Carterhatch Supported Living Services

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 changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The provider had failed to robustly assess the risks relating to the health safety and welfare of people. This was a breach of regulation 12, safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service scored 62 (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. Lessons were learnt to continually identify and embed good practice.

Incidents and accidents were documented, and staff knew how to report any incidents of concern. The provider ensured learning through discussing any accidents and incidents in staff meetings and staff supervisions.

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.

There were systems in place when new people were referred to the service. People received robust assessments to ensure the service could meet their care and support needs. People were also able to visit the to see if they liked it before making a decision to move in. This process was fully supported by staff. Where people had specific communication needs and required Makaton sign language and/or pictorial formats to communicate. The service ensured these were used to make sure people were fully involved in decisions. The service worked well with people’s care teams to make sure people experienced safe and effective transitions 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.

People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it. The provider completed regular reports on any safeguarding issues and used this to analyse trends and address and concerns they found.

Relatives were confident people were safe living at the service. Comments included, “[Person] has no awareness of risk and is kept safe in a supportive environment” and “[Person] feels safe there.”

People who lacked capacity to make certain decisions for themselves or had fluctuating capacity had decisions made by staff on their behalf in line with the law and supported by effective staff training.

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.

Care plans and risk assessments were not consistent. Some serious risks were not clearly identified or explained, and key guidance was hard to find. These gaps meant staff may not have clear information they needed to provide safe care using these documents alone. For example, swallowing difficulties, fire risks, what staff should do if someone became distressed. One person’s care plan failed to provide a clear, step-by-step guide for staff to respond when the person became distressed. This made it harder to manage risk consistently. Another person had high blood pressure and staff documented observations. However, there was no information on the safe range of blood pressures, or the action staff should take if readings were not in normal range for the person. Another person had no risk assessment for their wheelchair, shower chair or for going out into the community. There were no risk assessments for paraffin-based creams, which are a fire risk. One risk assessment stated a person needed close supervision using stairs, but their care plan stated they did not use stairs. Another care plan stated a person used a special machine to help them breathe. There was no risk assessment in place and no guidance for staff on how to safely support the person to use the machine.

We discussed the with the manager who told us they were aware of these concerns and were starting a review of people’s care records.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for 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.

There were enough staff and people received their commissioned hours. There had been a new management team who started shortly before the inspection. Staff feedback noted supervisions were not always consistent prior to the new management team. Recent supervisions were documented in the supervision matrix. Staff were positive about the support they received from the management team.

Staff recruitment and induction training processes promoted safety. There were regular agency staff who had also received an induction. All background checks were completed prior to staff starting the job. Staff knew how to take into account people’s individual needs, wishes and goals.

Staff received appropriate training which was refreshed. Staff had also completed training suitable to their role in working with people with a learning disability. Staff also told us they felt they had access to training and that it supported them in doing their role well.

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.

The service used effective infection, prevention and control measures to keep people safe, and staff supported people to follow them. The service had good arrangements for keep premises clean and hygienic. The service had a dedicated cleaning staff who made sure communal areas were kept clean. We observed cleaning throughout the inspection.

Staff used personal protective equipment (PPE) effectively and safely. The service’s infection prevention and control policy was up to date. Staff were encouraged to be vaccinated against flu to help prevent the spread of infection.

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 provider followed recognised national guidance for administration of medicines in a supported living setting. People had their own locked medicines cabinets in their rooms. Staff administered people’s medicines. However, people did not have access to their medicines cabinets and staff administered medicines. We spoke with the management team about this, and they said they would be completing mental capacity assessments to ensure people were able to consent to this.

Staff followed effective processes to assess and provide the support people needed to take their medicines safely. This included where there were difficulties in communicating and when assessing risks of people taking medicines themselves.

The service ensured people’s behaviour was not controlled by excessive and inappropriate use of medicines. Staff understood and implemented the principles of STOMP (stopping over-medication of people with a learning disability, autism or both) and ensured that people’s medicines were reviewed by prescribers in line with these principles.

Where people had been prescribed ‘as needed’ medicines, there was information for staff on what the medication was. These are medicines such as pain relief or to help with anxiety. However, the information did not include the actions staff should take before offering the ‘as needed’ medicines. A relative commented, “Medicines are kept safe, carers are careful and good (with people’s medicines)”