Green Care Services

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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last inspection we rated this key question good. At this inspection the rating has remained good. This meant people were safe and protected from avoidable harm. There were systems to help learn from accidents, incidents and when things went wrong. People and their relatives were involved in this learning and informed about how changes were made to improve the service. The staff worked closely with other professionals to support people to have safe transitions, including support to access different health and social care services. There were processes designed to help safeguard people from abuse and to investigate any concerns and allegations. Risks to people’s safety and wellbeing were assessed and planned for. The staff worked with people and other professionals, including the positive behaviour teams, to help plan strategies to reduce people’s anxiety and potential agitation. The provider helped maintain safe environments both within people’s homes and in the community. There were enough suitable staff to support people and meet their needs. Staff were appropriately skilled and the provider regularly checked their knowledge and competencies. Procedures for infection prevention and control were operated effectively. People received their medicines safely and as prescribed. The staff worked with people using the service and other professionals to monitor people’s medicines and to help ensure these were right for people.

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.

There was a learning culture at the service, where staff and managers reflected on, and learnt from things that went wrong. There were discussions about incidents and information from these was recorded. This included looking at how these incidents could be learnt from, to help avoid recurrences. People using the service and their relatives explained the provider was transparent when things went wrong and apologised. We saw that all incidents, accidents and complaints were recorded, analysed by managers and responded to. When possible, and appropriate, the person using the service and/or their relatives were involved in investigating and learning from these. For example, there were instances where staff had supported people to understand when they had acted in a way which caused offence or harm to others. They had helped them look at alternative ways to communicate their feelings. Information about things that had gone wrong was shared with other professionals and incorporated into care plan reviews and updates.

The provider supported people to make safe transitions between services. They worked closely with schools, colleges and day centres to help understand people’s needs and provide them with personalised services. For example, they had supported 1 person who had moved from a residential care service into the community. They had worked with therapy teams and the positive behaviour support team to develop person-centred resources for communication and to help develop a plan of different activities which met the person’s needs. They had experienced setbacks and trialled support which had not always worked as planned. There was evidence to show they had monitored this and liaised closely with others to help develop a personalised service. This had enabled the person to have a happier and more fulfilling life. When supporting another person, the staff had identified the person was unhappy in their current day setting. They had worked with different teams to help their transition to more individual community-based activities. This had a positive impact and had reduced the person’s anxiety. All care plans included easy to access information which could be removed and shared with other professionals when needed. For example, during a hospital admission or when there was a change of professionals working with the person. This included key information about the person, how they communicated and who/what was important to them.

There were systems to help safeguard people from abuse. These included procedures for dealing with safeguarding concerns. Staff were trained so they understood how to recognise and report abuse. They confirmed this and were able to describe how they would respond to different scenarios. People using the service and their relatives told us they felt safe. Their comments included, “[Person] is safe and looks forward to staff coming’’ and “We are very happy, we have a great relationship with staff and [person] is safe.’’ The provider had acted appropriately when they were concerned about potential abuse. They had liaised with the local authority and healthcare professionals, when needed, to investigate what had gone wrong and to make sure people were protected from further harm. Some people were supported with their money, either by staff shopping for them, or by staff supporting them to make purchases and manage their own money. There were appropriate procedures relating to this and relatives confirmed that staff kept a record of transactions and receipts.

Risks to people’s safety and wellbeing were assessed and planned for. Risk assessments and plans considered people’s wishes, individual needs and choices. The assessments were developed in consultation with the person, their families and external professionals when needed. They were regularly reviewed and had been updated following changes in people’s needs. The provider worked in consultation with positive behaviour support teams to develop plans to ensure people received the right support to manage their agitation and anxiety. The staff monitored how these plans were working, and changes were made when needed. For example, the staff explained how they had tried techniques to manage risk with 1 person, but these had not worked in the way they had expected. They had discussed this with the external professionals and redeveloped the risk management plans to better reflect the person’s needs. One staff member commented, “I am constantly risk assessing and aware of my service user and the things that may trigger challenges.’’ Staff also gave us examples of how involving people in managing risk had led to positive outcomes. For 1 person, the staff had recognised the person was unhappy in the day centre where they spent most of their time. The staff worked with the person, their family and external professionals to develop a plan of community-based activities which led to different and new risks. They assessed the risks associated with different activities and through monitoring outcomes they had minimised these and supported the person to have more positive experiences. They communicated with the person throughout, discussing the risks and seeking their views.

The provider assessed people’s home environments and the environments within the community where they supported people. Assessments included information about potential hazards and risks and how these should be managed. Staff received training to understand about the safe use of any equipment people needed and their competencies when using equipment were assessed. The provider had liaised with other professionals when they identified a need for change within someone’s environment or equipment. For example, asking for occupational therapist assessments when they had identified a decline in a person’s mobility or independence.

There were enough staff to keep people safe and meet their needs. People told us that care workers arrived on time, stayed the appropriate length of time and completed all tasks. People were cared for by the same familiar care workers. People and their relatives were given information in advance about the staff who would be working with them each visit. The provider had liaised with commissioners to request extra staffing when they had identified this was needed for people to receive safe and fulfilling care. There were systems for recruiting and selecting staff to make sure they were suitable and upheld the values of the organisation. Selection procedures included checks on their work history, references, skills and right to work in the United Kingdom. The provider also held face to face interviews and all staff underwent a comprehensive induction which included checks of their knowledge and skills. There was a programme of planned training for staff, who told us this was helpful. The provider matched staff who had the skills, interests and, when needed cultural experience and language skills, to help ensure people were supported by staff who understood them and could provide sensitive and appropriate care.

There were procedures to help manage infection, prevention and control. The staff had training in these. People using the service and their relatives told us staff wore gloves and other personal protective equipment (PPE) when needed. The management team carried out spot checks which included observing whether staff had good hand hygiene and whether they followed infection prevention and control processes.

People received their medicines safely and as prescribed. There were procedures for managing medicines. Staff were trained to safely handle these, and the managers regularly assessed their knowledge and competencies. People told us they were happy with the support they received with medicines management. Their comments included, “The carer does the medicines and of course they never miss these, they record what they do’’ and “They help me get my tablets out of the packet and then watch me take them.’’ The provider had assessed risks and planned for people’s medicines. There was detailed information about these. Staff kept records to show when medicines had been administered. These were checked and audited by the management team. We saw that where there had been errors in recording or medicines related incidents, the provider had taken appropriate action to investigate and respond to these, including helping staff to learn how to make improvements. Some people received ‘as required’ (PRN) medicines. There were suitable systems to help make sure these were administered when needed. The provider worked with people using the service, their families and other professionals to monitor whether they were prescribed the right medicines. This included working with others to follow the STOMP (stopping overmedication of people with a learning disability, autism or both) principles. The registered manager described examples of how they had found alternatives to medicines to help manage people’s agitation and anxiety and this had resulted in good outcomes for people, including feeling less sedated.