Outreach Services

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 81 (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 promoted a practice of learning from any incidents, accidents and other relevant events. Incidents were thoroughly analysed and followed by a full de-brief. If there was any learning to share with staff or any additional staff training needs identified, this was put in place. Incident and accident records were reviewed to monitor any safety related themes. Where mitigatory actions were required to help prevent any future recurrence, they were implemented in a timely way. Staff were encouraged to participate and apply learning to improve safety as much as possible to reduce the risk of harm to people using the service. One member of staff explained, “If there are any incidents, we sit down and discuss and learn from them. We move forward."

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. Processes were consistently followed to ensure sufficient and relevant information was gathered and shared when people were admitted to, or discharged from, the service. This supported continuity of care and helped staff to understand and respond to people’s needs safely and effectively. We saw examples of how staff had supported people prior to their joining the service to aid a smoother transition into the service. This also enabled staff to gain a greater knowledge of the person prior to their admission, helping the person’s transition into the service to be as seamless as possible.

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 were adequately protected from the risk of any harm or abuse. Any incidents or concerns were appropriately reported and shared with relevant safeguarding authorities. Systems and processes were in place to enable transparent investigations to take place in the event of any safeguarding concerns. The provider took a preventative approach to safeguarding and were aware of relevant risk factors and triggers. Staff were trained in safeguarding matters and knew what action to take to keep people protected. One member of staff told us, "I know how to report safeguarding, I wouldn’t hesitate to report anything.” An external professional confirmed, "We did have a recent safeguarding, but the service has been very responsive in dealing with this."

The provider always worked well with people to fully understand and manage risks by thinking holistically. Staff provided care that fully met people’s needs and was safe, supportive and enabled people to do the things that mattered to them. There was a transparent and open culture which encouraged creative thinking in relation to the management of people’s safety and risks. Staff adopted a ‘Can Do’ attitude to enable people to take positive risks, which considered their safety whilst maximising their freedom, choice and independence. We saw examples of people engaging in activities previously thought by alternative providers as impossible for the person to achieve. One member of staff told us, “I am so proud, the difference we make in the quality of life to people, we don’t set limits on people, we will take positive risk and work through it, and that way we open up a bigger world.”

Staff demonstrated an enabling attitude and encouraged people to challenge themselves and used innovative ways to manage risks to help ‘make it happen’ for people. As a result, people were supported to have a meaningful and fulfilling life of their choosing. People were provided with information about how to keep themselves safe in a format which they understood. For example, in pictorial or booklet format. Risks identified to people were current and relevant to them, such as, how to keep safe online and how to navigate social media platforms in a positive way. The service did not utilise restraint, seclusion or segregation to manage risks of any confrontations and/or behaviours that others found challenging. Instead, staff used positive behaviour support planning and adopted proactive approaches such as preventative strategies in response to early signs of distress, helping people to regain control. Where possible, staff equipped people with the tools and techniques they needed to help self-manage risk and so take ownership of their lives.

The provider was fully aware of all potential risks in the care environment and controlled them well. They made sure equipment, facilities and technology supported the delivery of safe care. The provider actively engaged with people (and their significant others were appropriate) in decisions about the environment in which they lived. For example, people had a say in how they wanted their homes to be furnished and decorated. People’s environments were not only designed around their needs, but also their wishes, preferences and individuality. For some people with physical limitations, we saw how their homes had been adapted in innovative ways to meet their mobility needs and to allow access to the equipment they needed. Equipment and technology were used to support independence and was personalised where appropriate. For example, we saw how mobility chairs had been custom made for people to maximise their comfort. For another person, the installation of ceiling hoists had enabled the person to access all areas of their home with ease, and to carry out tasks more independently. As a direct result of these design changes, people’s independence and freedom was maximised and people were able to live in a way of their choosing.

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. Where possible, people were involved in decisions about the staff who provided their care and support. Some people had been involved in the recruitment of their own staff, to ensure they aligned with the core needs and values of the person. Staffing rotas and shift patterns were not fixed and were developed to work around not only people’s needs, but their activities and interests. People were supported by a core staff team. There was good continuity of care and support for people and people were supported by staff who knew their needs well. As staff were matched to people based on preferences and character; people had developed strong and meaningful relationships with the staff supporting them. Recruitment systems ensured staff were recruited safely. Staff had the right competence, knowledge and skills to carry out their roles. Processes such as supervision and appraisals were used to develop and motivate staff and review their professional development. Training was delivered in a variety of ways to help ensure maximum staff engagement. For example, some staff had fed back they preferred face to face training, so the provider organised training days where real life scenarios were discussed to better aid learning and development. Inaddition, staff were able to request any additional training they felt they needed to better meet the specific needs of the person they were supporting.

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. Staff were trained and understood their roles and responsibilities for maintaining high standards of cleanliness and hygiene in people’s homes. Staff also understood the importance of food safety and hygiene and followed required standards and practice when handling and preparing food. Where appropriate, people were encouraged to partake in household chores and educated by staff on the importance of maintaining a clean and hygienic living environment.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. The provider adopted and practiced the standards for stopping over medication of people with a learning disability, autism or both with psychotropic medicines, (STOMP). STOMP is aimed at people living with a learning disability, its principles help to help stop the overuse of these medicines and helping people to stay well and have a good quality of life, without the need for excess medicines. We saw several examples of people having stopped or severely reduced their reliance on some medicines, due to direct staff support. The provider worked effectively with other agencies to ensure people received their medicines as prescribed. The provider took an active role in medicines reviews and risk assessments. Where people wished to manage their own medicines, they were empowered to do so safely, and in a way which respected both their choice and independence.