Aylestone

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 69 (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 promoted a positive culture of safety based on openness and honesty. Staff listened to concerns, reported safety events and ensured these were investigated. Lessons were learned and used to improve practice. A relative told us, “There were concerns about a year ago with a person being aggressive to other people. Staff contacted us and were open with us, they worked to get on top of it. They now deal with the situation well.” Relatives knew who to raise concerns with and felt confident to do so. Staff described how they recorded incidents, which were reviewed by the management team to identify improvements. For example, reviews of incidents of people’s distress had resulted in more effective strategies to reduce the risk of further incidents. We reviewed several incidents on the electronic system and saw action plans in place. These were monitored with oversight from the area manager. Relevant parties were informed of outcomes. Minutes of meetings showed how learning was shared with staff. Staff confirmed learning from incidents was consistently shared with them.

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. Staff worked with external agencies collaboratively to ensure people were safe and involved in their care. A relative told us, “Staff did a transition plan. They assessed, observed and worked with me for some time to see how [Name] was supported and we worked with that.” Care plans provided examples of joint working, including assessing for potential moves to more independent living and working with health professionals to identify strategies for people to enable them to engage in health appointments and screening and stay healthy.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Relatives confirmed they felt their relative was safe overall. A relative told us, “If [Name] bruises themself, staff do safeguarding straight away. [Name] bruises easy and if staff see it, they map it.” A second relative described how staff followed safeguarding procedures “There have been odd occasions when something has happened, staff report it and safeguarding it straight away and it’s investigated and resolved. Staff reported an injury to [Name] that was self-inflicted and we had a call from safeguarding to investigate if it was abuse. I told them no, but it did show the right processes had been followed.”

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. Staff demonstrated they understood their role and responsibilities in protecting people from harm. Records showed staff had reported concerns to the local authority safeguarding team, who were responsible for investigation concerns of abuse. Staff had completed training in safeguarding, and their understanding was regularly assessed. Managers maintained up to date and accurate records relating to people’s DoLS (Deprivation of Liberty Safeguards). This helped to mitigate the risk of people being unlawfully restricted.

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 were supported safely by staff who understood and followed guidance in people’s care plans to mitigate risks. For example, we observed staff supporting a person in line with their assessed needs and preferences to minimise their distress. They communicated with the person in their preferred way, gave them reassurance and interacted with the person when they demonstrated they were ready for this. Risk assessments were personalised and included detail and guidance in relation to people’s specific conditions such as epilepsy or other specific healthcare conditions to show potential risk factors and how this was being mitigated. Where people experienced distress, care plans included positive behaviour support strategies that followed best practice. The provider did not practice physical restrictions and provided staff with specific training around understanding learning disabilities, autistic people and distressed behaviours. This gave staff the knowledge and skills they needed to support people safely using the least restrictive interventions.

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 or effective care. Although we found people’s rooms were personalised in line with their preferences and tastes, we found the environment was not utilised fully to meet people’s individual needs. For example, communal areas did not support one person’s sensory need to interact with their environment in a meaningful way. There was a lack of dedicated retreat or calming spaces or sensory toolkits. The rear gardens were spacious but underutilised. We found used cigarette butts around people’s outdoor seating areas. These were cleared away immediately when we raised this with staff but demonstrated a lack of innovation and awareness on how the environment could best be used to support people safely and more effectively. The provider’s representative had identified this and was working with the provider to agree funding for a sensory room for people to access. Additionally, the provider had upgraded all en-suites to ensure they were safe and accessible for people to use.

The provider made sure there were enough qualified, staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. People appeared happy and at ease with staff and relatives told us they were happy with established staff teams as this meant people received consistent care and built positive relationships. Comments included, “Staff know when [Name] is upset and when to give them space. Sometimes [Name] will target staff, staff never have a go back, they just wouldn’t. They know [Name] is not always in control of what they are doing and they are able to manage this” and “We see plenty of staff around when we visit. They are allocated 1-1 with people and that seems to work well.”

However, some relatives were not always satisfied staff were sufficiently trained or confident. Comments included, “I think some staff are nervous, they don’t know how to approach [Name] to encourage them to achieve more. Some staff appear to lack confidence. For example [Name], can be challenging but there are ways to encourage them to participate in things. Some staff don’t have the approach and lack the confidence to do this” and “Staff who have worked with [Name] for a while are very good and know how to get the best out of them. Newer staff or staff covering for absence don’t seem to have the same approach. I would say it is very dependent on who is on shift.” We observed variances in staff approaches, with some staff being proactive and encouraging and other staff supervising with minimum engagement.

Ongoing training kept staff up to date with the requirements of their role and they could undertake relevant qualifications. Staff told us they received the training they required to meet people’s needs, including specific health conditions and learning disabilities. A staff member told us, “The training is good and we are given time to get to know people which is important. People have 1-1 and this means they can go out and have individual support.” Staff told us they received good induction, support and guidance from their managers. Records showed staff were safely recruited to the service including checks with the Disclosure and Barring Service (DBS) before their employment to ensure they were suitable to work in the service.

The provider assessed and managed the risk of infection. We received feedback from people and relatives who were satisfied with the infection control measures employed by the service. Daily care records showed regular cleaning being undertaken by staff as agreed in people’s care plans. Staff had access to personal protective equipment (PPE). Staff received training in infection, prevention and control and food hygiene to support good practice in this area.

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. A relative told us, “I don’t know all the medicines [Name] takes but staff do consult with us around changes in medicines. I know staff keep an eye on (person’s medical needs) and if there is anything new, they speak to me.” Peoples care plans included information on their medicines and any specific guidance to ensure staff administered these safely and as prescribed. These included medicines prescribed as and when required.

Staff worked with health professionals to ensure people’s medicines were regularly reviewed and remained necessary and effective in line with STOMP (Stopping Over Medication of People with a learning disability, autism, or both). The provider had systems and processes for the safe management of medicines. Staff received appropriate training and had their competency to administer medication regularly checked by the management team. Regular medicines audits were undertaken by the managers. Where medication errors had occurred, actions had been taken and lessons learnt to reduce the risk of further errors.