Shared Lives and Reablement Scheme

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.

This is the first assessment for this assessment service group under this location. This key question has been rated good. This meant the service was 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.

Lessons were learnt to continually identify and embed good practice.

The registered manager told us there were processes in place for staff to learn from incidents. They commented, “We send out any messaging to staff via email. If it’s immediate, we would call them. We have supervisions and team meetings where incidents are discussed, and staff receive the minutes of these team meetings too.”

Accidents and incidents were responded to appropriately, however there was not always clear evidence of lessons learnt to improve practice. This meant staff may not have learnt from previous incidents making them more likely to occur again. We raised this with the manager for them to address.

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.

The registered manager told us they worked effectively with the hospital discharge team and other care providers where required. Staff attended meetings with the Swindon Intermediate Care Centre [apurpose‑designed space that supports people who are moving between hospital care and independent living].

One professional commented, “This allows space for good conversation between the ward staff, therapists and Reablement to agree discharge arrangements.” The service then assessed whether the person would be suitable for the service.

Staff also worked well with care providers, where people receiving support from reablement required longer term care and support. A professional told us there was good communication between Reablement, Social Care Staff and a local care provider when a person was transferring from Reablement to long term care.

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. Staff had received training in safeguarding. There was a safeguarding policy which detailed procedures for staff to follow in the event of a safeguarding concern. Incidents were reported to the local authority safeguarding team where appropriate.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risk assessments did not clearly reflect, or address risks associated with some people’s documented health conditions, including sleep apnoea, acute coronary syndrome and lymphocytic leukaemia. Additionally, risks relating to the use of a catheter had not been assessed for one person. This meant staff may not have all information to mitigate any related risks. However, there was no evidence that people had come to harm from these shortfalls.

However, we saw risk assessments for other areas such as mobility and eating and drinking. People told us staff supported them safely.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Some environmental risks had not been assessed. For example, there was no evidence that fire safety risks associated with the use of home oxygen had been assessed or considered for one person. This meant staff may not have been aware of these risks which put the person at risk of harm.

However, the service worked well to ensure equipment was safe for people to use. The registered manager commented, “Some staff have been trained by occupational therapists to prescribe some equipment, such as perching stools. We have risk assessments in place for equipment and staff check equipment before they use it.”

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.

Staff had been recruited safely and received a range of training relevant to people’s needs. Staff received regular supervision where wellbeing, sickness, challenges and any service updates were discussed. People told us staff seemed well trained and stayed for the full duration of their visit.

One staff member commented, “Usually there are enough staff, sometimes weekends are tight due to less staff on, combined with holidays and sickness, but this is now being managed better.”

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. There were no concerns raised in relation to infection prevention and control. Staff had completed training in infection prevention and control and had access to personal protective equipment. The registered manager told us, “Infection prevention and control is embedded within daily practice to minimise the risk of infection and protect the people we support and staff. The service follows current infection prevention and control guidance, with clear policies and procedures in place that are reviewed regularly.”
 

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

People’s medicine administration record [MAR] charts were not always accurate. For example, one person was prescribed a medicine which was recorded as a ‘when required’ [PRN] medicine although the registered manager confirmed this should not have been. We also found that there were no PRN protocols in place for people and the registered manager confirmed they do not routinely use these. However, the provider’s policy on managing medicines stated these should be in place. This meant staff did not have clear guidance on when to administer PRN medicines. MAR charts were handwritten by staff and therefore difficult to read in some cases.

Risks had not always been assessed relating to high-risk medicines such as blood thinning medicines. This meant staff may not know how to manage the associated risks, such as heavily bleeding, effectively.

Finally, some records of care delivery referred to the application of a cream; however, it was unclear what cream was being used, whether it was prescribed or an emollient, and the reason for its use.

One staff member told us, “The medication policy is confusing and it gets tweaked and changes, there not always consistency either, we all seem to understand it slightly differently, then it gets slightly changed or added to and we don't always know or understand this.”

However, people’s allergy status was recorded. Medicine related audits took place frequently. Staff received training in medicines, and their competency was checked annually. People did not raise any concerns in how their medicines were managed. There was no evidence that people came to any harm as a result of the shortfalls.