Bright Opportunities Enabling Services Limited

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 requires improvement. At this assessment the rating has changed to 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 demonstrated a good learning culture. Managers described significant learning after concerns about restrictive practice, Mental Capacity Act (2005) compliance and governance at the previous CQC inspection in 2022. They reviewed restrictions, assessments, care plans and best-interest decisions, put Deprivation of Liberty Safeguards (DoLs) in place where needed, and sought support from the local authority and social workers. The registered manager told us they had, “Skilled themselves on mental capacity.” Risk assessments and care plans were now reviewed routinely. Post-incident forms were introduced, and learning incidents were discussed at team meetings. Managers said they had moved from, “Firefighting” to prevention and that, “We just know our clients better now.” The provider was open to feedback and had identified further areas to review. The relatives of people knew who the registered manager was and how to raise concerns if they had any. They spoke positively about the support and said they had never needed to complain and had no concerns. This meant people benefited from a service that continually improved through reflection and learning.

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 managers worked with others to solve problems and make improvements. Staff said they could reach health professionals when needed, and they communicated with other agencies to help ensure continuity of care. Regular contact was maintained with the local authority, social workers, GPs, and other professionals.
The provider had good arrangements to support continuity. New staff shadowed experienced colleagues before working independently. Staff described systems used to pass information between colleagues including handovers and communication books. People had hospital communication passports and Herbert Protocol documents in place to optimise their health when other professionals needed to be involved in people's lives. The Herbert Protocol is a nationally recognised risk-reduction tool used by police and other emergency services to support the timely location of vulnerable individuals who are reported missing. This meant people experienced smooth, safe transitions between services, reducing risk and promoting continuity of 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.
The provider promoted people’s rights to live safely and free from abuse, neglect and avoidable restrictions. Managers monitored restrictions, consent and best-interest decisions, and had addressed concerns identified at our previous inspection. Practice reflected a least restrictive approach, helping to protect people from avoidable harm while supporting their independence and rights. Staff understood how to recognise, report and escalate concerns, had completed safeguarding training and were confident concerns would be acted on. Staff told us they felt people were safe and well cared for, and professionals expressed confidence in the safety and quality of care.

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.
Staff had a detailed understanding of people's risks, anxieties, and behavioural presentations. Staff were skilled in recognising signs that people may be becoming overwhelmed and used a flexible, person-centred approach to support their wellbeing. They adapted activities in response to people's verbal and non-verbal communication, encouraging participation in activities when someone showed uncertainty while respecting people's wishes and changing plans when needed. Staff balanced reassurance with independence.
Staff understood people's risks and the support required to reduce these. Staff identified a person's difficulty responding to fire alarms and had implemented interventions to help them safely evacuate during an emergency. Managers told us the fire service had been involved in supporting the person. Easy read information and ear defenders had been introduced, and fire drills had been used to build confidence and familiarity. A manager confidently said, "We would get them out in a fire." Managers told us the person had successfully taken part in a recent fire drill at the day centre following this work. Staff supported unplanned changes and continuously assessed risks. This supportive approach enabled people to maintain their autonomy, do the things that mattered to them, while receiving the care they needed to keep them safe and well.

The provider identified and controlled risks in people’s home. They made sure equipment, facilities and technology supported the delivery of safe care.
Environmental checks were proportionate for the supported living setting. Risks associated with people’s home environments were assessed and managed wherever possible. Managers helped to monitor safety through smoke alarm tests, fire drills, fire extinguisher checks, fire risk assessments and emergency equipment checks. A personal emergency evacuation plan (PEEP) was in place to provide guidance for staff in the event support was needed during an emergency evacuation. This meant people were protected from avoidable risks and received care in an environment where equipment and support arrangements promoted their safety and wellbeing.

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 support from staff who were competent and understood their needs. Some recruitment records needed slight improvement because employment histories and gaps were not always explored or recorded in detail. The provider told us they would review this.

Staff received training appropriate to their roles and demonstrated a good understanding of the needs of people they supported. For example, staff received training to equip them with the skills to provide safe and compassionate care to people with a learning disability and autistic people. One relative told us, “[Staff] keep up with their training”, which we confirmed from reviewing records and speaking with staff. Managers addressed competency gaps, supported qualifications, and funded additional learning where this benefited people. Staff described thorough induction, shadowing, and showed knowledge of people’s needs, preferences, risks, and communication.
Staff told us they felt supported within their roles and were able to seek guidance from the registered manager when required. If staff became unwell or unavailable at short notice, there were cover arrangements in place to ensure safe care would resume. Recruitment of staff was done safely. This meant people received timely care and support.

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.

Staff supported safe infection prevention and control practice in people’s homes. Staff completed training and competency checks, including practical hand hygiene demonstrations. One staff member told us acrylic nails, nail polish and long nails were allowed if gloves were worn. This did not match the provider’s policy, or best practice guidance, and the provider agreed to review the policy with staff. Staff had access to suitable personal protective equipment. Staff knew how to report infection risks or concerns if they had any. Cleaning schedules covered daily cleaning and weekly deep cleaning. Fridge temperatures and water temperatures were monitored. This meant people were protected from avoidable infection risks and received care in a safe environment.

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.
The service had good medicines systems, including twice-daily stock checks, electronic medicines administration records, monthly audits, expiry monitoring and competency assessments. Daily stock checks had been introduced following previous learning.
Records demonstrated staff monitored people's health needs and generally recorded reasons when prescribed medicines administered on an as required basis (PRN) were used. Examples included PRN medicines being administered when a person had symptoms of a cold or when support was required to manage constipation. Managers described how support around medicines had developed over time, enabling a person to have greater understanding and involvement in decisions about their medicines. Staff received medicines training and understood their responsibilities in relation to safe medicines administration.

One person was prescribed PRN medicine. In addition to the electronic medication administration record (eMAR), a paper MAR chart was in use to support safe administration, reduce the risk of medication errors, and prompt staff to complete associated actions, such as informing relatives. However, the paper MAR was not being maintained as intended. Entries extended beyond the designated recording areas, were difficult to read, and did not consistently contain sufficient information to support safe administration of the medicine. Audit records did not always clearly demonstrate whether discrepancies had been identified, investigated, and addressed in a timely manner. It also was not always easy to review if the effect of the, ‘As required’ medicine had been recorded, such as if it had worked or not. Despite this, from reviewing daily notes and the person’s care plan, the person had still received their medicines safely and only when they needed it. The provider agreed to review their practice to make it more effective and easier to audit.