L'Arche Bognor Regis Bethany

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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

People now received safe person-centred care. Risks to people were now mitigated. Medicines were now managed safely. People took part in decision about their safety and wellbeing. The culture of the service promoted a positive approach to risk management. Safeguarding procedures protected people from abuse. There were enough skilled staff to ensure people’s safety and meet their needs.

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.

People felt included in discussions about their care and wellbeing. Learning from incidents and accidents was discussed with people to mitigate a recurrence. People felt able to talk to staff about safety concerns. A person told us they had been provided with good advice after getting into a “tricky situation” and this had helped them to stay safe.

Staff said there was an improved culture of safety and learning. There were opportunities to learn lessons and improve outcomes for people. There were better processes to support and manage people's specific health needs, including seizures and diabetes and a greater awareness of risk management. Staff said they felt better informed to support people safely as a result of this learning.

Lessons were learned from safety incidents. Accidents and incidents were appropriately reported and managed. Lessons arising from these were shared with staff and acted upon. There were improved processes to ensure information held about people was correct and up to date. Everyone was encouraged to raise concerns, and this had led to safer outcomes for people.

People felt involved in planning their care and treatment plans. People told us they saw a variety of health and social care professionals to support their health and wellbeing. People had hospital passports which were up to date and accurately reflected their care needs and wishes. This ensured people had continuity of care in the case of a hospital admission.

Staff had an awareness of the risks to people relating to their health and care. Staff supported people to medical appointments and meetings with healthcare professionals. There were regular opportunities to discuss changes in people’s care and well-being needs. Information was used to inform people’s care records and pathways to ensure continuity of care.

We did not receive any specific feedback from professionals who worked at the service during this assessment about safe systems, pathways, and transitions.

Information about people was kept up to date. Improved processes enabled care records to be updated in a timely way and changes shared promptly. Auditing processes were in place to check the accuracy and quality of this information. Partnership working was promoted and encouraged. These processes enabled shared learning and kept people safe.

People felt safe and protected from harm. They were comfortable with the staff who were supporting them and had no concerns about the way they were treated. People knew how to complain and raise a concern about staff conduct. People spoke warmly and positively about staff. A person said, “All the staff are good really; they have such a hard job and are always busy helping us.” Another said, “Staff are nice and treat me well.”

Staff knew how to protect people from abuse and harm. Staff had completed safeguarding training and were knowledgeable about the types of abuse and how to recognise these. Staff knew how to appropriately report concerns they might have about people’s safety and felt confident to do so.

We saw positive engagement and interactions between staff and people. People were treated as equals by staff and spoken to in a respectful manner. People were free from restrictions and were provided with choice and opportunities as to how to spend their day. People were comfortable approaching staff when they needed support, and we saw their wishes and choices were listened to and respected.

Processes were in place to protect people from harm and abuse. Processes were open and transparent and supported by a robust safeguarding policy and positive risk management. Safeguarding concerns were reported and investigated appropriately. Staff received regular safeguarding training and competency checks to ensure their knowledge and practice was up to date.

People were supported by positive and effective risk management. This promoted independence and enabled people to take part in things they enjoyed. A person told us staff had supported them to manage risks when going out alone, including assessing their road safety skills and how to seek help. They said, “Staff are doing a good Job to keep us safe.” Another person took part in sports because risks associated with their health were known and mitigated.

Staff had an awareness of risks to people and how these were mitigated. Staff supported people to be involved in conversations about risks to them including personal safety and health risks. A staff member said, “We share information with people to aid decisions and choices about their lives.” Staff followed people’s individual risk management plans to ensure people were supported in a safe and person-centred way.

Throughout the inspection we saw people were supported safely. We saw staff going through safety checks with a person before they went out alone, including checking their mobile phone was charged and working. People were seen using equipment around their home to support their independence, such as making snacks in the kitchen. The environment was well kept and free from hazards.

Risk management processes identified and mitigated risks. Multidisciplinary professionals supported risk management processes. For example, where there was a risk of falls or specific risks relating to people’s health. Lessons were learnt from incidents and there were opportunities for people to feedback about their experiences. Safety decisions made in people’s best interests followed proper guidance.

People lived in an environment that was safe. A person told us, “I feel very safe living here, especially now we have new stairs.” A regular visitor told us there had been a vast improvement in the physical state of the house. People told us everyone had a role to play in keeping the house clean and free from hazards.

Staff told us they had an improved awareness of safety. A member of staff said “We had become complacent about our environment. Now we risk assess everything.” Staff provided examples of improved security, flooring, and door sensors which they said made the environment much safer.

We saw the environment was clean and fresh, with décor that was light and bright. The lounge had been refurnished and decorated, and people’s bedrooms decorated to their tastes. Flooring was safe from trip hazards and the kitchen area was uncluttered and clean. The home reflected people’s interests and personalities and felt homely and welcoming.

Processes were in place to ensure the environment was safe and free from hazards. There was a regular program of audits and safety checks, including those for gas, fire, and water safety. Risk management processes were in place for emergency situations. These included fire safety assessments and individual personal emergency evacuation plans for people (PEEP).

People told us there were enough staff to support them well. Where people had added 1-1 support hours these were used appropriately. There were opportunities for people to be involved in the recruitment of staff. People spoke positively about live in staff. A person said, “I don’t mind having live in staff, I like their company.” Another person said, “I trust L’Arche to get good ones which they seem to have done so far.”

Staff told us there were always enough staff to provide safe care. Staff covered gaps in the rota to minimise the need for agency staff. A staff member said, “Some people’s routines are so important to them it is essential they are supported by staff who know them well.” Staff said their induction provided them with the skills and knowledge to undertake their role. This included approved training to support people with a learning disability and autistic people.

We saw there were enough staff to meet people’s needs safely. Staffing levels reflected the planned rota. Staff had time to sit and talk to people as well as support them individually with aspects of daily living and personal care. There was enough staff to support people with their planned activities, including a shopping trip and going out for lunch. We saw positive engagement and interactions between people and staff throughout the assessment.

Safe employment processes protected people from the recruitment of unsuitable staff. Appropriate checks with the Disclosure and Baring Service (DBS) provided information about convictions and cautions held on the Police National Computer. Checks on overseas staff ensured they were safe to work with people and had the correct authorisation to work in the UK. Gaps in employment histories were explored and suitable references obtained. This information helps employers make safer recruitment decisions.

People were protected from the risk of infection. People knew what infection and prevention control (IPC) was and why it was important. A person said, “Hand washing is a good thing to do”. People told us staff wore gloves and aprons when they were supporting them with personal care. Three people told us they helped keep the house clean and this was important to keep everyone well.

Staff received training on IPC. They were knowledgeable about how to keep good standards of hygiene and sanitation and how to prevent the spread of infections. The registered manager knew what to do if an infection outbreak. Staff told us personal protective equipment (PPE) was readily available to them.

We saw staff wore PPE appropriately during the assessment. There were ample stocks of PPE around the service. The environment was clean, and furnishings and equipment were in good order. Staff demonstrated good food hygiene practices. Food was stored correctly and appropriately labelled.

The provider had an up to date infection control policy. Staff received training in IPC and food hygiene to mitigate the risk of infection outbreaks. IPC audits were undertaken regularly, and actions airing were addressed. There was a robust cleaning schedule that ensured regular sanitation of the environment. Processes were in place to record and report infection outbreaks appropriately.

People had person centred medicine plans. This enabled people to receive their medicines safely and in line with their preferences. A person told us “I like to have my tablets put in my hand so I can take them one at a time.” Another person said they applied topical creams without staff support.

Staff administered medicines safely. This was supported by training and competency checks to ensure their practice was safe. Staff were knowledgeable of people’s individual needs, including when to give ‘as and when required (PRN) medicines and when to seek additional medical support. Staff told us improvements had been made to the way medicines were stored and administered and safer medicine practices were now in place.

Improvements had been made to ensure medicines were managed safely. There were improved processes for ordering, storing and disposal of medicines. Safety checks ensured medicines were received safely and reflected the prescriber’s instructions. There were clear protocols for administering PRN medicines and regular medicine checks and audits. The providers policies supported the safe management of medicines.