Meadowfold Hyndburn Ribble Valley Short Break

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. This is the first assessment for this service. This key question has been rated outstanding. This meant people were protected by a strong and distinctive approach to keeping people safe, including positive risk-taking to maximise their control over their lives. People were fully involved, and the provider was open and transparent when things went wrong.

This service scored 94 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a strong proactive and positive culture of safety, based on openness and honesty. Staff actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice. Staff could confidently advise of steps taken in response to incidents. A staff member said, “I would document in detail including the times, description, and any injuries. If need be, it would be escalated to the manager. I would contact families and call 111/999 (if required).” Incidents were thoroughly investigated and reviewed by the management team. Appropriate action was taken to help prevent re-occurrence, including support plan updates and staff debriefs. Creative and person-centred solutions were implemented to manage risk and avoid safety events reoccurring. One person had previously spilt hot water on themselves when using the kettle, so the service provided a single cup kettle which was easier to hold. This meant the person could continue to make hot drinks independently whilst reducing the risk of further incident. Others using the service were known to pull hair, so staff supporting them wore a hat. This reduced the potential harm to staff.

The provider always worked with people and partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care, including when people moved between different services. The service had created a pictorial guide, and a virtual tour. Short visits enabled people to familiarise themselves with the environment and staff prior to their stay. This helped minimise anxieties or triggers attributed to change. From the initial referral, key-workers were allocated to individual’s and worked closely with people, relatives, partners and other services to plan care and support. Observations were sometimes carried out at schools or day services, so staff could better understand people’s routines and adopt consistent approaches. Systems were in place to cascade information about new admissions to staff. Relative’s gave examples of how people were supported with their transition. A relative told us, “The transition was good. It was a big change for [person] and myself, but they were very accommodating.” The registered manager and staff spoke about collaboration and support offered when people moved between services; to supported living placements or more independent living. A partner fed back, “A person was placed as an emergency. The team were proactive in how to plan for this person’s move into a long-term placement and actively facilitated the practical steps.”

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. People using the service were observed to be well treated and cared for, and we received positive feedback from people and relatives. A relative told us, “They treat [person] very well, they enjoy it. When [person] is back home they’re always happy.” Safeguarding details were displayed on the staff notice board for easy access, and staff explained how they monitored and escalated concerns. The service took steps to keep people safe and address concerns, such as sexual safety. For example; forward planning of stays to ensure compatibility, providing higher levels of support where required and allocating specific bedrooms or spaces to reduce risk. Whilst there was a good level of safeguarding training for contracted care staff, consideration had not been given to the auxiliary team. Training was scheduled promptly by the registered manager during inspection.

The provider always worked well with people to fully understand and manage risks by thinking holistically. Staff provided care that fully met people’s needs and was safe, supportive and enabled people to do the things that mattered to them. The service contacted relatives and other services prior to each visit to check for changes to people’s needs, associated risks, or to request updates about ongoing concerns. Staff confirmed risk assessments were thorough and regularly reviewed, which ensured they had a good understanding of people’s individual risks and agreed strategies. A staff member told us, “I always know I can go to a file and find what I need.” Behavioural risk assessments, positive behavioural support (PBS) plans and associated training ensured approaches to manage behaviour that communicated a need, emotion or distress were consistent, proportionate and protected people’s rights. Any restrictive practices in place were thoroughly documented and person-centred. A staff member explained, “We have PBS training. Everyone’s behaviours can be different so PBS training level 3 and 4 is tailored to the service users specifically. Antecedent, behaviour and consequence (ABC) forms may get discussed in team meetings or the registered manager may speak to staff to investigate triggers, and we will try new strategies.” During inspection we observed staff intervening appropriately to signs of distress, offering reassurances and redirecting people as agreed in their support plan; and staff communicating between themselves to understand potential triggers.

The provider was fully aware of all potential risks in the care environment and controlled them well. They made sure equipment, facilities and technology supported the delivery of safe care. The building was purpose built, with consideration given to the safety of people using the service. Underfloor heating reduced the risk of burns, wider doorways assisted timely evacuation in an emergency and furniture was fixed to the wall to prevent injury or entrapment. Soundproofing had recently been installed to reduce distress for people sensitive to noise. Adjustments were made to the environment prior to people’s stays, to reduce known risks. One person walked on their knees, so mats were used to prevent injuries. Another had previously attempted to run into a patio door, so furniture was moved to prevent re-occurrence. A self-contained apartment meant stays could be facilitated for people requiring their own space, and several bedrooms were purposefully designed to meet the needs of people with more complex behaviours. For example, televisions being fixed behind a safety screen, lockable furniture and pica proof mattresses. Pica is a medical term for when people compulsively eat non-edible items. A relative said, “The environment is good. [Person] has their own room and en-suite, and there are quiet places for them to use because they don’t like noise.” Equipment was available to meet a wide range of needs including specialist beds, ceiling track hoists and accessible baths. A safe space bed was also available, to help provide a low stimulation, safe sleep environment for those who needed it. Staff completed weekly health and safety checks and undertook visual inspections of equipment people brought into the service, ensuring it was safe for use. The registered manager had a schedule of external maintenance checks and servicing enabling them to have good oversight.

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. Staff were recruited safely, with appropriate checks having been made. They confirmed they received a robust induction and programme of training. Rotas considered the occupancy rate and people’s individual needs, and included skeleton staff to cover emergency placements. However, a couple of relative’s fed back that there were not always enough staff to facilitate people’s preferred off-site activities. A relative told us, “The odd occasion, there is not enough staff to take [person] out but it’s usually ok.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff had access to an infection prevention and control (IPC) policy. Training was refreshed annually, and an IPC champion supported the team. The IPC champion had introduced an auditing tool and other systems to ensure good standards, which meant the external IPC audit had been very positive. The auxiliary team completed daily cleaning checklists, and we observed the service to be clean and tidy throughout. Measures were in place to ensure good hygiene, such as personal protective equipment (PPE) stations, soluble bags for soiled laundry and hazardous waste bins. Staff spoke about measures taken to prevent or respond to infection outbreaks, explaining, “During outbreaks, we would consider isolation, extra PPE, deep cleans and use of fogging machines. Families would be informed.” People’s personal care needs were included in support plans, and the service had taken positive steps to work with people and improve personal hygiene levels.

The provider always made sure medicines and treatments were safe and met people’s needs, capacities and preferences. Staff always involved people in planning, including when changes happened. People’s medicines were managed safely and administered in line with best practice guidance, including controlled drugs and covert medication. Storage and security of medicines were robust, and regular checks and medicine counts were carried out. Records showed staff highlighting missing or out of date medicines as it was brought into the service, with prompt action taken to inform relatives or source replacement prescriptions. Relatives confirmed staff contacted them prior to stays to discuss changes to people’s health or medicines and information in people’s records provided clear instructions, highlighting key points. Two staff administered people’s medicines to reduce the risk of errors. The service worked with the local epilepsy nurse to ensure protocols were up to date, and staff had a good understanding of ‘STOMP’ (stopping over medication of people). A staff member said, “I have flagged concerns (about over medicating) before, and families have then been to the GP for a review.” The registered manager gave another example of supporting people’s medicines review which had a positive impact on behaviours and engagement. Processes were in place to ensure staff were appropriately trained to administer medicines, and their competencies were periodically checked in line with good practice.