Complete Care and Enablement 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 remained the same. This meant people were safe and protected from avoidable harm.

This service scored 78 (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 provider learned from incidents to improve safe practice. A person had been referred to hospital as staff expressed concerns about their presentation. Following the person’s discharge back home the provider ensured training was implemented so staff could clearly identify symptoms in the future; this would help prevent recurrence and it also enhanced staff knowledge and understanding.

Robust policies and procedures supported a strong learning culture. The registered manager had a range of monitoring tools at their disposal and good support from other senior managers in sharing any learning outcomes; these helped to drive improvements and ensured people consistently received a safe, high standard of care. Both the provider and staff were passionate about identifying areas for improvement, and continuous learning was embedded into everyday practice. Where poor practice was identified, or when incidents occurred, the provider took prompt action and lessons were learnt and shared.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

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.

Staff had a good knowledge of how to safeguard the people they supported. A member of staff told us, “I always check to see if [person] is okay. If there are any signs of bruising or if they were to neglect themselves, I would raise this with senior members of staff.” Staff we spoke with had no concerns about raising safeguarding concerns with leaders. A member of staff said, “I do not have any concerns about raising anything with [registered manager]; they are great and would listen.”

People had ‘missing persons forms’ in place containing relevant details, such as last time seen, last seen by and intentions when last seen. This ensured the authorities would be provided with clear information should a person go missing, which would help increase the chances of a person being found.

People who required restrictions on their liberty had appropriate Court of Protection Deprivation of Liberty Safeguards (COPDoLS) authorisations in place. One person’s authorisation was over 12 months old; they continued to be supported lawfully whilst awaiting reassessment. We saw the provider was in communication with the local authority regarding this.Not all staff we spoke with had a clear understanding of what a Deprivation of Liberty Safeguards (DoLS) or Court of Protection DoLS order was. This meant there was a risk that people’s rights under the Mental Capacity Act 2005 were not always fully protected; we made managers aware of this and were assured any knowledge gaps would be addressed with training and supervision.

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. People’s safety when accessing activities and places independently and with support, was well considered, with no unnecessary restrictions in place and people’s right to choose was respected. People who were at risk of choking, had appropriate risk assessments incorporated into their care records. For one person, it stated staff should support and encourage them to remain upright whilst eating to lessen the risks of choking, and we saw this in practice during a mealtime observation.

Staff ensured people had a hospital passport in place. A hospital passport is a document used to share key information about a person, especially someone with a learning disability, autism or complex needs, when they go to hospital.

People’s specific risks had been reviewed by staff, leaders and specialist teams where required. For a person with epilepsy, a seizure monitoring chart had been completed and staff ensured this was up to date. People had epilepsy care plans and passports in place. We identified that for one person, We identified that for one person their epilepsy care plan was last formally reviewed in 2022. We were told no changes had been required and this was still valid. Evidence of more recent communication with external professionals in relation to this was provided however, it is best practice to clearly demonstrate all information continues to be relevant within specific support plans.

There was good use of technology to aid with oversight and management of services; for example, CCTV was used to good effect by staff in monitoring and helping to keep a person safe in their own home. Protocols were in place for this.

Staff had a good knowledge of people’s presenting diagnoses and their positive behaviour support plans. They were able to provide the key details about the person without documentation. Staff confirmed restraint was not used in relation to people they supported and were aware of the importance of de-escalation strategies when behavioural and emotional changes were identified.

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

A social care professional told us how the type of housing sourced by the provider was able to meet all the needs for 1 service user. A move from a long-term hospital placement had been facilitated by Complete Care and Enablement; the person had been kept safe and was now enjoying living in their own home. They had recently hosted their own birthday party for friends and family.

Staff ensured people had access to tailored equipment to meet their individual health and social care needs. Most people had profile beds which allowed for them to be raised and lowered and which supported with comfort and mobility. People who required assistance with moving and handling techniques had detailed documentation. Staff were provided with good practice step-by-step guidance, including the use of any specialist equipment or techniques specific to individuals.

Staff ensured people had up to date personal emergency evacuation plans (PEEP). A PEEP is an individual plan which details how best to support a person to be safely evacuated during an emergency, such as a fire.

Staff ensured visitors showed identification and signed in; ensuring only those authorised to do so entered people’s homes and had contact with people living there.

Staff and leaders seemed to have considered whether environments were suitable for people. Single floor accommodation had been sought for those less mobile, people’s rooms were decorated to their liking, emphasising their personalities, and environments were free from unnecessary obstructions and easy to navigate.

Housing providers were responsible for most building repairs and upgrades, and we saw evidence the provider communicated any issues to them. When repairs were not the responsibility of the landlord, we saw that staff liaised with people’s representatives to try and ensure environmental improvements were timely, and in the person’s best interests.

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.

Staff teams within people’s homes were predominantly stable; there was no or little reliance on agency staffing. Where agency staff were used this was consistent. Shifts and rotas were well planned. Staff worked flexibly when needed, supporting each other, leaders and, most importantly, people who used the service. When unexpected staffing pressures arose, such as unplanned absences, we saw staff step up and cover shifts at other homes locally.

The provider ensured there were a range of pre-employment checks prior to staff working with people. The provider was always exploring ways people could be more involved in future recruitment processes; for example, people had submitted specific questions or been part of the interview panel.

Staff received training to ensure the people they supported were safe. This included training in complex behaviours, medication administration and epilepsy management. Staff told us staffing levels were always appropriate and in line with what had been planned. They said annual appraisals took place and supervisions were completed with line managers, which they found beneficial.

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

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Where the service was ordering new supplies of medicines, processes were in place to ensure the supply of medicines arrived on time. Supporting information to assist staff in managing medicines clearly showed who was responsible for the ordering, collecting, storage and administering medicines.

Medicines administration records (MAR) charts were used by the service to record the receipt and administration of medicines. Overall, MAR charts indicated people received their medicines as prescribed. Some of the MAR charts were written by the service and information recorded was not always sufficient to ensure all possible risks with administration were mitigated. These handwritten MAR charts were not always being checked for accuracy by another member of staff, and receipt of these medicines were not being recorded. People’s allergies were not always recorded on MAR charts, although these were recorded within wider support plans documents.

Additional information about the administration of medicines on a ‘when required’ basis were present and gave a good description of when these medicines should be administered. When people were refusing their medicines, their mental capacity was assessed, recorded and they were supported appropriately. There was a process in place for medicines being administered covertly, including obtaining pharmaceutical advice from an appropriate healthcare professional.

Staff ensured medicines were locked in secure cabinets in people’s homes. Staff were aware of what medicines people were prescribed and what they were for. They told us they had completed medicines training and had completed competency assessments in which senior staff shadowed and observed them administering medication.