Dolphin Homes Ltd Supported Living Services Office

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 was previously in breach of regulation in relation to staffing. The service is no longer in breach of this regulation.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

We observed staff listening to people and responding to their concerns. Staff knew what incidents to report and how to report them.

The service investigated incidents thoroughly and shared outcomes with people and relevant stakeholders. We saw evidence of change as a result of incidents which had occurred.

The registered manager told us they received safety alerts from the government, local authority and CQC which informed them of upcoming risks along with themes and trends to ensure the provider could take appropriate action to mitigate these risks.

The service 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.

The provider had an admissions policy in place. The registered manager was able to explain the process including assessing people’s needs to establish suitability, ensuring specialist equipment was available and staff had additional training if required.

People were consistently supported when they were distressed and there was a focus on planning for a good day and understanding what had caused people distress so positive changes could happen.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on protecting people’s right to live in safety, free from bullying, harassment, abuse, and discrimination.

People told us they felt safe living in the home.

Staff knew how to protect people from abuse and who they would report any concerns to both internally and externally.

The service shared concerns appropriately by following the correct process and ensuring these were reported to the relevant agencies. Where restrictive practices were in place Deprivation of Liberty Safeguards (DoLS) were in place or had been applied for, to legally authorise restrictions placed on people to keep them safe.

The service did not always work well with people to understand and manage all risks.

People were assessed for risks of falls, risk of choking and risks relating to medical conditions. When risk had been identified staff acted to keep people safe such as using specialist equipment to monitor their health condition.

Some risk, for example in relation to people’s unhealthy eating and limited activities had not been identified and comprehensively assessed to determine how people were to be supported to reduce the risk to their physical and mental health.

The service did not always control potential risks in the care environment. They did not always make sure equipment, and facilities supported the delivery of safe care. We have reported on this under the infection, prevention and control quality statement.

Health and safety and fire safety risk assessments were completed and checks made of equipment to ensure it was safe to use. Regular audits were undertaken to ensure the environment and equipment remained safe to use. Any concerns were reported to the management team or appropriate person for further action.

Staff attended regular fire evacuation drills to ensure they could safely support people out of their home in the event of a fire. However, not all people evacuated their homes during these drills, and we were not assured plans were in place to help these people manage their anxieties around evacuating. We spoke with the registered manager about this who assured us they would ensure additional support was given to people to encourage them to evacuate their home when required.

Improvements had been made following our last inspection. The service 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 and relatives told us there were enough staff and rotas confirmed this.

The registered manager had a training matrix in place which evidenced most staff had completed all their statutory and mandatory training and competency assessments to ensure they were able to meet people's individual needs. Where staff had not completed training, they were booked on to a session. The provider followed safe recruitment practices.

The service did not always comprehensively assess or manage the risk of visitors spreading environmental outbreaks.

Relatives told us 1 of the supported living services we visited had an environmental outbreak which had been ongoing for over 2 years. As a visitor to the services, we were not informed of the outbreak prior to our visit and having reviewed the provider’s risk assessment, we were not assured other visitors were always informed. This posed a significant risk of the outbreak being spread. Relatives we spoke with also shared their concerns about the length of time the outbreak had been ongoing.

We spoke with the registered manager about this who told us they were liaising with families, the local authority and the housing provider. Staff, people, and families were provided with guidance on preventing bites, reducing spread, and managing laundry or furniture where required. They detailed the treatments which had taken place and were currently ongoing.

We observed the supported living services we visited were clean

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

‘As required’ (PRN) medicines protocols did not always contain clear information. Two people were prescribed a variable dose of medicines. There was no information detailing which dose should be administered. For 2 people, the overall maximum dose in a 24-hour period had been miscalculated. This meant people were at risk of being administered too much medicine. Most Medication Administration Records (MAR) we reviewed did not contain the reason ‘as required’ medicine had been administered or its effectiveness. The registered manager told us they would take immediate action to mitigate the risks to people.

Where people were prescribed emollient creams, the risk assessments did not detail clothes and bedding should be washed regularly at the highest temperature allowed on the care label to minimise the risk of build-up.

Staff received medication training, and their competency was checked to ensure they understood the requirements for the safe administration of medicines. Staff supported and involved people to manage their medicines. Records showed people had received their medicines as prescribed.

The registered manager told us, during people’s annual health reviews, Stopping Over Medication of People with a learning disability and/or autism (STOMP) plans were reviewed. This ensured people’s medicines were reviewed to ensure psychotropic medicines were not inappropriately prescribed or overused. We reviewed evidence of people’s medicines being reduced as a result of these meetings.