Select Lifestyles Limited

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• 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

Staff received mandatory training to meet the range of people’s needs at each supported living service. Staff received support through supervision and appraisal to support their continuous learning and improve their working practice. Managers made sure recruitment checks were undertaken on all staff to ensure only those individuals that were deemed suitable and fit, would be employed to support people at the service. People and those important to them were supported to understand safeguarding and how to raise concerns when they did not feel safe. Staff understood their duty to protect people from abuse and knew how and when to report any concerns they had to managers. Managers assessed and reviewed safety risks to people and made sure people, and those important to them, were involved in making decisions about how they wished to be supported to stay safe. There were enough staff to support people with their needs. Managers reviewed staffing levels regularly to make sure there were always enough suitably skilled and experienced staff on duty. However, incident records including body maps were not always effective. Body maps are used to record any bruises or injuries people may have, this allows the management team to identify where a safeguarding incident had happened, this meant, assurance of the provider reporting and acting in a timely manner was not evidenced.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People felt able to speak up if they had a concern. They also felt improvements would be made to their care if needed. One relative said, “[Person] is safe, we are told about any incidents and actions taken” another relative told us, “[Person] can show certain behaviours, staff support them well and keep [Person] safe, were involved in any changes to their care”.

Staff told us that they had regular reflective supervision sessions to review what was working well, and what could be improved at the service. Staff gave examples of how the staff team had learnt from incidents. For example, one staff member said, “we have one person who is at risk of falls, as staff we have been involved in the monitoring and risk assessment to keep the person safe, this including working with health professionals”. The provider monitored people’s support needs and contacted commissioners with supporting evidence if they identified further support was needed.

Partners told us around recent complaints they had around various supported living properties. Management teams were asked to mitigate risks to people and review the provider’s systems and processes. Partners told us how the management team completed reviews following concerns raised and provided action plans to resolve concerns.

There were processes to review incidents and then make improvements. There were regular meetings with staff and management. This provided protected time for reviewing and reflecting on any accidents or incidents, this included learning for the future. The provider had service action plans, these identified areas that required changes for the future in the delivery of care. There was a clear policy on the duty of candour and the registered manager understood their role in responding to duty of candour. This policy guided staff to tell the person when something has gone wrong. We reviewed complaints records and we saw this policy had been followed. The management team held multi-disciplinary meetings to discuss people’s care.

Feedback from relatives was not consistent. We found some people had a positive interaction with the service and some people felt communication could be improved. People told us that communication between staff and other health providers was good quality. One relative told us, “Communication could improve around appointments [Person] attends, as were not always fully informed of all the information”. Another relative told us,” They’re pretty good and they ring me as well if anything happens”.

Staff had good knowledge of which health and social care professionals supported which people. Staff were able to explain when these professionals visited, and what type of support they offered. Staff knew how to monitor people’s health conditions, to ensure timely referrals were made to other services. For example, we saw speech and language (SALT) teams were involved with people who were at high risk of choking.

Partners told us around recent complaints they had around various supported living properties. Management teams were asked to mitigate risks to people and review the provider’s systems and processes. Partners told us how the management team completed reviews following concerns raised and provided action plans to resolve concerns.

Staff kept clear documentation on people’s holistic needs. If the person required a hospital admission, this document would go with them to the hospital. This meant hospital staff would have clear guidance on how the person liked to be supported. Where people required external health and social care support, documentation showed that suitable referrals had been made. For example, where people were at high risk of falls or currently having raised incidents of falls, there was a referral and input from occupational therapist and general practitioners. Systems and processes were not always robust in capturing or monitoring people's individual needs.

Relatives told us staff were responsive to learning people’s needs. One relative told us, “Yes [Person] is safe there – the staff try their best with him, he can present different challenges”. Some people would be at risk if they did not have continuous supervision and control, where this was the case, we were told management and the local authority had applied the suitable Deprivation of Liberty Safeguards. 'A process to oversee these was found in place and the registered manager had a matrix present'. These safeguards are to ensure people who cannot consent to their care arrangements are protected if those arrangements deprive them of their liberty. One relative told us,” [Person] showed certain behaviours of distress ‘when first moved in, but the staff have learnt triggers and how to manage behaviours, incidents have lowered and this is down to how staff have been so consistent, it’s improved loads”. ‘However, reported on under processes, peoples experience of safeguarding was not always positive and placed them at increased risk of harm’

Staff understood how to respond to allegations of abuse. Staff told us that they had no concerns, but if they did, they were confident the management team would act appropriately. Staff were confident in using whistleblowing processes if they felt concerns was not being responded to. The registered manager understood how to respond to allegations of abuse. They had a process of how to investigate and keep people safe. Staff knew where to find the safeguarding policy. They were aware of the policy guidance and knew how to follow it to keep people safe from potential abuse.

"We saw people and staff had positive relationships. There was an open culture of communication, and we saw no evidence that people were at risk or fearful of the staff team. Staff had good rapport with people and knew their needs well. We did raise during a visit to a person’s home, where their dignity was not respected. They did not want or allow curtains or blinds to be put up in their bedroom, however, no action or implementation of appropriate privacy protection was explored. This meant inside their bedroom was visible from outside. We raised this concern with the provider who took immediate action during the assessment. "

If an allegation of abuse was made, there were appropriate policies in place to guide the staff team. Records showed that incidents were quickly investigated and referred to the local authority safeguarding team if needed. We did find during our inspection that the auditing and management oversight of body maps was not effective. For example, we identified a body map in place that had recorded bruising, this was appropriately completed by staff, however, was not escalated to management or picked up during a management audit. This had gone undetected for a month where no action was taken to investigate the cause. People were at risk of financial abuse due to the lack of process in place. For example, where money was taken out of the cash tin, the amount was not recorded or accounted for. The only way staff could ensure money was not missing was awaiting for service users to return home and completing a money count and check of receipts. Staff supported people to keep safe when they went into the community. We saw where people required 2 staff to support them, this was provided.

People’s relatives told us that staff understood their needs well and offered support to keep them safe. One relative told us, “Since [Person] has been [supported by Select Lifestyles Limited] risks are managed well, the place before they lived had consistent incidents resulting in potential harm. That’s not happening now though.”’

Staff understood how to support people to be involved in making choices around risks, this including informed risks. The management team ensured that staff were aware of how to provide people with information and ensure they understand risks. Some relatives told us, management involved them in completing care plan and risk assessment guidelines for people.

We saw people were supported safely. One person could become distressed with new people entering their home, we saw staff were quick to respond to this person and offer support that reduced their agitation. This meant the person was kept safe as their distress did not escalate.

People’s needs were clearly documented in their care plans, so staff had clear guidance on a person’s mental, physical, and social needs. Staff knew how to support people to manage risk. For example, one person required the use of a safe space bed. A safe space bed is a specialised bed that has zipped up sides which secure the person inside. Management team worked closely with the local authority and family to ensure all correct appropriate lawful documentation was in place due to this being a restriction to the person. Staff kept records on how they had supported people and at what time. This allowed changes in a person’s needs to be identified and improvements made to their planned care if required. There were clear processes in place for how to respond to an emergency. Staff had clear evacuation processes to follow, and these processes considered the unique needs of people. The provider had a business contingency plan. This covered all supported living properties to ensure in the event of any emergency backup procedures were in place.

People’s environment was managed safely. Relatives provided positive feedback around the environment. One relative told us, “They let [Person] choose what they want in their room”. Some people showed the inspection team their bedrooms, they showed they felt safe in their bedrooms having their own personal belongings. However, we saw people’s homes did not follow the Right support, Right care, Right culture guidance.

The management team described a clear process for monitoring the safety of the environment. For example, the registered manager documented their regular checks around the building and explained how they passed concerns to the maintenance team to resolve. We saw that any areas they had picked up, had been resolved to keep people safe. Staff knew how to respond in the event of an emergency evacuation. For example, if a fire alarm sounded, staff could explain how people would be supported to move into a safe space.

‘People’s homes did not follow a supported living model of care. For example, recruitment signs were outside one supported living home. We raised that this was a person’s home and not appropriate, the provider took immediate action and removed the sign during the assessment. The use of notice boards around the home and offices were set up in most of the homes where the scheme managers would spend their time. This does not follow the Right support, Right care and Right culture guidance. Some people at the care home used equipment such as hoists and mobility equipment. We saw these pieces of equipment were well maintained and stored appropriately. Areas were clear of any blockages, allowing people to follow easy to read escape routes. Staff had access to appropriate fire fighting equipment. We did raise during this inspection a concern around one of the properties having a fire door, this required a key to open, however, the key was stored in the office the other side of the building. Management told us, they would report this to the maintenance team and have the lock changed to a turn lock from the inside.’

Systems were in place to check the safety of the environment and equipment. However, these checks did not always identify safety concerns. We identified a concern around a fire door not having easy access as the fire door was locked and the key was kept the other side of the building, meaning people would be trapped in the event of a fire. The provider responded immediately to the concern found and had the lock changed. Other checks were effective. For example, checking the alarm systems and completing fire evacuations. Management completed audits of the environment, this included checks to ensure the properties were in good condition and to identify any concerns. We saw evidence of where any concerns were raised in a timely way and recorded to track progress.

Relatives told us there were enough staff, and any needs were responded to quickly. One relative told us,” [Home manager] she is brilliant, and I can’t fault her. Also, there is a registered manager who I can speak with”. Relatives told us they felt enough staff were around to support their family member.

Staff spoke about the training provided to them. They explained how it had supported them to be more effective in their roles. A staff member told us, “The training is good, I feel it helps me”. Staff told us they had regular opportunities to meet their manager on a one-to-one basis for supervision. These meetings gave them the opportunity to feedback about their experiences and request further guidance/training if needed. The management team understood how to promote safe recruitment practices.

We saw there were enough staff to provide support to people safely. Staff were matched to meet the needs of peoples allocated 1:1 support hours. Staff were not suitably trained in specific communication needs of service users and health conditions. Staff had completed mandatory standards of training. Where people used methods of communication such as Makaton to communicate choice, this was not always picked up by staff or clearly understood. ‘For example, staff did not have training in Makaton. A communication technique used by people using the service.’

Processes to ensure there were enough staff were in place. The provider had a system in place to monitor support hours, this alerted managers to where people had not had their required weekly support hours and helped identify where they were requiring more time. Where this happened, we saw evidence where the provider would request further hours from the commissioner. A clear induction process was completed by new staff, this included staff shadowing and completing mandatory training before they completed any care and support with people. The provider kept a training matrix, this allowed managers to monitor and ensure staff were correctly skilled and up to date with training. Staff completed competency assessments, this identified confidence in staff completing tasks and areas to improve skills. If staff were not providing the expected level of care, there were clear processes to monitor and improve their performance. Safe recruitment processes were followed. For example, previous employers were contacted to give references on the staff member. Staff had also had regular Disclosure and Barring Service (DBS) checks. These check the police database for convictions or warnings that may impact the staff members safety to work with people.

Relatives told us that the properties were always kept clean. One relative told us, “I go every week so if I notice anything I will say straight away anyway. “

Staff knew what personal protective equipment they should wear and when. Staff knew how to put on and remove this equipment, in a safe way. This protected people from the spread of infection. We saw evidence that during team meetings management would discuss with staff correct procedures to follow, including updating staff on any new guidance.

Properties were clean and hygienic. We saw that staff had access to personal protective equipment throughout the home, this included gloves and aprons. Individual homes were respected to reflect how each person wished to live. We did observe staff supporting people to keep clean and hygienic homes.

There were processes and policies, to ensure the environment was kept clean and hygienic. This protected people from the spread of infection. Staff had received training in infection control, how to put on protective equipment and how to keep people safe in the event of an infection outbreak.

Relatives told us that staff gave their family member their medicine at regular times, and as their prescription required. People we spoke with told us they felt confident with the staff administering medication. One person told us, ‘Staff help me with my medication, I am happy with this’. However, we found systems and processes in relation to medication did not always ensure people were safe from the risk of harm.

Staff were able to explain how they supported people to take their medicines safely. One staff member told us, “We have a clear medication system in place, this supports us to safely administer medication”. The provider had a quality officer who would complete daily observations and checks on the electronic medication system, this meant that any errors or concerns were picked up, however, this was not always effective in management responding in a quick manner. The registered manager worked closely with the quality officer and completed monitoring of staff performance and reoccurring themes. Staff knew who to report medicine concerns too. For example, if they felt a person’s medicine was no longer effective, they understood where to document this, and which health professionals to contact.

The provider had an electronic system that monitored and recorded medicine administration. Staff would access this via a mobile tablet that each home had. In the registered providers office, a quality officer would monitor this daily and keep a live track of all medicines that were to be administered for that day. The electronic system linked directly to the pharmacy, this meant the provider could keep a live check on stock and the provider could. During our inspection we raised concerns over stock levels of medicines not matching. For example, when completing an on-site count of medicine we cross referenced this to the electronic live medication stock levels and found discrepancies. These showed that medicines were missing from the service yet recorded on the system as still present in the homes. We found medication had instructions where once opened had to be used in a certain timeframe. For example, we found 2 people had open bottles of liquid Paracetamol, no open date had been recorded on the bottle. Furthermore, topical creams were found with no open date, this meant there was a risk of expired creams could be used on people. This could cause people to have reactions, or the cream not been effective. A further concern we raised involved return medicines. Staff kept clear records of when they had given prescribed medicines. Following our assessment, the provider informed us they had take action to address the medicines concerns identified. We will check if these improvements have been sustained during our next assessment.