The Cube Disability Ltd

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 69 (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. Feedback was sought from staff and people following the previous holidays and changes were made based on this. This included changes to accommodation booked. People’s relatives told us they had seen improvements. On previous holidays one person had returned with constipation as their food intake and continence care had not been monitored appropriately. On the holiday reviewed during this assessment their bowel care had been managed appropriately and they were free from constipation.

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 had grab sheets available detailing people’s needs, to be shared with medical staff in the case of illness or emergency. Staff had details of the closest hospital to the accommodation available to them. Staff had the opportunity to get to know people and their support needs before going away with them. Meetings were arranged prior to the holiday to give staff the opportunity to read people’s care plans and ensure they understood their needs and for people to meet the staff and other people using the service that they would be going away with. This ensured continuity of care and that people were informed and comfortable with the people they would be on holiday with.

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 told us they had received training on safeguarding and knew how to keep people safe. Mental capacity assessments had been completed where there was reason to believe people were unable to make decisions about their care and support and to ensure there were no unlawful restrictions. People’s relatives told us their relative felt safe on holiday.

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. Some risk assessments would have benefitted from consideration of other possible risk mitigation measures, but this had been picked up by the registered manager in their audit of the files and plans were in place to address this. For example a risk of scalds from hot drinks had been identified for one person but the only risk mitigation listed was to remind the person that their drink may be hot. One medication risk assessment had inaccurate information as the service was not told the person was taking regular medication until they arrived to go away on the short break. Staff had added this information to their records but there was insufficient time before the holiday to update the risk assessment fully. The manager had identified this as an issue to address for future holidays. People’s relatives told us they, and their relative, were involved in the risk assessment process. They said “[relative] was as involved in this [care planning and risk assessment] process as they could be.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. One person required the use of a hoist for transfers from their wheelchair. This was hired to be delivered to the holiday accommodation. This included the hire company’s audits of the equipment to ensure its safety. Staff told us they checked the environment for hazards on arrival. They had appropriate equipment available to them to ensure people’s safety, for example thermometers to check bath temperatures.

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. To ensure there were sufficient staff the manager looked at how many people needed assistance with personal care and whether this was from one or two people. They used this information to calculate how many staff were required. Whilst breaks for staff were not designated in a rota, staff told us they had ample opportunity to have breaks from supporting people to ensure they were well rested. People’s relatives told us they felt staff had sufficient knowledge of people and familiarity with their needs to be able to support them effectively. We saw evidence that staff were recruited safely. Work histories had been gathered and two references had been sought for each member of staff. Disclosure and Barring Service (DBS) checks had been carried out prior to people starting work. We saw evidence that staff training was up-to-date and the service had ensured that people had specific training for working with autistic people and people with a learning disability. This has been a legal requirement since 2022.

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. Feedback was sought from staff and people following the previous holidays and changes were made based on this. This included changes to accommodation booked. People’s relatives told us they had seen improvements. On previous holidays one person had returned with constipation as their food intake and continence care had not been monitored appropriately. On the holiday reviewed during this assessment their bowel care had been managed appropriately and they were free from constipation.

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. People brought their prescribed medicines from home on holiday with them, ensuring there was more than sufficient supply to last them the time they were away. Medication administration records (MAR) were completed while people were away and these indicated that medication was given as prescribed. The service was not made aware of a course of antibiotics that one person was taking until they arrived to go on the trip. This was hand-written on the MAR. There were protocols in place to inform staff when to administer ‘as required’ medicines. Some protocols would have benefitted from additional detail, but this had been identified by the registered manager during their audit of the plans. For example, one person had as required pain relief. Whilst the person was verbally able to tell staff when they were in pain, the protocol did not describe the non-verbal signs of pain they may demonstrate. The registered manager had identified this and was planning to add further detail to the plans. Staff received training and competency checks for the administration of medicines. People’s relatives had no concerns about the administration of medicines.