Zeno Limited

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

People received safe care, which met their needs. Staff received regular training and supervision and told us they felt supported in their roles. People’s homes were clean, well maintained and where needed had been adapted to keep people safe whilst supporting their autonomy. Accidents, incidents and complaints were logged and reviewed to identify patterns and trends and consider any lessons learned. The provider employed a graded transition approach, to support people to safely and effectively move into the service from their previous care provider. Relatives were complimentary about how smooth the transition process was. Enough staff were deployed to meet the needs of people and support them to complete their chosen, social, leisure and vocational activities. People received their medicines on time from staff who had been trained and assessed as competent.

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.

Relatives knew how to report concerns or make a complaint of needed. Comments included, “I’ve not had to raise any concerns, but if I did I would speak to the [area manager’s name] or the [service manager’s name]” and “I have the head guy’s number, he respond’s quickly.” Relatives told us staff informed them of any incidents or accidents which had occurred. One stated, “I ring regularly, but they will ring me if something happens.” Another relative said, “They’ll ring and tell me if [relative] has done anything. They’ve never glossed over anything.”

Staff explained the process for documenting accidents and incidents. One stated, “If there is an incident or accident, then the manager of the service gets notified. However, if this is after 5pm then the on-call manager will be notified. The on-call manager sends a report to all managers including the 3 registered managers. An incident or an accident form is also completed. These get signed off by the service manager and scanned over to head office for the registered managers to see. If there is not enough information or detail on the form, staff will be asked to amend these.”

Accidents, incidents and complaints were all managed in line with policy & procedures. Logs were used to capture what had happened and detail actions taken and outcomes. Incidents and accidents were reviewed at different levels of management to ensure effective oversight. Any identified actions or learning were shared with the necessary people, including staff and where appropriate relatives.

Relatives spoke positively about the transition process, both into the service and internally as progress was made. One stated, “The move [to Zeno] has gone like a dream. The transition was easy. The staff at Zeno came to visit [relative] for 2 weeks before the move, it was handled really well.” Another said, “They [Zeno] have worked wonders with relative. Previously [relative] had been sectioned and drugged up like a zombie. Although [relative] has had some blips here, overall, they have coped very well and have now moved from ground floor accommodation to an upstairs flat, where they have more independence.”

Where circumstances allowed, detailed assessments were completed prior to any admission and a graded approach used when people transitioned from another service into Zeno Limited.

This included staff spending time with the person prior to the transition, to start to build a therapeutic relationship. The graded approach allowed for any potential risks or issues relating to the move to be identified and actions taken to minimise these, to ensure any transitions were done safely.

People using the service were safe, with relative’s feedback supporting this. One stated, “[Relative] is 100% safe, we trust the staff.” Another told us, “There is no question about it, [relative] is safe. I can sleep well at night knowing they are well looked after.”

Staff had received training in safeguarding and knew how to report concerns. One staff told us, “Safeguarding training is mandatory. We complete e-learning and the Mental Capacity Act face to face training also includes safeguarding. I would report any safeguarding concerns to my manager. If she did not react to this, I would report it to a registered manager or other managers in the company. If the company would not react I would report abuse to social services and/or CQC.”

The provider used a log to document safeguarding concerns. This included a description of the potential abuse, who had been informed, actions taken and any lessons learned. Route cause analysis was also completed to identify and patterns and trends, identify potential causes and support the learning process. We identified no indications of a closed culture within the service. The provider was open and transparent with people, relatives and professionals. They acknowledged any mistakes and explained what action would be taken to make improvements.

Risk assessment was a collaborative process which included people, relatives and professionals involved in people’s care. One relative told us, “Due to our experiences, it’s hard to trust people, but I trust these now [Zeno], they listen to me. Risk assessments have been carried out by the staff, who have sought our opinion.”

We noted examples of individualised approaches being used to manage risks to people. For example, a ‘smart’ lock had been fitted to a person’s kitchen door, so that the area was accessible without support, unless the person was in a heightened state of arousal, when the door could be locked remotely. Another person was at risk of eating uncooked frozen foods. Rather than restrict access to the kitchen and the fridge freezer, it had been agreed with their family, to store the majority of freezer items elsewhere, but leave items such as ice cream in the person’s freezer.

Each person had a positive behaviour support (PBS) plan, which explained any risks, behaviours they may display and how these would be managed and supported. For each risk the provider considered the severity of the risk before and after strategies were introduced, to ensure these were effective. PBS plans included proactive strategies for staff to use, to help promote a positive experience for people. For example, ensuring the environment was appropriate, communication was done in line with the person’s needs and wishes, and they were supported to complete activities of their choosing. People also had situation specific support plans, which covered specific issues or risks. For example, one person found car travel challenging, so any journeys needed to be managed in a consistent and specific way.

As people were living in their own accommodation and had tenancy agreements with their respective landlords, safety and upkeep of the premises was largely the responsibility of the landlord. However, who was responsible for what was detailed in the service level agreement between each landlord and Zeno Limited. We found Zeno Limited were proactive in ensuring people’s homes were safe and all necessary safety checks had been completed.

Environmental risk assessments had been completed and action taken to address or minimise risks to people. For example, the surface temperature of radiators was restricted, to reduce the risk of people with sensory impairments from being burned. Where necessary, radiator covers had also been fitted to further reduce risks. Each service manager completed a range of daily, weekly and monthly safety checks within each property and a monthly health and safety checklist was completed to ensure processes were in place, risks were being managed and checks had been completed. There was an action plan sections at the end of this document for logging any issues and what would be done about them.

Enough staff were deployed to keep people safe, meet their needs and support them to complete their chosen activities as detailed within their support plans. One relative told us, “There is always enough staff, never been a problem with this. [Relative] likes and needs to be out of the house, which they are. They are living the life of riley.” Staff had developed positive working relationships with people, which resulted in positive outcomes. A relative stated, “The bonds that the staff have made with [relative] are really good. They know [relative] and how they operate. As an organisation it has got sufficient robustness within itself and the training of staff. They do a sterling job in every case they have. They have a lot of skill and experience in stabilising people.”

Staff also spoke positively about staffing levels. The provider did not use agency staff, relaying on their own staff to cover any gaps or shortfalls, to ensure continuity of care. Safe recruitment processes were followed, with all necessary pre-employment checks being carried out. This included seeking references from former employers and completing checks with the Disclosure and Barring Service to ensure applicants were of suitable character to work with vulnerable people. The provider also offered trial shifts to potential employees, to help determine their suitability to the role. Staff received enough training and support to carry out their roles safely and effectively. Training completion was monitored via a matrix, this showed a completion rate of over 90% for all required sessions. Staff supervision and appraisal was completed in line with the provider’s policy.

Each property we visited was clean and tidy. Guidance was in place for staff to follow to ensure the upkeep of each property. These included daily cleaning schedules and deep clean audits. Where able, people were also supported to take responsibility for cleaning their home.

The provider had up to date policies and procedures in place. These covered areas including, infection prevention and control (IPC), clinical waste management, safe management of blood and bodily fluids and use of personal protective equipment. The provider completed periodic checks of each property to ensure IPC practices were being maintained appropriately.

People received their medicines safely and on time, from staff who had been trained and their competency assessed. Relatives reported no concerns with the medicines management process. Clear guidance was in place for each person, which explained what medicines they took, how they liked to take these and what staff should do if they refused any medicines. Where people required their medicines to be given covertly i.e. without their knowledge, authorisation was sought from the person’s GP and a pharmacist consulted to ensure each medicine could be given in a certain way, such as crushed and mixed with food.

Medication documentation reviewed during the assessment was up to date and had been completed accurately and consistently. Protocols were in place for any ‘as required’ medicines, such as pain relief, barrier creams or constipation remedies. These explained how and when to administer and signs to look for, if the person was unable to request these medicines from staff. This ensured these medicines were managed safely and used effectively. Stock checks were completed daily by staff to ensure all medicines had been given as prescribed. Regular medicines audits were carried out, to ensure medicines processes were robust and had been followed consistently.