NCYPE - College Residential Services Lingfield

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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

Safe systems were in place to manage risks. People and family members told us they felt the service was safe. Where things went wrong there were systems to identify, manage and learn from the incident. There were enough staff to support people safely. Safeguarding procedures protected people from abuse and avoidable harm. However, medicines were not always managed safely, although inspectors found there was no impact to people.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

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.

People were safe and protected from harm. People’s environments had been adapted to keep them safe and they were supported by trained staff. Family members told us staff knew people well and they observed good relationships between people who used the service and staff. They said, “Yes, [person] is definitely safe and if there are any incidents they call me straight away,” and “I have seen first hand that [person] is absolutely safe, and they would be honest with me it they felt unsafe or unhappy.”

Staff demonstrated knowledge about their role in safeguarding people. They told us safeguarding was “Top of the agenda” and there were systems in place for them to continue their learning. A member of staff told us, “We have safeguarding briefings every month, before a staff meeting. I think the safeguarding system is amazing here; we are very well organised and it is a well-structured system.” Deprivation of Liberty Safeguards (DoLS) documents in place were appropriate and staff and leaders received training in this area.

We observed how people interacted with members of staff in a confident and relaxed way and we heard lots of laughter and conversations going on in the houses we visited. There were evening activities including football and a disco, which we saw people in take part in with great enthusiasm.

There were processes, policies and procedures in place to keep people safe. The provider’s safeguarding policy helped staff to recognise, report and record abuse. Staff had access to a whistle blowing policy and were encouraged to make concerns known. The service had a full record of safeguarding concerns, and this included the type of abuse, people involved and description of the incident as well as the outcome and any lessons learned. The provider told us they were aware of their Duty of Candour responsibility. We saw documents which demonstrated openness and transparency with service users and family members when things went wrong.

People were supported by staff who knew the individual risks and assisted them in the least restrictive way possible whilst minimising the potential for harm. People’s risk management plans supported them safely and helped them to develop independent living skills. Risk management plans considered safe staffing requirements as well as the environment, equipment, and any distressed behaviour. This enabled people to be safe in their own home, as well as to take part in activities of their choosing, including cooking, water sports, shopping, and going on public transport. Family members told us, “Staff have really learned [person’s] ways of communicating which helps [person] to feel confident to try things out, like going to a disco. Their confidence has grown a lot since being there,” and “[person ] learns quite a lot, including life skills.”

Staff were knowledgeable about risks to the people they supported, including those associated with a range of health conditions. Staff spoke confidently and with knowledge about the ways they offered support to people. We were told, "People’s risks do not stop me/us from doing things they want, like trips out or different activities." Others said, “We help people to manage their risks all the time, we want them to have the best experiences,” and “We do risk assessments for everything and for activities which are riskier, these are dynamic and are reassessed as the person’s needs and abilities may change.” People's capacity was considered when such choices had been made and their right to take informed risks was respected.

We observed how staff listened to people and offered gentle guidance when appropriate. For example, staff gave discreet encouragement to a person as they got themselves a drink. This meant the person was able to carry out the task independently with the confidence that staff were close by in the event of them needing their support.

Risk assessments and care plans were in place, which supported staff in the delivery of safe care. Assistive technology was used to enhance safety and well-being, for example, some people had an audio listening device in their room to detect any seizure activity. The software system in use enabled to staff to record the care and support they provided as and when the care was delivered, which included changes to people’s needs, risks or concerns. Managers had oversight of the system and were able to act promptly to any changes or risks in people’s care and safety. Processes were in place to record accidents and incidents, which were analysed to identify patterns and themes, so action could be taken to reduce risk.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

The registered manager ensured there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care that met people’s individual needs. People and family members told the staff were trained to carry out their role. Family members said, “The staff continuity is good and they seem confident and capable. We trust the care they give,” and “There is a good staffing ratio and know what they are doing. I believe they have the right training judging by the tools they have in their toolbox to solve problems.”

Staff told us there were always enough staff to provide safe care. Any gaps in the rota were covered by members of the staff team, to minimise the need for agency staff, who may be unfamiliar with people’s needs. We were told, “Our staffing levels are getting better and better as we speak. We hardly need to cover extra shifts. Staffing levels on the units have definitely improved. The senior managers are doing their best to ensure there are enough staff and a good skill.” Staff spoke positively about training available to them and said, “We have lots of training and regular supervision. We always get training relevant to any new condition or diagnosis a person may have.” We were told the provider had a comprehensive induction programme, “New staff members do lots of shadowing and are assigned an experienced staff member as a mentor throughout their probation. Their supervision is weekly during this time.”

We observed staff were engaging with people in a positive and friendly way and took time to sit with people and chat about their day. There was no indication that staff were pressured for time as they carried out their duties.

Staff received regular supervision and an annual appraisal. Safe recruitment processes were in place. Checks were carried out as required and these included police and criminal records checks, right to work checks and references were obtained and verified. References were obtained and appropriate checks were made to ensure staff were safe to work with people and authorised to work in the UK. The rota reflected safe staffing ratios were consistently maintained. There was a comprehensive programme of training to ensure staff had the skills and knowledge to undertake their role.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People’s records contained information to support staff to meet their individual needs. However, we saw examples where this information was missing or outdated. Staff did not follow the current prescription or update records in a timely manner. This meant that people were put at a risk of avoidable harm. Staff were knowledgeable about people’s individual needs, and their preferred method of receiving their medicine. Family members told us they were confident that people were getting their medicines on time and that they were informed of any changes to medicines. They said, “I am confident [person] gets it on time and have never heard of missed medication.”

Staff were trained to ensure that medicines were used safely and effectively. Staff told us they received specific training on the administration of epilepsy rescue medicines. They worked closely with other health care professionals to ensure they were able to provide holistic care the people living at the service. Staff had annual competency checks to ensure they were able to administer medicines safely. We saw copies of letters from the GP or specialists which were used as a reference when a medicine or dose was changed. However, sometimes these letters were superseded by new instructions from the prescriber and no longer matched the prescription. The service worked with the local GP and a range of onsite healthcare professionals where needed, to meet the healthcare needs of the people living at the service. Staff told us, “A lot of us are medicine trained which makes it easier to share knowledge and support each other as a team,” and “Seniors often do spot competency checks to make sure we haven’t forgotten anything.”

Staff did not always follow the provider’s processes to ensure people received medicines safely. Transcribing (the process of accurately copying details of a person’s prescribed medicines onto a medication administration record) was not safe or in line with best practice. Staff who were not directly employed or managed by the provider copied medicines information from previous records and rarely referred to the original prescription. This could lead to errors with people’s medicines records. People’s medication administration record records did not always contain sufficient detail. Residential staff administered medicines at the college but there was no process in place to ensure these medicines were transported safely to the college. There was a nurse led service on site which was available 24 hours a day to provide medicines support to the residential service. Inspectors had no concerns about the quality of the support provided, and acknowledged the benefits to the service. However, the provider did not have sufficient oversight to ensure that this process was managed effectively or that there was clarity between the nursing team and the care team about respective responsibilities.