Voyage (DCA) Swindon

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 inspection we rated this key question good. At this inspection 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.

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’s understanding of people’s needs meant that staff adapted how they spoke to people which prevented re-occurrence of incidents.

Incidents and accidents were recorded and reviewed by the management team to ensure actions were implemented. We looked at several incidents and found that the provider had provided support to people involved and that a lessons learnt section ensured continuous improvement and development staff identified some trigger words and adapted how they spoke to a person to ensure that the person did not become anxious again. Learning from incidents was shared with all staff in team meetings to ensure they understood changes in the way they needed to support people.

People and staff spoke to us about how they would raise concerns outside of the management team to help prevent the development of a closed culture, with staff understanding and being committed to safeguarding and also knowing who to contact in the event of any concerns. Training was extensive and in-date, with the training matrix showing upcoming training dates and dates of completion and expiry. The manager then informed us this is embedded into staff culture and practice through competency observations.

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.

People were supported to write their own hospital passports, to help ensure health care staff had a good understanding of their needs so people received continuity of care.

We looked at transitioning planning and documentation and found that people were put first and that the provider was implementing all agreed transitional plans. The provider proactively looked at ways to enable and empower people and successfully reduced their paid support needs. We saw evidence that the provider had worked to reduce a person’s support needs from 2:1 to 1:1 in the community.

The registered manager had a tracker in place for all Deprivation of Liberty (DoLS) applications and evidence showed they were regularly reviewing this. Of the care plans we reviewed, we saw best interest decisions demonstrated they were the least restrictive option to support people safely.

QS Score:3

The provider worked with people 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 with relatives and with the Commission.

People told us they felt safe in their home and that staff helped them stay safe. Staff received training and demonstrated a good understanding of their safeguarding responsibilities. People were supported to develop skills to stay safe in the community. One person told us they had helped write their risk assessment for accessing the community. There were easy read documents on how to speak up if people did wish to discuss anything.

People were proud of their homes and wanted to show how they had personalised their spaces. Some told us what being safe meant to them and spoke about safe relationships. Staff and managers challenged other agencies when they felt it appropriate to do so. For example, a person’s medication was changed during a medicine review, but the provider noticed that this had an adverse effect on the person and worked with other professionals to get the decision reversed.

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.

Risks to people’s health, safety and welfare had been assessed and action taken to manage those risks. Staff demonstrated a good understanding of the risks and said care plans were updated regularly with people when their needs changed. We viewed signed and dated changes and care plans were updated at least annually by the provider.

Regular meetings were held where individual’s progress and their outcomes were discussed. Outcomes were either signed off as complete or re-visited if something was not achieved. For example, a person wanted to go to the beach but then became anxious when prompted to wear sun cream. The provider looked at the trigger for that anxiety and changed some wording in their communication passport when supporting the individual. This meant that the individual could return to the beach on another occasion.

The provider had successfully worked with a person to reduce their support from 2:1 to 1:1 when attending clubs and activities which showed the provider’s commitment to empowering people.

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

The provider assessed people’s homes for risks and took action to ensure people, staff and visitors remained safe. The provider worked with landlords to ensure actions they were responsible for were completed in a timely way. Household equipment was reviewed and found to be a risk to a person. The provider introduced an alternative which demonstrated consideration of least restrictive practices.

People’s assessments had been written in a person-centred approach. For example, people’s care plans reflected they had been involved in their care planning as well as taking into account family engagement. We also saw needs were identified at the assessment stage and then added into daily support plans and risks were identified and documented.

There were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care that met people’s individual needs.

People and their relatives told us they felt there were enough staff to meet their needs, including support for them to attend community activities they enjoyed.

Pre-employment checks had been completed for staff before starting work. New staff received an induction, including shadowing experienced staff. Staff told us they received regular training, supervision and an annual appraisal.

Staff told us there is always someone to talk to if they ever have any queries out of hours and that there are always plenty of well-trained staff to support the service.

The provider assessed and managed the risk of infection and assured and told us they would raise anything with appropriate agencies promptly. People told us staff supported them to keep their home clean.

Staff completed infection prevention and control training and told us they had access to all the protective equipment they needed.

The provider made sure medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning their medicines support, including when changes happened. Staff and managers felt confident to challenge decisions of partnership organisations when considering changing medication at review stage. The provider had detailed evidence to show why a medication change was not in an individual’s best interest.

People told us staff provided good support for them to take their medicines. Staff had completed training in the safe management of medicines and the management team regularly observed their practice to ensure they were doing this safely. Staff kept accurate records of the medicines people had been supported to take.

People were supported to have regular reviews of the medicines with their doctor to ensure they were not prescribed more medicine than necessary. Any medication errors were swiftly documented and raised in the appropriate way.