ARCH Winchester

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 66 (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.

There were processes to identify and manage safety concerns, including lone working safety measures, and incident reporting and reviews. Care staff understood the processes they had to follow if there was an incident. They listened to concerns about safety and reported safety events, which managers investigated. Staff told us they could ‘raise anything’ with managers who they said were responsive. Managers and staff learned lessons from safety occurrences and improved their practice accordingly.

There were risk assessments to guide care staff when supporting people who may display challenging behaviours.

We saw leaders respond to an incident. They checked the immediate risks were addressed and that the person and staff were supported and de-briefed afterwards. This ensured support was provided during the incident and that any learning from the incident was identified and applied to reduce the risk of repetition.

The provider shared relevant national patient safety alerts with staff. This ensured care staff had access to any learning at a national level relevant to their work with people, in addition to the learning which took place within the service.

The provider worked with people and healthcare partners to establish and maintain safe systems of care.

People, because of their mental health condition or life experiences found it difficult to trust others. Staff who would work with them were therefore involved in planning meetings prior to people’s care starting, which eased their transition, as they were then supported by a familiar member of staff. People were also given a copy of the service user guide, which contained relevant information to support their move. The care staff team obtained key information about people’s needs and risks whenever people moved into the service. They shared information with services taking over people’s support when they left the service.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Care 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 had not notified CQC of all safeguarding alerts about people made to the local authority as required. Although there was no impact upon people their submission is a legal requirement. The provider acted immediately when we brought this to their attention and submitted them. They also took action to identify why they had been omitted and to strengthen their processes.

However, the provider had policies and processes to protect and support people from the risk of abuse. Care staff had completed training in safeguarding adults which they updated annually. Staff understood the types of abuse people might experience. Leaders and staff were knowledgeable about the processes in place to safeguard people, to ensure their human rights were upheld and to protect them from discrimination.

The provider had oversight of any safeguarding concerns, which were acted upon immediately to keep people safe and reported to the local authority as the lead safeguarding agency. Learning took place following safeguarding incidents to reduce the risk of repetition. Following a safeguarding incident, processes had been reviewed to further strengthen the management of people’s finances where staff supported them with this.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided safe, supportive care to meet people’s needs, enabling people to do the things that mattered to them.

People's risks related to their health and well-being were assessed and managed. Where people had risks related to the management of their mental health or substance misuse, staff discussed with them and with relevant professionals how to manage these risks. Staff had access to relevant information about people’s identified risks and the signs that might indicate they were becoming mentally unwell and understood the actions to take.

People were not subject to excessive or unnecessary restrictions upon their lives. For example, the house rules regarding visitors and smoking were there for people’s safety and people were made fully aware of them. Staff liaised swiftly with relevant professionals to manage any risks.

Staff formed positive working relationships with people, they understood the meaning and significance of people’s communications and behaviours and responded appropriately.

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

Fire risks had been assessed and mitigated. People were not allowed to smoke within the houses. The provider had screened each person to identify if they required a personal emergency evacuation plan in the event of a fire.

The provider assessed people's risk of self-injurious behaviours before their care began, to identify if the environment was safe for them. People told us if there were any issues with the property, they let the manager or registered manager know who would arrange for any repairs to be completed.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development.

The provider had not ensured they fully met a requirement for staff’s pre-employment checks but mitigation for this was in place. They completed a range of checks as part of their staff recruitment. These included seeking satisfactory evidence of applicants’ conduct for some, but not all, previous roles involving adults or children who were vulnerable due to their age, health or circumstances. The provider has informed us they are reviewing their policies and will update their recruitment policies and processes to reflect this requirement.

However, the provider did have additional processes to assure themselves of applicants’ conduct prior to them working with people unsupervised. New staff undertook an induction which included shadowing more experienced staff, before then working for a period under the direct supervision of more experienced care staff until they could demonstrate their competence, and skills and the provider was assured of their character. Staff could only then work with people unsupervised.

There were enough care staff deployed to support people, at a level which reflected their needs.

Care staff undertook the provider’s mandatory training and in-house training, which was tailored to the history, diagnoses, risks and identified needs of each person care staff worked with. This enabled care staff to gain an individualised understanding of how people’s diagnoses and history impacted them, any associated risks with their care and the signs and symptoms which could indicate they were relapsing. This training was provided as part of the care staff member's initial induction and then through on-going teaching and practical sessions, handovers, supervisions, written exercises and the review of learning outcomes from incidents.

Most of the care staff had also either achieved or were working towards a level 2 or 3 qualification in health and social care. Staff had an annual appraisal of their work, which enabled them to reflect upon their ongoing learning and professional development.

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.

Care staff had completed relevant training and had access to the provider’s infection control guidance. They had access to supplies of personal protective equipment (PPE) as required.

Care staff prompted and supervised people in accordance with their needs, to ensure they maintained a good level of personal care. This included washing, changing their clothing, oral health care, skin, hair and nail care. Staff also supported people to maintain a clean and hygienic living environment.

The provider made sure medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Care staff completed medicines training which they updated annually. The manager also worked closely with each member of care staff to ensure they understood people’s medicines and any associated risks. They regularly assessed care staff's medicines competency, which care staff confirmed, but did not record these assessments. This had not negatively impacted people’s care, but it made it harder for the provider to demonstrate they were doing what they could to make sure medicines administration was safe. We raised this with the provider, who immediately acted to ensure medicine competency assessments were recorded.

Staff ensured people's medicines were ordered and stored safely. Care staff documented the administration of people's medicines on their medicines administration record. People were encouraged to self-medicate and any associated risks associated had been assessed.

People who were prescribed high risk medicines which required additional health checks were supported by care staff to ensure they attended appointments for these checks as required.