Imola

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 assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

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.

Safety was a high priority for everyone. There was a proactive culture of safety and learning based on openness, transparency and learning from safety events. Staff had a strong awareness of safety hazards and risks and were confident to report safety events knowing they wouldn’t be blamed or treated negatively if they did so. There were systems in place to review safety events, to understand why a person had become distressed or an incident had occurred. Solutions were developed collaboratively, with the person or their representative, management, staff and the providers positive behaviour support (PBS) team. A PBS practitioner follows a framework that sets out how to deliver good quality support. They work with the individual and their support network to understand why someone is distressed, the impact their environment has on them and the best ways to keep them safe and happy. They looked at what could be changed to prevent further occurrences and lessons were learned to continually show and embed good practice. Staff received effective debrief sessions following incidents. Professionals told us management and staff worked well with them and took the right action when things had gone wrong.

Safety and continuity of care was a priority throughout people’s care journey. The service was proactive in planning and organising continued care and support for individuals before and following admission to Imola. Relatives told us that preadmission and transfer to Imola was managed well with a preadmission assessment and transition meetings. The service worked closely with family, the persons community learning disability team and their own PBS team to set up and manage safe systems of care during transition into adult care. Care and support plans were regularly reviewed and revised to ensure people’s needs were being met and risks were managed and reduced. Prior to admission the provider considered compatibility and whether they can or cannot meet people’s needs. There were processes in place that ensured a collaborative and joined up approach to safety that involved the person, along with their representative, staff and other health care professionals involved in their care. We saw examples of joint working to support and manage health needs, such as working with the GP to support an individual with a blood test, the dietitian to support an individual to gain weight and a neurologist to support an individual with sudden onset of seizures.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. The registered manager gave examples of when they had acted and worked collaboratively with professionals to protect people from harm. They were aware of the warning signs that may suggest a closed culture was developing and had taken active steps to address them. Professionals told us the provider and leaders were “highly receptive to safeguarding guidance provided, and accepting of bespoke safeguarding training delivered to the staff team and management network.” Staff were aware of potential indicators of abuse or neglect and knew what to do if they were concerned about a person. Records showed and staff confirmed concerns could be raised safely, and poor or unsafe practice was challenged. Staff knew people well and said they would recognise if individuals were concerned or unhappy by their behaviour. They would use a problem-solving approach to find the cause. There was regular engagement with people and their relatives. Relatives told us they were assured their family members were protected and safe at Imola. Sexual safety was considered, and people’s sexual health and sexual needs were supported. Management and staff had a good working knowledge of the Deprivation of Liberty Safeguards (DoLS) and the key requirements of the Mental Capacity Act (MCA) 2005. They put these into practice effectively and ensured that people’s human and legal rights were respected. Where restrictive practice was being used, they were legally justified, proportionate, necessary and only as a last resort. There was a clear commitment to reducing them. All restrictive practices were recorded in peoples’ DoLS.

The provider worked with people to understand and manage risks by thinking holistically. Management and staff had a positive attitude towards managing risk. People’s opportunities were expanded with good support and management systems enabling them to have a normal lifestyle, taking part in activities they liked and accessing the wider community. Staff were skilled and proactive in supporting people experiencing distress and were alert to emotional communication. The providers PBS practitioners supported staff to develop an individualised and detailed behaviour support plan incorporating positive proactive strategies for staff to follow. The plan ensured the right sensory opportunities and environmental adaptations for each person to reduce their anxiety and stress behaviours and improve wellbeing. There was a clear commitment to minimising the use of restrictive interventions, including specialist staff training in how to de-escalate anxiety. The service took a proportionate approach to imposing restrictions on people. People’s care plans reflected any foreseeable risks that may need reasonable restrictions such as supervised access to the kitchen and enhanced supervision. Risk and restrictive interventions were reviewed each month to see if they could be reduced or not. Unplanned use of restrictive strategies always triggered a meeting together with staff, management and a PBS practitioner to help staff understand how the persons behaviour had developed, changed or escalated and to review and revise the plan if needed. Staff felt these meetings were very helpful for their learning, involvement and better understanding of the persons need. People who had conditions such as epilepsy, were supported effectively to protect them from the risk of avoidable harm. Restraint was only ever used as a last resort to protect people and others from harm. Staff always followed good practice requirements.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The physical environment met people’s sensory and physical needs. People’s individual sensory needs had been assessed and considered. Changes to the environment, adaptations and reasonable adjustments had been made to help regulate people’s level of arousal, reduce risk and enhance their quality of life. For example, noise reduction, low level lighting and pastel colouring, temperature control and ensuring the environment was free from obstruction. Some people had the condition PICA, a compulsion to consume nonedible items that posed a risk of harm to their health and welfare. Systems were in place together with high level of observation and vigilance by staff to ensure environments used by people with PICA were safe and free from accessible items that could be ingested. There was a large garden with soft play areas for people who seek movement and open spaces. Since our last assessment the kitchen had been completely renovated as part of a scheme of rolling improvement works.

Overall staff were recruited safely but we found there had been a lack of oversight of the process. A new staff member had started employment prior to all required checks being completed and returned to ensure suitability; they did not have a risk assessment and management plan in place. The registered manager carried out a risk assessment at once. However, the provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. Our observations showed staff knew people well, and how best to support them if anxious or becoming upset. The registered manager told us staffing levels had improved, and more permanent staff had been recruited. Relatives and staff spoke positively about the staffing levels within the home and told us there were enough staff to provide a safe and effective service. There was an effective programme of staff training that included eLearning, some face-to-face training and training to meet the needs of people with a learning disability and autistic people. Staff told us they would like more face-to-face training, one staff member said, “I prefer face to face in house training with our PBS team, it has a more person-centred approach and helps us understand and meet the needs of the guys (people) here.” Another said, “I would appreciate more face-to-face training for the opportunity for questions and discussions.” Another said, “I would like more training opportunities that are specific to people’s needs, people at Imola have very specific and complex needs.” The provider had a robust induction process that included the service’s wellbeing model of care and values-based approach for inclusion and a good life for people. Staff felt very well supported; they received an annual appraisal to review their learning and development and regular supervisions to support them in their roles.

The provider did not always effectively assess and manage the risk of infection. The kitchen, communal areas and bedrooms appeared clean and hygienic. However, the laundry was small and cluttered and did not safely help the prevention and control of infection (IPC). Systems were not in place to ensure staff were following the department of health (DOH) infection control guidelines for the safe management of people’s clothes and linens. Soiled and clean washing was not effectively segregated; clean and soiled laundry baskets were stored on the floor, there were no hand washing facilities, liquid soap or hand towels available to staff. We saw that the laundry was listed in the providers 2025 annual scheme of rolling improvement works. Cleaning schedules and IPC audits were carried out to ensure standards were upheld. However, we found areas where there were potential risks to cross contaminate and harbour bacteria that had not been found. Such as dirty wet mops left head down in buckets in a reservoir of dirty water and stored in the laundry room. These were removed at once and attended to during our visit. The foot pedal of the waste bin in the staff toilet was broken and the lid had to be lifted by hand. Staff had received eLearning training in infection prevention and control, but they were not aware of who was the IPC lead for the service, or their role.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People’s care plans held up to date information about how to support them with their medicines. For example, one person preferred to take their medicines with a spoonful of yoghurt. There was a commitment at the service to STOMP, which is national best practice guidance on stopping the over-medication of people with a learning disability and or autistic people when distressed. There were systems in place to ensure people’s distressed behaviours were not inappropriately controlled by medicines. Protocols for people’s medicines prescribed to control their anxieties and associated behaviours held good detail of strategies to be used prior to administration and that medicine would be the last resort. Administration of medicines to people when distressed had to be agreed by management. Medication administration records (MARS) reviewed showed people were not over medicated, and their medicines were given as prescribed and recorded according to policy and national guidance. Each person had a person-centred pain picture, an effective pain assessment tool developed with the person/family/carer which helped to differentiate between physical and emotional signs and symptoms of wellbeing and those cues and behaviours that indicate pain. There were clear policies and procedures for safe management of people’s medicines. Staff received training in administering medicines and their competency was assessed annually. Medicines were securely stored and at the right temperature; the temperature of the medicine storeroom was measured daily. Records of controlled drugs (CDs) were correct and made in line with legislation and best practice. Medicine audits were carried out to detect any errors and if any were found they were addressed promptly. Medicine incidents were recorded, reported, investigated and learnt from.