Creative Support - Bedford 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 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.

Staff were encouraged to raise concerns and confidently spoke about what they would do in the event of an incident or accident; confirming appropriate action was taken. One member of staff informed us, “We talk about safety issues at all our meetings. They are taken seriously and listened to, and the management team will always take actions quickly if safety concerns are raised.”

Systems and processes were in place to report, investigate and share learning from safety events.

Lessons were learnt to continually identify and embed good practice. There was a clear vision for the service to deliver high quality and safe care to people. There was a focus on learning and improving the service wherever possible.

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 supported people to liaise with their landlord about housing related issues. Regular checks were carried out with people to make sure their environment was safe, and meetings held included discussion of potential risks and how they could be managed. Maintenance records were up to date and any actions addressed in a timely way.

Care plans were in place to help make sure safe care was provided and people had personal emergency evacuation plans (PEEPS) which were kept under review. A PEEP is a plan for a person who may need assistance, for instance, a person with impaired mobility, to evacuate a building or reach a place of safety in the event of an emergency.

Staff created pictorial guides, and social stories (a short, descriptive narrative using words and pictures that explains social situations and appropriate behaviours) to enable people to familiarise themselves with the environment and staff prior to moving in. This helped minimise anxieties and distress attributed to change. From the initial referral, the staff worked closely with people, relatives, partners and other services to plan peoples care and support.

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 had developed positive and trusting relationships with people which made them feel safe. One staff member told us, "I am trained to report any concerns that may put individuals I support at risk of harm or abuse. Any concerns must be reported to my line manager straight away to ensure the safety of the individuals at risk. I am aware of the code red and whistle-blowing procedures. All concerns must be documented for proof and evidence.”

People were empowered to keep themselves safe. For example, we saw that 1 person was at risk of inappropriate contact from people via their mobile phone. Support was provided to educate and promote an understanding of the different types of relationships. They were supported with understanding ‘Stranger Danger’ and offered support during key working sessions to discuss who they were currently in contact with by phone, and any issues or concerns that they may have. In addition, staff monitored any changes in the persons behaviour or presentation and encouraged them to discuss any concerns about relationships.

Easy read guides around safeguarding and bullying were given to people and staff spent time with them, using various communication aides such as symbols, objects and pictures to help people understand and take control of their safety.

The service had policies and procedures which covered how to safeguard vulnerable people from abuse and how to ‘whistle blow’ if necessary. We saw safeguarding training was considered essential by the registered provider and all staff completed this and regular refresher courses. The training records and discussions with staff confirmed this. The manager maintained a safeguarding log, to ensure they had effective managerial oversight of any safeguarding concerns.

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 developed positive and trusting relationships with people that helped to keep them safe. One person said, "I feel very safe because there are staff around, and they make me feel safe." A relative commented, "Without a doubt [relative] is safe. They [meaning staff] take every precaution to make sure [relative] stays safe."

People felt risks were well managed without overly restricting their freedom. People who had health conditions such as epilepsy, were supported effectively to protect them from the risk of avoidable harm. Best practice guidance was followed, and the risks were identified and mitigated whilst ensuring the person was able to maintain their independence and dignity.

People were enabled to take positive risks so they could have control over their lives, for example, people were supported to try new experiences such as using public transport and accessing the community. One person with mobility needs who had a passion for horses was supported to go horse riding weekly.

Staff understood there were times when people became distressed and took steps to understand why and what support they needed to express their emotions. There was a focus on understanding what caused people distress and planning to facilitate positive change. Staff received training and support in the use of positive behaviour support (PBS). This is a person-centred framework for providing support to people with a learning disability, and/or autism, including those with mental health conditions, who have, or may be at risk of developing, behaviours of distress.

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

Staff told us they had guidance and risk assessments to follow about working in people’s homes and using equipment to support people. An assessment of people’s home environment was always completed before a care package was provided and these were shared with the staff team, so any identified risks were known and mitigated.

Robust processes were in place to monitor the environment, and any equipment used to support people.

Staff worked closely with social housing providers and reported any concerns swiftly to ensure repairs or replacements were completed to maintain a safe environment. We spoke with a housing officer who told us there was an excellent working relationship with the service managers and staff. They commented, “I wish all services were as good as this one. They involve the tenants in everything and act quickly to make sure improvements are carried out. They always have the best interests of the tenants at the heart of what they do.”

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.

The senior operations manager told us there had been a big reduction in the use of agency staff over the last 12 months and more recruitment of permanent staff. This meant there was better consistency of staffing that ensured people were able to build trusting relationships with staff, and staff were able to get to know people well and how to meet their needs. A relative told us, “The carers are very good. The consistency of the carers has improved a lot recently which is very important to my [family member]. I am also pleased that they now have a male key worker who [family member] responds well to. They are able to motivate my [family member] to try more things and they have built up a good relationship which is working well.” However, 1 relative said that their [family member] did not always receive care and support from a consistent staff team. We raised this with the registered manager and the senior operations manager. They provided us with the staff rotas for that person which demonstrated they received care from a consistent staff team.

Staff expressed satisfaction regarding staffing levels, and 1 staff member said, “I think our staffing levels are very good, including at weekends. Where people need 1-1 support, they always get that.”

An assessment of people’s needs was completed before a care package was agreed. This meant the provider was able to assess how much support a person needed and how many staff were required to provide that support safely. The assessment also identified the skill mix of staff needed to provide people’s care. Staff rotas showed that sufficient numbers of staff were deployed to meet people’s needs. Records demonstrated that staff had been provided with induction training when they first commenced employment. There was an on-going training schedule for staff was in place including any specialist training they needed to ensure they could meet the diverse needs of all people using the service.

Safe recruitment practices were followed for staff working with at the service. Checks were carried out including references and the Disclosure and Barring Service (DBS). Records demonstrated that staff had been provided with induction training and an on-going training schedule for staff was in place.

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 confirmed they had completed Infection Control training and had access to Personal Protective Equipment (PPE). One member of staff said, “I use PPE such as gloves, aprons, face masks and hand sanitiser. The company supplies this.”

Measures were in place to control and prevent the spread of infection and we observed the services we visited to be clean and hygienic.

Staff completed training in relation to the control of infection, and they had sufficient personal protective equipment (PPE). The provider had an infection control policy in place that was up to date and accessible to staff. Regular audits were completed to ensure compliance with infection control protocols.

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. Systems were in place to ensure staff supported people to take their medication consistently and safely. However, a relative told us about an incident when they were visiting their [family member] where they saw that [family member] was holding a medicine pot covered with silver paper that contained their tablets. We raised this with the registered manager and senior operations manager who immediately organised for an investigation to be completed, and actions put in place to prevent any further incidents of the same kind.Other relatives told us they didn’t have any concerns about medication practices. One told us, “I don’t have any concerns about [family members] medicines being given safely. I know the staff are well trained.”

Staff had received training in the safe handling and administration of medicines and their competencies were regularly assessed. The staff understood the importance of safe medicines administration and what to do if they thought a mistake had been made. Robust systems were in place to check medicine administration records to ensure people received their medicines safely.

Daily records and medication administration records were accurately completed.

The provider understood and followed 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 the STOMP principles.