people that were at home. The staff who managed the incident felt they could not use the intervention techniques they had been taught due to the person’s behaviour at the time. The provider told us this was not the case and that the intervention would have worked. They told us further training would be provided.

Relatives also told us there were usually enough staff on duty to meet their loved ones needs but said that several staff currently used were agency staff. Staff confirmed this and told us they were not always confident due to the reduced staffing levels. Staff confirmed that agency staff were unable to perform certain tasks which limited the support they could provide. The provider confirmed that they were currently recruiting staff due to a number of staff leaving.

Staff confirmed they received supervision and had team meetings but were not confident their views were acted upon. The provider told us they had met with the staff since our assessment to reassure them.

Staff were recruited safely. Recruitment records showed that all required pre-employment checks had been completed to ensure only suitable individuals were employed to work with people using the service.

The provider had systems in place to assess and manage the risk of infection.

Staff followed infection prevention and control (IPC) procedures in line with current guidance. During our assessment, we observed staff carrying out cleaning tasks as needed, which helped maintain a clean and hygienic environment.

Staff had access to appropriate personal protective equipment (PPE) and demonstrated understanding of its correct use. Feedback from both staff and relatives confirmed there were no concerns about infection control practices.

The provider ensured that medicines were managed safely.

People were supported to receive their medicines as prescribed, including pain relief, which was offered in line with guidance from healthcare professionals. Medicines were stored securely, and appropriate audits were in place.

Medication Administration Records (MAR) were completed accurately and showed people received their medicines at the right times.

Staff understood how to administer medicines safely and had completed medicines training and competency assessments. Staff were aware of protocols for reporting and managing medication errors.