Arrow Support Limited

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

People were now protected by effective systems to investigate and report allegations of abuse and were no longer subjected to restrictive practices without a legal framework in place to support them. People were protected from the risk of abuse because staff had been trained on how to recognise and report abuse and they knew how to apply it. Risks associated with people’s care needs and the environment had been appropriately assessed and staff had been provided with information on how to support people safely. However, whilst it was clear that staff knew people well, more work was needed to ensure this level of knowledge was fully translated into people’s individual risk management plans. People were supported by staff who had been recruited safely and who had the skills and experience to meet their individual needs.

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.

People who wished to share their views told us they felt listened to and involved in their care, were able to make changes to their support and raise concerns if something was not right. One person said, “Staff are here to support me if I need it, but I choose what I want to do.” Relatives said they were comfortable raising a concern or complaint and felt they were taken seriously if they did. One relative said, “When we had an issue we spoke with the office, and they took immediate action.” Another said, “I’ve had meetings. We talk about things. I know if I have problems, I can voice my opinion and get things changed. They are an approachable company and will respond.”

The registered manager described how they had created a proactive and positive culture of safety within the service, based on openness and honesty. All incidents, accidents and concerns were recorded, reported and investigated. This enabled lessons to be learnt and open and honest conversations with the staff team. They told us how they shared information with people and external agencies, such as healthcare professionals when things had gone wrong as well as liaising with families where appropriate to do so. Staff understood their responsibilities to document and report accidents and incidents in accordance with the provider’s policy and procedures and felt able to raise concerns with the management team when needed.

The provider had clear systems and processes in place to record accidents and incidents. The registered manager reviewed these to identify any learning which may help to prevent a reoccurrence. Outcomes were shared with the staff, people, and external agencies. All information was shared with the provider’s governance team for independent review. Feedback received from people, relatives, staff and other health and social care professionals was seen positively and used to support learning and development. The service’s development plan allowed actions to be captured and was used to measure service progression.

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 consistently told us they had confidence in the staff; they were happy with the support they received, and they felt confident raising concerns if something was not right. Comments included, “No concerns from me,” “Happy with the support I receive, the staff are helpful,” and “Yes, I do feel safe, it’s my home. If I had any concerns, I would speak with one of the staff or [Care manager name] or [Registered manager name].” Relatives did not raise any concerns about people’s safety. One relative said, “They [meaning staff] are all very experienced. They all love the job they do. They look after [person’s name] very well.” Another said, “We have no concerns, but if we did, we have a number for the main office and also the social worker.”

The registered manager described how the service protected people from bullying, harassment, abuse, discrimination, avoidable harm, and neglect. All of which were underpinned by the service’s policies and procedures. The registered manager told us that all accidents and incidents were recorded and reviewed by the provider’s governance lead to identify any learning which may help to prevent a reoccurrence. Staff told us they had received training to enhance their understanding of how to protect people from any form of discrimination and were aware of their responsibilities to report any concerns about people’s safety. One member of staff said, “If I had any concerns about people’s safety I would report it straight away.” Another said, “We always encourage the people we support to talk to us and raise concerns.”

At the previous inspection July 2023, we found the failure to effectively establish and operate systems to investigate and report allegations of abuse. And to provide care and support in line with the Deprivation of Liberty Safeguards code of practice placed people at an increased risk of harm and risked compromising people’s rights. At this assessment, we found improvement had been made, the provider was no longer in breach of regulation 13. The provider had effective systems and processes in place to help ensure people were protected from the risk of abuse and avoidable harm. Staff at all levels recognised when information of concern needed to be shared with the local authority’s safeguarding team and the Care Quality Commission. The provider monitored all incidents and safeguarding concerns through their digital incident management system (Radar). This enabled management oversight to take place at all levels ensuring the right action was taken and improved outcomes for people supported by the service. In addition, the governance team held weekly safeguarding scrutiny panels which provided additional advice and support as well as providing professional oversight. People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. When people receive care and treatment in their own homes an application must be made to the Court of Protection for them to authorise people to be deprived of their liberty. We found people were no longer subject to restrictive practice without a legal framework in place to support them. Where restrictions had been placed on people’s liberty to keep them safe, the registered manager worked with the local authority to seek lawful authorisation for this. There were systems in place for reviewing restrictive practices to ensure that any restrictions remained the least restrictive option. This meant the provider could be assured that any restrictions continued to be in a person’s best interests.

People’s involvement in the development of their care and support varied due to their individual needs and wishes. One person said, “I am aware there is one, [meaning a support plan], but I do not want to be involved.” Another person described their support needs, which we found was consistent with their support plan and risk assessments. Most relatives we spoke with told us they were fully involved in the support planning and risk assessment process. Comments included, “Yes I am involved 100%,” “I was asked to comment on the support plan. I didn’t have anything to add,” and “I had a Zoom meeting with them several months ago. We do feel that we have been involved in the process.”

The management team and staff had a good understanding of people’s individual needs. For example, staff were aware of people's individual risks, potential triggers or signs that might show the person was becoming unwell or anxious. Staff described how they supported people to manage their emotional distress or anxieties whilst maintaining their independence and learning new skills. One member of staff said, “Each person has a small stable team of staff who provide support. So, we know people really well. If I’m ever unsure there is always a manager I can call.”

At our previous inspection, we found a failure to ensure that risks relating to the management of people’s support needs were being effectively mitigated and managed. At this assessment, whilst we found improvement had been made and the provider was no longer in breach of regulation 12, some improvements were still needed. The registered manager described how the service assessed people’s needs before offering a placement. Assessments were used to develop person-centred support plans and risk assessments. These were reviewed regularly with the involvement of people, relatives, and staff. The registered manager and senior team completed a support plan audit. The provider used this to monitor compliance. We found some support plans and risk assessments contained clear information regarding risks and provided guidance for staff on how to support people to minimise those risks. However, whilst it was clear that staff knew people well and had a clear understanding of each person’s level of risk, more work was needed to ensure this level of knowledge was fully translated into people’s individual risk management plans. For example, some people’s risk assessments lacked detail in places, it was not always clear what the risks were or how they were being mitigated. Whilst the provider had a lone working policy, there were no lone working risk assessments in place. We discussed what we found with the registered manager who told us they were in the process of updating all people’s support plans onto a new format and were confident that any gaps would be addressed. When we returned for the second day of the inspection, we found care managers had already made improvements.

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

People were not able to tell us if there were enough staff to meet their care and support needs. However, people told us they were happy with the staff that supported them. Comments included, “I am very happy with my support,” “Staff are good, helpful,” and “[Care manager’s name] really understands me.” Most relatives did not raise any concerns with us about staffing levels or staff’ competencies. Comments included, “Very flexible, and we are able to cancel support if needed,” “[Person’s name] needs support 24/7, we have a stable staff team, no problems,” “We have fixed times and there are no problems,” “They [meaning staff] are reliable, they turn up when they should,” “They [meaning care managers] let us know if a carer can’t come in advance. Staff let us know if they are going to be late but that is rare,” and “Only once in the last year have, they been short staffed.” However, one relative shared with us that the lack of drivers had impacted their loved one’s ability to lead a normal life. We shared what we had been told with the registered manager who told us they were aware of the issue and were working with the family to resolve this.

The registered manager told us there were enough staff to meet people’s needs safely, as each person had their own dedicated support team based on their assessed needs and funded support. Staff confirmed they attended training, received regular supervision, and told us there were enough staff on duty to support people and keep them safe. Comments included, “Yes, we have regular training, and it is a combination of face-to-face and online stuff and all of it is refreshed every year,” “We have supervision every 3 months and, regular spot checks.” And “People have the same staff especially the service I work at – it is always the same faces. It really helps people, it would be unsettling for them if they have new faces all the time and you can see that when we build trust over time people are more willing to do things and try things with staff they know and trust.”

People continued to be protected by safe recruitment processes. Records confirmed a range of checks including application, interview, and Disclosure and Barring Service (DBS) checks were conducted before staff started working at the service. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. All staff received a thorough induction and did not work unsupervised until they had been assessed as competent to do so. The provider monitored staff training on a training matrix. This showed staff had received training in a variety of subjects relevant to their role. However, we noted that given the nature of people’s specific needs the provider did not provide any form of mental health awareness training. We discussed what we found with the recruitment and compliance manager who immediately arranged for mental health awareness training to be added to staff’s training schedules. Records showed staff were receiving regular supervision. Care managers carried out a series of spot checks and competency assessments to check staff's knowledge and identify any training needs.

Most people we spoke with did not have a view on how the provider either supported them or staff to maintain good infection control procedures to reduce the spread of infection. However, one person said, they had clubbed together with their other housemates and had employed a cleaner. Relatives did not raise any concerns about the cleanliness of people’s accommodation, equipment, or the wearing of PPE [personal protective equipment] by staff.

Staff told us they had received training in infection prevention and control and had access to sufficient supplies of personal protective equipment [PPE] when needed. Care managers told us that all staff were issued with handy IPC [Infection, prevention and control] information cards which were attached to their lanyards.

The provider had infection control policies and procedures in place and staff had access to personal protective equipment [PPE]. Staff received training in infection control and used PPE to help prevent the spread of infections. Regular audits and spot checks identified any areas for improvement, which were addressed through staff supervision, team meetings and additional training if needed.

People who chose to share their views said staff supported them to order and take their medicines at the correct time. One person said, “Staff remind me to take my tablets.” Relatives did not raise concerns about the management of people’s medicines, one relative said, “Medicines were very well organised. Another said, “Staff remind [Person’s name] to take his medication. It is very important for his condition."

Staff told us they had received training in the safe administration of medicines and their competencies were assessed. Staff felt medicines systems worked well and they had supplies of medicines when they needed to be given. Care managers told us there were systems in place for recording, reporting, and investigating any errors or incidents. They described how they had worked with staff to reduce medicine errors where they occurred and felt this area of practice had much improved. Regular medicines audits identified areas for improvement and recorded when actions had been completed.

People’s medicines were managed safely. There were systems in place to audit medicines practice and clear records were kept showing when medicines had been administered or refused. Regular medicines audits identified areas for improvement and recorded when actions had been completed, where errors were noted or improvements required, this was shared with staff. Systems were in place to monitor staff training and competence. However, we found how the service managed 4 people’s medicines was not in accordance with the regulation, best practice guidance or the provider’s medication policy. We discussed what we found with the registered manager and nominated individual who assured us they would address these concerns.