London Borough of Merton - Supported Living Service

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 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 promoted a culture of safety within the service. The registered manager reviewed accidents, incidents and near misses and ensured that learning from them was shared throughout the team. Staff and managers were trained to keep people safe. They understood how to identify and raise concerns about people’s safety This included the safeguarding procedures to follow and how to whistleblow.

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 safely transition into the service. This process began with people’s needs being assessed before they received a service. This was to ensure that the provider could meet people’s needs safely. People were supported to make an informed choice as to whether they wanted to move into the service and were supported in their decision making by relatives and advocates. Following transition people, their relatives, staff and a social worker held a review meeting to confirm the safety and suitability of the service. This meeting was also used to review any changes to people’s needs and preference.

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 felt safe. One person told us, “I’m very good. No problems. No worries.” Staff received training to protect people from abuse and avoidable harm. Staff understood how to raise safeguarding alerts if they were concerned about people’s safety or wellbeing. One member of staff told us, “I would alert the registered manager and I know how to send safeguarding alert.” Where safeguarding concerns had been raised, the provider transparently participated in enquiries and acted on their findings. The registered manager understood their responsibility to report safeguarding concerns, participate in investigations and to notify CQC.

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.

People’s risks were assessed and risk assessments detailed how their identified risks were mitigated. People and their relatives were involved in risk assessments which covered a range of areas. When required, referrals were made to health and social care professionals for specialist assessments. For example, where people were identified with swallow safety risks, referrals were made to speech and language therapists. Staff followed their guidance and care records detailed how to manage the risks posed by foods of specific consistencies such as stringy and fibrous or dry and crumbly food. This meant people were protected from choking.

People were supported to take positive risks. The provider promoted people’s independence and risk assessments supported this. For example, skills teaching programmes and risk assessments supported some people to travel independently to specific locations and for specific activities. These activities included shopping, work and social activities. Risk assessments detailed how people could undertake these activities as safely as possible. Where agreed, arrangements were in place for staff to confirm people’s safe arrival at destinations. This meant that people were supported to access the communities independently and safely.

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

People were supported in safe environments. One relative told us, “I feel that [family member] lives in an environment that gives [them] confidence.” The provider delivered regulated activities to people at 4 supported living locations. Each location had regular health and safety, infection control, environmental and fire safety checks. Where shortfalls were identified, leaders took action. This meant that continuous monitoring ensured safe environments.

People were protected by the preparedness of staff to respond to a fire emergency. Staff received fire safety training, regularly tested fire alarm systems and supported people to rehearse building evacuations. People had personal emergency evacuation plans in place. These detailed the support people required to safely leave services in an emergency. This meant staff had the information and training necessary to keep people safe.

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.

People received their care and support from safe and suitable staff. The provider used robust processes to recruit staff. This included reviewing applications, interviewing candidates, taking up references and checks of criminal records data bases. New staff received an induction and training through a probation period, at the end of which their competence and suitability was confirmed.

Staff received training to ensure they were skilled and knowledgeable. One relative told us, “I feel staff are trained and knowledgeable to keep my [family member] safe.” Staff received training in a range of areas including health and safety, first aid and medicines. Staff were also supported to work towards courses leading to qualification.

The provider ensured that staff were deployed in sufficient numbers at each of the supported living settings to keep people safe. Support staff were supervised by senior staff and managers through direct observation, one-to-one supervision meetings and annual appraisals. This meant they received the leadership support they required to deliver care and support effectively.

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.

People were protected against the risk and spread of infection. Staff received training in infection prevention and control. This meant they received guidance on best hygiene practices. Staff wore personal protective equipment (PPE) when meeting people’s personal care needs. This included the use of items such as gloves. PPE items were used once and then disposed of appropriately. This mitigated the risk of cross-contamination.

Staff followed guidance to ensure that services were clean. For example, staff undertook a programme for regularly cleaning frequent contact points such as door handles, rails and light switches. Posters were on display promoting correct hand washing procedures, and hand sanitising gel was available for people, visitors and staff. Staff received food safety training to promote best practice around the storing and preparation of food.

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.

People received their medicines safely. Staff were trained to administer medicines to people and managers reviewed their medicines competence. Staff recorded medicines administration in medicines administration records which were checked weekly by senior staff for correct completion.

People consented to the administration of medicines. Medicines were stored securely in people’s rooms. The keys for people’s locked medicines cabinets were held by staff to prevent the risk associated with people accidentally accessing them. Leaders carried out physical checks of medicines stocks to confirm people had received their medicines as prescribed. Where people were prescribed ‘when required’ medicines, staff had clear guidance in care records from the prescriber. This meant that staff knew the circumstances when they could be administered and maximum permissible dosages before further direction from the prescriber was sought.