Ambito Community Services East Midlands

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 for this service. This key question has been rated 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 service promoted a culture of openness, learning, and improvement. Incident forms were completed by staff, reviewed by management and actions taken where appropriate. Incidents were discussed at team meetings and shared with staff using internal communication channels to ensure lessons were learned. Debrief meetings also took place with individual staff following incidents.

Families described a service that responded appropriately when concerns were raised and learned from issues. One relative explained that they raised concerns regarding a staff member using a word which had distressed their relative, “This has now stopped which is brilliant. It was sorted out well.”

Staff told us the service promoted a reflective learning culture where open discussion was encouraged and learning from incidents was shared across the team. They described a supportive approach from managers, where mistakes were used as an opportunity to improve practice rather than to apportion blame. Staff said they felt comfortable raising issues and reflected that discussions in supervision and team meetings helped them to continually develop their skills.

Staff had completed duty of candour training and a policy was in place. An incident reporting policy was also in place and accessible to staff.

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.

People experienced safe care, with effective systems for managing risks and transitions.

People and their families were involved in discussions with multidisciplinary teams where appropriate. Referrals to partners were made in a timely way. Information was in place in the event of a person using the service requiring emergency treatment or admission to hospital.

The Registered Manager told us that support plans were updated and training provided if people’s needs changed following discharge from hospital. Support plans included a ‘Circle of support’ section which including details of professionals supporting the person using the service to assist with communication and involvement of other partners where appropriate. Staff worked with other services to ensure transitions were safe and effective.

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 protected from abuse, neglect, and discrimination. Staff had completed safeguarding training for both children and adults and knew how to report abuse and were confident to do so. Safeguarding policies were in place and easy read information available.

Safeguarding information and the local authority contact details were displayed on the office noticeboard. Referrals were made to the local authority where required and notified to the CQC as appropriate. The signs of potential closed cultures were considered and action taken where appropriate.Records of safeguarding concerns were kept and those concerns discussed with relevant staff and others as appropriate.

Families felt their relatives were safe. A relative said, “I have no safety concerns with the staff; they are amazing.” Another family member said, “My relative is very safe with them; I have no worries.” Another family member said staff had appropriately responded to a safeguarding concern.

Staff had a clear understanding of their safeguarding responsibilities. They were able to describe the signs of abuse, including changes in behaviour, physical indicators and unexplained injuries. Staff told us they documented concerns appropriately and escalated them to managers, the local authority safeguarding team or emergency services if required. Safeguarding was discussed at each staff member’s supervision meetings.

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.

Risk assessments and support plans were in place to manage risks. Staff completed training regarding the management of risks including choking and moving and handling. Documentation was completed when people showed distress and these events were analysed to minimise the risk of reoccurrence.

Families described consistent risk management. Staff followed specialist guidance, including mobility support and choking risks. One relative said, “My relative is a choke risk… the staff know and cut the food into tiny pieces.”

Staff told us they used detailed risk assessments and support plans to help them understand each person’s needs. They described how they assessed and managed risks relating to mobility, seizures, nutrition and behaviour. Staff encouraged positive risk‑taking and adapted activities so people could take part safely. They said they always involved people as much as possible in decisions about their care.

The provider made sure equipment, facilities and technology supported the delivery of safe care. Appropriate arrangements were in place to manage emergencies. A business continuity plan was in place. Personal Emergency Evacuation Plans were up to date. Health and safety policies were in place and staff completed health and safety training and fire safety training. Risk assessments and support plans contained guidance for staff on how to minimise environmental risks. Staff competency was assessed through observations which included the safe use of moving and handling equipment.

Staff were confident in the safe use of equipment such as hoists and told us they followed policies and checked guidance on digital systems when needed.

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.

Feedback on whether there were enough staff was mixed. Staff were safely recruited. Staff felt supported and received induction, training, appraisal and supervision.

Most families described regular, reliable support, though some highlighted staffing shortages. One relative said, “They struggle for staff… they can cancel due to lack of staff which is frustrating.” Another reported, “They are struggling with staff recently… my relative is still on their books but I miss their help.”

Staff acknowledged that staffing levels could be challenging at times due to sickness or vacancies. However, they told us managers worked hard to ensure people’s support was not cancelled, often stepping into frontline roles themselves. Staff said rotas were planned to allow enough travel time and ensure people received unhurried, safe care. They described the team as supportive and willing to cover shifts for each other.

Professionals described the service as dependable, with no reports of missed visits or inconsistent staffing. Professionals described staff as enthusiastic, caring and skilled in their roles. Individual staff were highlighted for their proactive involvement in therapy and their high quality interactions with people who used services. Professionals felt staff had the right competencies to meet people’s needs.

We did not see any impact on care delivery during our assessment.

Families consistently praised staff competency. A relative said, “The staff are well trained, including about the syndrome my relative has.” Another family member said, “They are kind and caring and know my relative well.”

Staff understood behavioural cues, communication styles and health needs such as epilepsy and complex mobility.

Staff consistently reported they received high‑quality training that enabled them to carry out their roles safely and effectively. Training included safeguarding, medication, epilepsy, manual handling and communication. Staff completed competency assessments before being signed off to carry out tasks such as medicines administration or specialist nutrition support. They told us they could always seek advice from senior colleagues if unsure.

The provider was promoting greater involvement of people who used the service in staff recruitment. A new procedure was in place and new interview questions were being introduced which had been produced alongside people who used services part of a group who represent people who use services. People’s reactions to prospective staff were also considered as part of the recruitment process through observations of interactions.

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.

Risks of infection were managed and controlled. Suitable equipment was in place to enable effective infection prevention and control (IPC). A range of IPC policies were in place. Staff observations by management included infection control practices.

Families described good IPC practice. A relative said, “They wear gloves and aprons with personal care.”

Staff understood their responsibilities around IPC and described using appropriate personal protective equipment. Staff had completed IPC training.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Medicines were managed safely and effectively. Staff received training and their competency was assessed. New more detailed competency assessments were planned for introduction by the provider. We saw examples of these new completed assessments following our inspection visit.Medicines policies were in place. Medicines were administered safely in line with support plans.

Guidance was in place for staff for ‘as required’ medicines, medicines audits were completed and medicines errors were investigated and lessons learned shared with staff. The registered manager explained actions taken to minimise the use of medicines where appropriate.