Dorset Healthcare University NHS Foundation Trust

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• 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

This means we looked for evidence that people were protected from abuse and avoidable harm.
At our last assessment in we rated this key question as good. This meant service was safe and protected from avoidable harm

At this assessment the rating has remained the same.
The service’s referral and admission processes ensured that staff had access to essential information to determine whether patients’ needs could be safely met. Staff described how risks were assessed on admission using a nationally recognised risk assessment tool and how these were regularly reviewed, including after any incident. Patients were protected from bullying, harassment, abuse, discrimination, avoidable harm and neglect, and staff demonstrated a clear understanding of their safeguarding responsibilities. Patients always received safe care and treatment in relation to the environment, infection prevention and control, and the safe management of medicines.
 

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 service had an initiative-taking and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learned to continually identify and embed good practice.
The service demonstrated a positive learning culture where incidents, complaints, feedback and safeguarding concerns were reviewed and used to improve practice. Staff described a culture where learning was actively encouraged.
We reviewed four incidents and found that staff understood what constituted an incident and knew how to report concerns appropriately. Incidents and near misses were recorded on the incident reporting system. The recording completed by the staff team demonstrated that immediate actions taken following incidents were clearly documented, alongside risk ratings, actual impact assessments and Duty of Candour (the legal requirement for healthcare providers to be open and honest with people when something goes wrong with their care or treatment) requirements where applicable.
Managers reviewed all incidents and near misses to identify themes, learning and actions required to reduce the likelihood of recurrence. A tracking system was used to monitor actions arising from incidents and provide assurance that identified improvements had been completed.
All incidents and near misses recorded on the reporting system were reviewed by the Clinical Service Manager and Service Director. Learning was shared through established governance arrangements, including Health Team Meetings held every six weeks and Integrated Health and Social Care meetings held every four weeks. Staff described the use of incident data within these meetings to promote reflection and discussion, including consideration of the number and type of incidents occurring and what actions could be taken to improve safety and reduce future risk.
There was also a Trust-wide Learning and Review Group which enabled staff across the directorate to review patient safety incidents and share learning more widely. Recent learning had focused on improving communication with patients and carers regarding service expectations and supporting people through transitions between different stages of care pathways.
Managers described holding staff debriefs as soon as possible following incidents. Learning identified during debriefs was shared through team meetings and supervision to promote continuous improvement and support staff wellbeing.
Staff demonstrated a good understanding of Duty of Candour and described ensuring that people and their families received explanations when incidents occurred and were kept informed throughout investigations and reviews.
There was evidence that people knew how to report concerns and received feedback following incident reviews and that learning was used to improve practice and patient safety.
 

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 service worked collaboratively with health, social care and community partners to support safe care pathways and transitions. Staff described strong links with Adult Social Care (ASC), acute hospitals, commissioners, care providers and advocacy services to support continuity of care and minimise risk.
People could access the service through a wide range of referral routes including General Practitioners (GPs), self-referrals, carers, Adult Social Care, care providers, day services, children's transition services, criminal justice liaison services and psychiatric liaison teams. Referrals were screened jointly by health and social care staff and discussed through weekly multidisciplinary allocation meetings. Staff advised there were no waiting lists within the service and referral-to-treatment targets were being achieved.
There was transition planning for young people moving into adulthood. Staff described dedicated transition houses for young adults aged 18 to 25 developed jointly with social care partners to support independent living skills before moving into longer-term accommodation.
The service maintained close links with acute hospitals. Staff advised that if a person with a learning disability attended Dorchester County Hospital Emergency Department, an alert was automatically sent to the team inbox, allowing staff to support reasonable adjustments, communication needs and continuity of care.
We observed one discharge planning meeting involving the Community Learning Disability Team, inpatient services, Adult Social Care, provider representatives, police services, advocacy services and the person receiving care. Risks, legal restrictions, previous discharge attempts and future support arrangements were discussed in detail. The meeting was well organised and demonstrated effective multidisciplinary working and person-centred discharge planning.
Community Treatment Reviews (CTRs), Local Area Emergency Protocol (LEAP) meetings, Section 117 reviews, Continuing Healthcare (CHC) reviews and Circle of Support meetings were used to monitor care pathways and support safe transitions between services.
 

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 improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff demonstrated a good understanding of safeguarding responsibilities and described effective working relationships with safeguarding teams, local authorities and external agencies.
Learning from safeguarding reviews and wider safeguarding themes was shared through governance systems and team meetings. Staff demonstrated awareness of safeguarding procedures and were able to describe how concerns would be escalated and investigated.
Care records reviewed demonstrated consideration of risks relating to self-harm, self-neglect, exploitation, domestic abuse, financial abuse, hoarding, vulnerability and risks associated with deteriorating mental health. Safeguarding concerns were reflected within risk assessments and care plans where appropriate.
One care record described ongoing safeguarding concerns relating to domestic issues and vulnerability to exploitation. Staff demonstrated understanding of the risks and were able to describe the actions being taken to reduce harm.
The assigned safeguarding lead for the service had established links to Adult Social Care hub and Local Authority safeguarding team. They Attended multi-agency safeguarding risk management meetings and professional meetings. Allied health staff were delegated ‘nominated enquirers’ for gathering further safeguarding information in relation to individual cases when needed. Staff training across the in safeguarding was 100% compliant.
Because Mosaic (the safeguarding system) and RiO the trusts electronic recording system didn’t talk to each other the service had implemented a system where emails regarding safeguarding incidents came directly to allocated nurse and safeguarding leads.
The service monitored safeguarding themes and trends. The themes identified included self-neglect for example not doing enough activity. The team then met to establish how these could be improved.
Staff demonstrated understanding of the safeguarding needs of people who lacked capacity and described using multidisciplinary Best Interest processes involving families, advocates and relevant professionals when required.
Mental Capacity Act
We reviewed staff training records. On the day of inspection, 90% of staff had received training in the Mental Capacity Act. Staff we spoke to had a good understanding of the Mental Capacity Act, particularly the 5 statutory principles. Staff knew where to get advice from within the trust about the Mental Capacity Act.
We reviewed care and treatment plans and saw that staff had assessed and recorded the people’s capacity to consent to treatment decisions appropriately. When people lacked capacity, we saw staff made decisions in their best interests and recognised the importance of individual wishes, feelings, culture and history. They did this on a decision-specific basis and involved people who knew the person were appropriate.
 

The service always worked well with people to fully understand and manage risks by thinking holistically. They provided care that met people’s needs and was safe, supportive and enabled people to do the things that mattered to them. Staff assessed and managed risks to people and themselves well.
The service involved patients and those important to them in identifying, understanding and managing risks in a way that promoted independence whilst maintaining safety. Risk management was person-centred and balanced people's rights, preferences and individual goals with the need to minimise avoidable harm.
Patients and carers were involved in risk assessments and care planning through the My Wellbeing Plan, which incorporated contributions from the individual, family members and professionals. Staff worked collaboratively with patients and carers to identify goals, develop personalised support plans and regularly review risks as people's needs changed.
We reviewed nine care records and found risk assessments were generally comprehensive, regularly reviewed and reflected people's current needs. Risk assessments considered a wide range of risks including self-harm, self-neglect, falls, road safety, aggression, exploitation, financial abuse, domestic abuse, physical health risks, vulnerability and risks associated with deteriorating mental health. Risk formulations were individualised and linked to clear mitigation plans which reflected the person's strengths, preferences and support needs.
Staff described supporting positive risk-taking to maximise independence. Examples included helping people learn bus routes, develop daily living skills, establish healthy lifestyles, access community activities and prepare for more independent living. Staff worked alongside Adult Social Care (ASC) to support adults transitioning from the family home into supported accommodation through dedicated transition houses, enabling people to develop confidence and practical life skills while ensuring appropriate support remained in place. Staff received training on reducing restrictive practice.
The service used a range of evidence-based and specialist approaches to manage risk, including Positive Behaviour Support (PBS), trauma-informed care, Occupational Therapy (OT), Speech and Language Therapy (SALT), behavioural analysis, multidisciplinary Best Interest (BI) decision-making and specialist psychological input. Staff worked closely with carers, providers and partner agencies to understand the causes of behaviours of concern and develop personalised strategies that reduced distress whilst promoting independence.
The Intensive Support Team (IST) provided rapid assessment and intervention for people experiencing deteriorating mental health, escalating behaviours or potential placement breakdown. The service operated between 8am and 8pm, seven days a week. Referrals assessed as an emergency had a 2 hour target with urgent and routine referrals having a requirement to have been reviewed or triaged within 48 hours. Staff described responding quickly to changes in risk and working alongside community teams, Adult Social Care, providers and commissioners to help people remain safely within their communities wherever possible.
Where risks were associated with providers' understanding of an individual's needs, staff worked directly with providers to improve care. We saw examples of the Intensive Support Team completing behavioural analysis, reviewing incidents, modelling Positive Behaviour Support approaches and providing education and coaching to provider staff. This improved staff understanding of people's needs, promoted more consistent support and helped improve placement stability.
Staff also demonstrated creative approaches to reducing restrictive practice whilst managing risk. The service had developed a specialist pathway to support people who lacked capacity or experienced significant anxiety around blood tests. Individualised desensitisation programmes, multidisciplinary Best Interest decision-making and collaboration with families enabled people to access essential healthcare using the least restrictive approach possible.
Where people lacked capacity to make specific decisions, staff demonstrated a good understanding of the Mental Capacity Act (MCA), Deprivation of Liberty Safeguards (DoLS) and Best Interest decision-making. Families, advocates and relevant professionals were involved appropriately to ensure restrictions were lawful, proportionate and represented the least restrictive option available.
We observed a multidisciplinary discharge planning meeting for a person preparing to move from inpatient care into supported living. The meeting involved the person, Community Learning Disability Team, inpatient staff, Adult Social Care, provider representatives, police, advocacy services and the consultant psychiatrist. Risks, legal restrictions, previous discharge attempts and community support arrangements were reviewed in detail. The person was supported to contribute to discussions and the rationale for decisions was explained clearly, demonstrating collaborative and person-centred risk management.
Carers consistently reported feeling involved in managing risks and spoke positively about the collaborative approach taken by the service. Families described staff as proactive, responsive and supportive during periods of increased need. They valued being involved in care planning and reported that staff listened to their concerns, acted promptly when risks increased and worked together to achieve the best possible outcomes whilst maintaining the person's independence.

The service always detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.
The service operated from a range of community premises which were clean, organised and suitable for the delivery of care. They had a full range of environmental audits.
The physiotherapy room was clean, spacious and well organised. Equipment was stored appropriately in dedicated storage areas and clinical space was not being used for storage purposes. An extensive range of specialist equipment was available to support assessment and treatment. Wheelchair weighing facilities were also available without appointment. These were regularly checked ensure they were safe and in good working order.
Hand sanitising stations were available at entrance points and handwashing guidance was displayed throughout clinical areas. Clinical waste was appropriately segregated and managed using colour-coded systems.
Premises provided good accessibility, including disabled access arrangements, accessible toilets and sufficient circulation space.
The West Team office in Dorchester had some environmental limitations. Staff highlighted restricted office space, steep stairs and cold temperatures during winter months due to the age of the building. During inspection of the Dorchester site, the location was accessed via an uneven paved walkway and a narrow route which may present challenges for people using mobility aids. Some areas of the building required access via steep stairs and staff advised that colleagues with accessibility requirements may need to work from alternative locations. Patients did not access these areas
Medical and safety equipment inspected were safe and in good working order. Records demonstrated that servicing and equipment checks had been completed
 

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.
The service ensured there were sufficient numbers of suitably qualified, skilled and experienced staff to meet the needs of people using the service. Leaders reported that staffing levels were regularly reviewed and managed to ensure safe and effective care across the Community Learning Disability Teams and Intensive Support Team.
At the time of inspection the East Community Learning Disability Team had two Band 6 nursing vacancies and one Band 5 Occupational Therapy vacancy. Recruitment was underway, with interviews already arranged. The service demonstrated a commitment to co-production by including a person using the service on interview panels for recruitment.
Leaders reported that sickness levels within the East team were low. Staff received regular supervision, with clinical supervision provided every two months and management supervision every six weeks. Staff also had access to annual appraisals, specialist training and opportunities for continued professional development.
The West Community Learning Disability Team reported being fully staffed with no vacancies and did not routinely rely on bank or agency staff. Leaders described low staff turnover, with many members of staff having worked within the service for several years, supporting continuity of care and the development of therapeutic relationships.
Staff described caseloads as generally manageable and reported feeling well supported by managers. Where people's needs increased or they experienced a deterioration in their mental health, staff were able to access additional multidisciplinary support, including the Intensive Support Team.
Lone working arrangements were well established. Staff described robust systems including designated end-of-day check-ins, the Safe Zone personal safety application, access to personal alarms, breakaway training and Prevention and Management of Violence and Aggression (PMVA) training where appropriate.
Carers consistently described staff as knowledgeable, skilled and responsive. Families valued the continuity of care provided by familiar staff and reported that established relationships contributed to improved wellbeing, stability and positive outcomes for their relatives.
 

The service assessed and managed the risk of infection in line with current national guidance. We observed that the premises at both the Dorchester and Slade Road sites were clean, tidy and well maintained. Hand sanitising stations were available at entrance points and clear handwashing instructions were displayed above sinks throughout the premises to promote good infection prevention and control practices.
Staff understood their roles and responsibilities in maintaining high standards of cleanliness and hygiene. Cleaning services were provided by an external contractor. We reviewed the cleaning arrangements and found the cleaners' room to be clean, tidy and well organised. Cleaning equipment was colour coded, cleaning policies were available and a cleaner induction pack was in place. Daily cleaning schedules were completed and a communication book was used by cleaning staff to report maintenance issues, concerns and incidents directly to service managers. However, whilst daily cleaning schedules were in use, there was no published cleaning schedule or completed cleaning log available for review.
We observed the physiotherapy room to be clean, spacious and well organised. The room was being used appropriately for clinical purposes and not as a storage area. A separate equipment storage room was available and was similarly well organised. There was an extensive range of equipment available to support patient assessment, treatment and rehabilitation.
 

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happen.
There were no clinic rooms located within any of the sites inspected. We inspected the medicine storage cabinets and found them to be clean, secure and well organised. Medical and safety equipment held by the service was in good working order and records demonstrated that equipment checks and servicing had been completed in accordance with trust requirements.
The service ensured medicines and treatments were monitored to support people's safety and to meet their individual needs, preferences and capacity. Staff described involving people in discussions about their medicines and treatment options wherever possible and supporting them to understand changes to prescribed treatment.
A senior manager advised that community teams were responsible for administering depot antipsychotic medication prescribed by psychiatry services where this formed part of a person's treatment plan. Depot medication is a long-acting antipsychotic injection administered at regular intervals, usually every two to four weeks, to support people who may have difficulty remembering or consistently taking oral medication. Staff explained that depot medication could support treatment adherence and reduce the risk of relapse for some individuals.
Staff also described supporting people to manage their medicines independently wherever possible. This included helping people access aids such as dosette boxes and blister packs. Dosette boxes are compartmentalised containers organised by day and time, enabling people to take medicines safely and at the correct times. Blister packs provide a similar function, with medicines pre-packaged by a pharmacy into individual doses. Staff described these as practical measures that could promote independence whilst reducing the risk of missed or incorrect doses.
The service did not routinely store large quantities of medicines on site. Medicines management activity primarily related to depot medication administration and supporting people to manage medicines safely within community settings. Staff described working closely with pharmacy services to ensure medicines management processes remained safe and effective.
Oversight of medicines was supported through pharmacy involvement. Staff advised that depot medication processes, storage arrangements and medicines management systems were subject to pharmacy review and audit. This provided additional assurance that medicines were managed safely and in line with trust requirements.
Care records reviewed during the inspection demonstrated consideration of medicines within wider risk assessments and care planning. In one care record, staff described a person's preference to maintain control of their own medication and their ability to recognise when additional support may be required. In another record, prescribed "as required" (PRN) medication formed part of a relapse prevention plan and was used alongside early warning signs monitoring and crisis planning to support the person's mental health and reduce the risk of hospital admission.