SCC Adult Social Care Supported Living and Mallow Crescent short breaks service

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 identified a breach of regulation in relation to people’s safe care and treatment. Risks to people’s safety and wellbeing were not always addressed in a timely and comprehensive way. There was a lack of guidance for staff regarding how risks could be mitigated for some people. There was an inconsistent approach to how people were supported to transition into the service which meant some people did not always receive their support in a holistic way. We found other instances where people were supported manage risks positively in a way which enhanced their opportunities. People received the support they required with their medicines and records showed prescription guidance was followed. There were sufficient staff deployed to meet people’s needs and safe recruitment practices were followed. Staff were aware of their responsibilities to keep people safe from the risk of abuse. Safe infection prevention and control measures were followed and people were supported to maintain their homes to a good standard.

This service scored 62 (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 they were informed of any concerns, and action was taken to support their relatives safely. One relative told us, “They always let me know if they have any concerns, so I presume they’re looking after him ok.” A second relative shared information regarding how staff had supported their loved one and ensured action had been taken to help them stay safe going forward.

Staff were able to describe the process to follow to report accidents and incidents. One staff member told us, “We get lessons learnt on email, in handover and somethings will be discussed in team meetings. We might need to do reflective practice or some training.”

Professionals we spoke with told us they felt the service had shown improvements in the way they responded to concerns. However, they told us the response times to concerns could be slow on occasions which meant actions could take too long to embed. Whilst this had not impacted people’s care to date, they felt timescales needed to be carefully managed to ensure risks were managed promptly.

Systems were in place to ensure concerns such as accidents and incidents were recorded and action taken to minimise the risk of them happening again. The recording system ensured that senior managers were also made aware of concerns. This enabled teams to check actions had been followed through before being signed off as completed. However, we found managers had not always reviewed the broader risks to people’s care when concerns had been identified. This meant shortfalls in the support other people received to manage risks to their wellbeing were not identified and addressed.

People did not always have a smooth transition when starting their support with the service or when their needs changed. Staff told us of difficulties with supporting some people’s communication needs and understanding how to respond to them. For example, we found one person was isolated in the lounge with the door shut as staff said they were unaware how to respond to their vocal sounds.

In other instances, we found staff had invested a great deal of time and support to help one person transition to their new home. The person appeared settled and reassured by the staff supporting them.

Staff provided mixed feedback on the guidance and training they received to support people effectively when they were transitioning into the service. One staff member told us, “It can be hard to know what to do, we try different things. I feel I can’t communicate with them effectively as I have not had training in Makaton (a visual communication system).” We spoke with the management team about the lack of guidance for staff in some settings. They took action to start to review care plans and risk assessments and requested Makaton training for staff. The management team assured us this work would continue.

We did not receive feedback from partner organisations or stakeholders in relation to this.

Processes to support people in transition were not always well planned. Records showed concerns had been raised in relation to one person’s care during a transition period. Despite this, systems to check the support other people were receiving had not taken place and guidance for staff had not been reviewed. This meant some people were not always being supported in a consistent and caring manner. In addition, where staff tried different approaches to support people this was not always recorded to help form a picture of the persons preferences. In another setting we found staff were working as a team to support a person which had resulted in them having a positive transition.

People told us they felt safe with the staff members supporting them and felt they treated them with kindness. One person told us of a potential safeguarding concern which was causing them upset. They were understood that staff were supporting them in trying to address this and felt able to discuss their concerns openly. Relatives confirmed they felt their loved ones were safe from the risk of abuse. One relative told us, “It’s must better for [relative] there. There is always someone around if they need it.”

Staff members were aware of their responsibilities to keep people safe from harm. They were able to describe the different types of abuse, signs of concerns to be alert to and reporting procedures.

We observed people appeared relaxed in the company of staff and approached staff with confidence when they required support. Information regarding safeguarding was available and displayed for both people and staff to refer to.

Safeguarding processes were in place which ensured concerns were reported in line with requirements. Where safeguarding issues had been reported these were responded to and risks minimised. Staff received training in safeguarding processes and were aware of how to access refresher information.

People and their relatives told us they felt staff were supportive and helped them manage risks. One person told us, “Staff help me with things.” One relative told us, “They’re on top of everything, I’m confident about that.” Despite these positive comments we did observe occasions when people would have benefitted from additional support to proactively manage risks to their wellbeing. For example, staff did not always demonstrate a good understanding of supporting autistic people and people with a learning disability. Where records showed one person had showed distressed behaviour staff had completed records indicating they felt the person had control over the situation. For another person, staff failed to respond to them showing signs of anxiety for a prolonged period of time.

Staff told us they felt supported to manage risks to people’s safety and well-being although on occasions believed additional guidance would be beneficial. This was particularly when people were new to the service and their needs were still being reviewed. When asking staff about one person’s needs in a specific area they told us, “I’m unsure how we should deal with it, we do it like this because we haven’t been shown and it is difficult to communicate with [person’s name]. Staff in another setting told us they found how one person showed their anxiety difficult to support.

On the first day of our inspection we observed risk assessments in one setting were not robust and did not always provide guidance for staff on how to support a person when they were communicating in a way which may upset others. We were informed that following our feedback guidance for staff had been updated. However, on the second day of our inspection we continued to find staff were unaware how they should support the person which led to them being isolated. In other settings we found staff were reluctant to support people in preparing their own meals due to this potentially causing one person distress. There was no evidence of how different approaches had been looked into to enable people to be involved in meal preparation. In a third setting we read guidance for staff which stated staff should not refer to the person’s behaviour but should distract them. However, the staff member supporting the person did not follow this guidance and the person’s behaviour continued for a significant period of time.

In other areas we found staff supported people to manage risks to their safety and well-being. Staff knew people well and understood the different approaches individuals responded to. We observed staff speaking to people about how they would manage attending an appointment the following day and other people preparing their own lunch with minimal staff support. Staff demonstrated a good understanding of people’s anxiety in a number of the settings we visited.

Risk management plans were in place for the majority of people’s care. Where these were not in place or additional information was required, staff started to addressed this during our inspection. The registered manager assured us they would be kept under full review and additional information recorded as staff learnt about people’s needs. In other settings we found risk assessments contained contradictory information, some of which was out of date. Despite this, we found staff were aware of how to support people to manage risks consistently and effectively in the majority of instances.

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 and relatives told us there were sufficient staff supporting them. One person we spoke with told us they were able to go out with staff and could ask for their support at any time. A relative told us, “Whenever I’ve been there I’ve seen a lot of staff and don’t have any concerns.”

The majority of staff we spoke with felt staffing levels were good. One staff member told us, “That’s the best thing from changing to supported living. They all have more hours now so they can go out more.” Although some staff told us it would be beneficial for there to be additional staff to enable records to be maintained, they did not feel people were unsafe.

We observed staff responded to people’s needs promptly and made time for people. We did not see people having to wait for their support. People and staff appeared to have a good rapport. We observed people and staff sharing jokes, chatting about places they had been together and discussing family events. There was a homely atmosphere in the vast majority of settings which people appeared to find supportive.

Systems were in place to ensure sufficient staff were available to support people safely. Rotas were prepared in advance and staff appeared to know people well. Although people had one to one hours allocated, there was little monitoring in place to ensure these hours were provided correctly. The registered manager and nominated individual told us they were reviewing how rotas were completed to enable hours to be monitored more effectively.

People were supported to live in a clean environment. One relative told us, “It’s always been clean and there have been gloves in the bathroom, so I assume they use them.”

Staff confirmed they had access to personal protective equipment (PPE) and the equipment they required was always available to them.

Systems were in place to ensure people received the support they required to keep their home clean and safe. Schedules were completed for the cleaning of communal areas and people were supported to clean their homes. We observed PPE was available to staff at all settings.

People received their medicines in line with their needs. One person told us, “[Staff members] always do that with me.” One relative told us, “[Person] takes quite a lot of medicines and the staff get it all ready.”

Staff confirmed they received training supporting people with their medicines. One staff member told us, “We check records during the day so we know if there have been any mistakes. I would ask if I was unsure regarding procedures.”

We reviewed records of people’s medicines administration and found these were in line with people’s prescriptions. Staff were confident in responding to any queries we had and were aware of safe administration processes.

Records confirmed that staff received training in medicines administration and their competency was periodically assessed. Medication systems and records were clear, and protocols were in place for as required medicines (PRN). Medicines were securely stored. Systems were in place to support people to order their medicines in a timely manner.