Affinity Trust - South West

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 was in breach of the legal regulation relating to safe care and treatment and staffing.

This service scored 47 (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 did not always ensure there was a positive and proactive learning culture.

There were processes in place for reporting incidents, however when incidents occurred, associated risk assessments were not always put in place.

Incidents were not always reviewed and signed off by management in a timely way. This meant potential opportunities to learn lessons when things went wrong were missed. However, during the assessment the provider responded to this and confirmed all incident reports had been reviewed and closed.

Some parts of the service had experienced a reduction in incidents. However, in 1 service these had increased. Most staff told us they received debriefs after incidents. One staff member told us, “After I submit an incident form, I get a phone call or email for a debrief invitation.”

The service did not always effectively work with people and healthcare partners to establish and maintain safe systems of care. There were systems in place to support people to transition between services, such as hospital passports. However, these did not always include accurate and up to date information. For example, 2 of the hospital passports we reviewed contained conflicting information to their care plans.

Staff were proactive in supporting people to transition into alternative accommodation whilst work was being completed on their home, with positive outcomes.

The provider did not always work well with people to understand what being safe meant and they did not always concentrate on improving people’s lives or protecting their right to live in safety.

For 2 of the supported living services, safeguarding concerns had been raised prior to our assessment. The registered manager provided assurances they were working with the local authority safeguarding team regarding these concerns. During the assessment we identified a safeguarding concern for 1 person within 1 service. We requested the manager raised a safeguarding alert with the local authority safeguarding team.

Staff knew how to recognise and report abuse. Comments from staff included, “We make sure they [people we support] are free from abuse, financial, emotional, physical abuse. Any concerns we let the manager know” and “I would report someone being abused or neglected. Notify the manager right away, on call, and also a safeguarding number we can call.”

One person said, “Yes” when asked if they felt safe. Another person told us they would go to their social worker if they didn’t feel safe.

We received some mixed feedback from people’s relatives relating to how safe they felt their family members were. Comments from relatives included, “I don’t think [name of relative] is safe. Other comments included, “No I don’t think [there are concerns]” and “No [concerns].”

The provider did not always work well with people to understand and manage risks across all the services.

Care and support plans did not always provide clear guidance for staff, and risks to people were not always assessed and mitigated. For example, 1 person’s pre-assessment record identified a risk to the person, however this was not recorded in the persons care plan and a risk assessment was not in place.

Staff did not always deliver care that met people’s needs safely. For example, 1 person had a Speech and Language Therapist (SALT) eating and drinking plan in place. Not all staff were aware the person had a SALT plan and information in their care plan was not accurate. Additionally, staff told us how they supported the person with meals, this was not in line with the person’s SALT plan. This placed the person at risk of choking.The provider took action when these concerns were raised and we saw that they had been addressed during the assessment.

People’s care records were not always updated following incidents. For example, 1 person had experienced incidents of self-harm, a risk assessment was not in place.

However, in some parts of the service we found appropriate risk assessments were in place and people were involved in these

We discussed our concerns with the registered manager who took immediate action to address these concerns.

The registered manager provided examples of where people were supported with positive risk taking. One staff member told us, “I am all for taking positive risks. We risk assess and try and minimise, but we all take a risk in life it's something we should do.”

The provider ensured potential risks in the care environment were controlled. They ensured equipment, facilities and technology supported the delivery of safe care.

Care plans included information relating to how people were supported to maintain a safe environment. One relative raised concerns regarding the safety of their family members home, the registered manager gave assurances this was being addressed.

One person had a change in their mobility needs; their care plan had been updated to reflect how staff would support them in the event of a fire.

The provider did not always make sure staff were qualified and skilled to provide safe care that met people’s individual needs. Staff had not always received training in relation to people’s specific needs. For example, 2 people needed support with a specialised diet prescribed by a speech and language therapist, staff supporting them had not received training relating to this. Three people required support with their mental health needs, the majority of staff supporting these people had not received training in mental health. Staff trained to administer medicines were not always available to administer people’s medicines. This meant there was a risk people would not receive their medicines when they needed them.

The registered manager confirmed they were working with the providers learning and development team to find a way to manage staff training and monitor the uptake.

We received mixed feedback from relatives regarding the skills of the staff supporting their family members. Comments included, “Staff on the whole yes, new staff training could have been more purposeful,” and “No staff have not had the right training,” and “Yes in general.”

One person told us staffing levels had recently improved. During our visits to the supported living services, we observed people were supported by enough staff. Staff told us there were enough staff. One staff member told us staffing levels were, “Much better now.”

We received mixed feedback from people’s relatives regarding staffing. Comments from relatives included, “Lots of different staff with different ideas, there is some consistency” and “Yes there are regular carers, they are excellent.” A health care professional told us, “There is still a heavy reliance on agency staff, but I feel more assured that the manager is working to recruit new staff and is making efforts to ensure consistency where possible.”

The provider had a robust recruitment process to support the safe recruitment of staff.

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. Training records confirmed staff had received Infection Prevention and Control training. Staff had access to personal protective equipment (PPE).

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

Medicines stock was not always managed correctly. This meant that at times the correct prescribed medicines were not always available when people needed them. In 2 cases medicines detailed in a person’s care plan for the treatment of an emergency was not kept in stock. In 1 case we saw evidence that this had impacted the person as the medicine to support them when they were anxious was not available when needed.

For 1 person with a specific health need staff were involved in prompting them to take their medicines. At times the person would refuse staff support. There was not a robust plan in place to support the person at these times and staff told us they did not feel confident providing support. Records were unclear regarding how staff supported the person with this medicine.

There was a medicine policy in place however, we were not assured that staff always followed it. A system of medicines audits was in place however, these audits were not always undertaken in a timely fashion and they did not identify the issues with medicines we found during our inspection.

We discussed our concerns with the registered manager who took action to address our concerns.