Support for Living Limited - 246 Haymill Close

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

We found aspects of the service were not always safe, although there had been improvements made by the provider in response to recent concerns. There were systems for safeguarding people, although these had not always been followed. There were some risks within the environment. The provider had taken steps to help improve the environment and to support staff to have a better understanding about how to recognise and report abuse. Risks had been assessed and planned for. However, these assessments and plans were not always detailed enough to guide staff to make the right judgements about preventing risks. People received their medicines safely and as prescribed.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us they knew how to make a complaint and when they had raised concerns these had been dealt with. One relative explained that following an accident, staff had received additional training and they had seen improvements. They commented, ''It has been a learning experience for the service, but I think [person] is safer now.'' However, they relatives also felt people were not always safe because of past incidents, accidents and safeguarding alerts.

Staff told us they understood how to respond when things went wrong. They told us they had opportunities to discuss these at meetings, and to learn how to improve the service. They explained there had been improvements in the way managers supported them to identify and learn from incidents and accidents.

Whilst there were procedures for dealing with accidents, incidents, and complaints, these were not always effectively operated. Staff did not always understand about best practice and this sometimes placed people at risk of harm or abuse. The provider had responded when things had gone wrong, they had taken appropriate action when staff had not followed procedures. This action included retraining staff and reviewing assessments and care plans.

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.

Some relatives told us they were not confident people were always safe. They explained people had experienced injuries and poor care in the recent past. These incidents had been investigated by local safeguarding teams and the provider was able to demonstrate protection plans were in place. However, a relative told us they felt it hard to trust staff who had given different accounts of what had happened. At the time of the assessment, there was a further ongoing safeguarding investigation. The experience of 1 person had made their relatives have new concerns about their safety and wellbeing.

Staff told us they had undertaken training to help them understand how to recognise abuse.

Safeguarding procedures had not always been followed by staff. Some staff had not reported allegations of abuse or acted on these when they witnessed poor care. Senior managers within the organisation and the acting manager were addressing this with staff. They had acted promptly when they were made aware of abuse and had worked with the local authority to investigate concerns and to help protect people.

Relatives did not always feel risks were well managed. They were concerned that people had been hurt when staff supported them to move and within the environment. These incidents had been investigated and responded to, but relatives told us they were not assured risks were well managed.

Staff told us they had undertaken a range of training to help them understand how to manage risks. Following incidents at the service, the provider had organised for further training for staff to help them understand about safely moving people.

During our visit, we observed 1 occasion when staff did not use approved techniques to support a person to move. Failure to follow correct procedures puts people using the service and staff at risk of injury. The situation was corrected, and further observations showed staff followed best practice. Staff supported people to eat and drink following guidelines and in accordance with planned care.

Risk assessments and management plans focused on reactive strategies for responding when people were at risk. There was not enough information about how to provide personalised care and support to avoid these risky situations happening. For example, 1 person was at risk of skin damage because of the way they sometimes moved and the fact they spent long periods of time without moving. The assessments identified how staff should check their skin and what they should do if they identified damage. However, there were no person-centred plans to support the person to spend less time engaging in these activities and therefore reduce the risk proactively. Some of the risk management plans identified ways to help reduce people's anxiety. Some of the information was personalised. But the plans referred to these strategies being implemented when a problem had arisen rather than using strategies to help provide a calming environment and prevent the person becoming anxious. Furthermore, the staff had not always followed the plans by providing this personalised care.

Relatives told us they did not have concerns about the environment but had in the recent past. They said that some equipment had not been safe or had not worked properly. However, they felt the provider had or was addressing these things. Some of their comments about the environment included, ''[Person's] bedroom is personalised and decorated'', ''Everyone is relaxed in the home, and it is good space wise'' and ''[Person] is happy about [their] room and is able to make choices about here to put things.''

The staff told us they knew how to ensure the environment was safe and they carried out checks on equipment and safety.

We saw a notice on a bath to state it had been deemed unsafe to use. Additionally, 1shower was not working. The environment was mostly free from clutter or hazards, although a room with confidential waste and old medicines packaging had not been secured to avoid unauthorised access. Most furniture and furnishings were in good condition. People had their own bedrooms which were light, personalised and well equipped. There was a spacious garden, although the staff told us people did not use this.

Following assessments by fire safety professionals a number of concerns were identified with the building. The provider had addressed most of these and put mitigation plans to help improve fire safety systems. The provider had arranged for further assessments and improvements to address outstanding issues. In the meantime, they had increased staffing levels, improved fire detecting and alarm systems and helped staff to improve evacuation techniques. The provider had a system for identifying and responding to problems with the building and equipment. They liaised with the organisations responsible for maintaining the building to help ensure repairs were carried out when needed. However, there was an issue with 1 person not being able to access the bath. Whilst they could access showers, their care plan stated they preferred baths, and this helped them to be calm. Therefore, improvements to the environment were needed to take place to help make sure this person could access the bath.

Relatives told us that they had been concerned with high staff turnover and felt this impacted on the service. However, they also told us they were happy with the number of staff and the current management of the service. Their comments included, ''[Acting manager] is lovely but there have been a lot of staff changes'', ''There seem to be enough staff'' and ''The support workers need support with some basic learning, but [acting manager] is making changes and has given us good feedback and information.''

Staff told us they undertook a range of training. They found this useful. They told us they felt supported by the current management team.

There were enough staff on duty to care for people. Staff attended to people promptly when they asked for or needed assistance.

There were enough staff to meet people's needs and keep them safe. The provider sourced peripatetic staff when needed to cover staff absences. The management team told us they used the same familiar peripatetic staff who knew the service and needs of people living there. The provider carried out a range of recruitment checks on staff to help ensure they were suitable. New staff undertook an induction and training, which included training to understand about the needs of people with a learning disability and autistic people. There were regular training updates and the provider sourced specialist training from health professionals when needed. There were regular meetings for the staff to discuss the service, the provider's expectations of them, and to share learning. The provider had systems to help staff reflect on their practice and discuss this with each other.

Relative's comments included, ''[The home] clean and well looked after'' and ''Staff wear gloves, everything is clean, and I have not had any issues.''

Staff told us they had undertaken training to understand about good infection control procedures.

The environment was clean. We saw staff cleaning the building and equipment. They wore gloves and aprons when needed. The staff washed their hands before and after supporting people and when handling food.

The staff undertook regular checks on cleanliness. When problems were identified these were addressed. Staff completed training to understand about good infection prevention and control.

Relatives told us they were happy with the support people had with their medicines. One relative commented that the person's medicines had recently been reduced and they were happy with this. Another relative explained there were good systems for handing over medicines with staff when the person visited them and when they returned to the service after a visit.

Staff told us there had been improvements to the way medicines were managed. They had been given new information and guidance. They felt they had the knowledge needed to provide safe and appropriate support with medicines.

The provider had improved systems for managing medicines following recent medicines concerns. They had updated procedures, storage arrangements, and training for staff. The management team tested staff knowledge and observed them handling medicines at regular intervals. The staff kept clear records of medicines administration and stock checks. There were protocols for staff to follow when administering 'as required' (PRN) medicines. We observed staff administering medicines in a safe and appropriate way. The staff liaised with prescribing doctors to make sure people's medicines were reviewed.