ISSAC

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 of the supported living service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 72 (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 demonstrated a positive learning culture, with staff encouraged to reflect on practice.

Staff meetings and supervisions were carried out, which provided opportunities to share learning and reinforce good practice. Staff described a reflective culture where learning and discussion formed part of everyday practice. One staff member told us, “We’re reflective practitioners, as a team we talk about a lot throughout the day.”

Accidents and incidents were recorded, monitored and analysed. We discussed introducing a ‘lessons learned’ section to the accidents and incidents log to further strengthen the service’s approach to capturing learning, recognising patterns, and supporting continuous improvement. This was promptly implemented by the registered manager.

Staff worked effectively with partner agencies to support safe systems, pathways and transitions.

The provider carried out pre-assessments before care commenced to help ensure people’s needs could be met safely and appropriately. Staff worked in a coordinated way with health and social care professionals, and information was shared promptly when concerns arose.

A relative described how the service supported an extended transition period to ensure their family member was fully settled and their needs were well understood. This helped promote continuity of care and positive outcomes.

People were supported to live safely and felt protected from abuse and avoidable harm. Staff had completed safeguarding training appropriate to their role and demonstrated an understanding of how to recognise and report concerns. Staff told us they had no safeguarding concerns about practice within the service.

Relatives told us their family members were safe and well supported by the service. A relative said, “I would absolutely say my [family member] is safe. Staff are brilliant and I would not let them care for my [family member] if they weren’t.” Our observations reflected this feedback. We visited people in their own homes and at an organised social event. People appeared relaxed, comfortable and at ease with staff. Interactions were positive and demonstrated people felt safe, well supported and confident in the staff who supported them.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people are supported to make their own decisions. Where they lack capacity to make specific decisions, any decisions made on their behalf must be in their best interests and be the least restrictive option. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. Where people receive care and treatment in their own homes, an application must be made to the Court of Protection (CoP) to authorise a deprivation of liberty. Appropriate Court of Protection authorisations were in place for people subject to restrictions on their liberty, which ensured care and support was provided in line with legal requirements.

We identified opportunities to strengthen the timeliness of notifications to CQC in relation to CoP deprivation of liberty authorisations and safeguarding concerns. The registered manager acknowledged this and provided assurance that processes were being reviewed to ensure notifications are submitted in a timely manner going forward.

Risks to people’s safety were identified, assessed and managed appropriately to reduce the risk of harm. People and, where appropriate, their relatives were involved in decisions about managing risks, supporting a person-centred approach.

Relatives told us they felt confident in the service's approach to keeping people safe. One relative described how staff followed specialist guidance and support plans to manage their family member's identified needs and said, “Nothing is left to chance.”

Staff used personalised risk management strategies that promoted independence while maintaining safety. The registered manager told us a stable staff team supported staff to develop a strong understanding of people’s needs, risks and preferences.

The provider identified and managed potential risks in the care environment. Equipment, facilities and technology were used to support the safe delivery of care and to promote people’s independence.

As a supported living service, the provider is registered to deliver the regulated activity of personal care only. Care was provided in people's own homes, where individuals retained responsibility for their living environment or, where the property was rented, responsibility for the property rested with the landlord. The provider assessed potential risks within these environments and took appropriate action to help reduce the risk of harm when delivering care.

Safe recruitment practices were not always robust. Whilst the provider used an electronic recruitment system which was colour-coded and prevented progression where mandatory recruitment checks were incomplete, we found that references had not always been obtained from staff members' most recent employer. They had sought references from alternative sources. However, these arrangements reduced the assurance available regarding the staff member's conduct, performance and suitability in their most recent role. The registered manager recognised the importance of obtaining references from staff members' most recent employers. They told us this practice would be implemented consistently going forward to strengthen recruitment decision-making and provide greater assurance regarding staff suitability.

The provider ensured there were enough suitably skilled, experienced and qualified staff to meet people’s needs. Staff received effective support, supervision and opportunities for development, and worked well together to provide safe, person-centred care.

Relatives told us staff were well trained and competent in their roles. A relative said staff received specialist training to meet their family member's specific needs. Staff completed an induction and ongoing training programme, supported by an in-house training provision that included training in positive behaviour support, managing distressed behaviours, emergency medicines and learning disability awareness. This helped ensure care was delivered safely, effectively and in line with best practice.

The service supported people with delegated healthcare tasks. We identified some opportunities to strengthen the recording of these arrangements. This included ensuring documentation clearly identified the healthcare professional responsible for delegating the task and provided a clear audit trail of decision-making and oversight.

Staff received regular supervision and support to help them carry out their roles safely and maintain good practice. In addition to formal supervision, managers carried out spot checks to monitor staff practice and provide feedback. Staff also had opportunities to participate in debriefs following incidents and events, which supported reflection, learning and the sharing of good practice. These arrangements helped to ensure staff felt supported in their roles and provided opportunities to discuss their performance, development needs and any concerns they may have had.

Relatives told us there were enough staff available and that care was delivered by a consistent staff team. People were supported by a core team of staff who knew them well and understood their individual needs, preferences and routines. This helped to promote continuity of care and enabled staff to build positive relationships with people using the service and those important to them. Relatives told us this consistency provided reassurance that people were receiving care from staff who understood their needs and how they wished to be supported. A relative told us, "The organisation understands my relative's needs and understand the importance of continuity."

The provider assessed and managed the risk of infection to help prevent the spread of infection and protect people’s health.

Staff had access to appropriate personal protective equipment (PPE), which they collected from the office. Staff had completed infection prevention and control training to support them in carrying out their roles safely. We identified an opportunity to strengthen practice in relation to the use of fabric towels, as these can increase the risk of cross-contamination if not managed appropriately. This was promptly recognised and addressed by the provider during the assessment.

Medicines were managed safely. This was confirmed by relatives. One relative told us, "Medication is dispensed safely and recorded effectively…medicines are signed out to us when we take our relative out." Another relative said, "My [family member] has a lot of medication, and they are really on it."

The provider had systems in place to support the safe management of medicines. A designated medicines officer, who had undertaken additional training to become a nursing associate, provided oversight of medicines management. Staff received medicines training, including face-to-face sessions, and competency checks were completed following induction and reviewed regularly to ensure staff remained competent.

During our review of medicines records, we identified some minor recording issues. We also found the service had sought GP authorisation for medicines to be administered mixed with food; however, confirmation from a pharmacist had not been obtained in line with best practice. The registered manager addressed this immediately during the assessment. These issues had not had a direct impact on people using the service. The registered manager provided assurance that the recording issues would also be addressed.