Head Office

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

There was sufficient staff to support patients, and staff had the required skills, and training to support patients in their care. All staff had received an induction before working at the service and they had received suitable training and supervision. Patients risk assessments were up to date and staff knew where to find current information about patients and supported them in accordance with care plans and risk management plans. Staff followed systems and processes to prescribe and administer medicines safely. Staff understood how to protect patients from abuse, had received appropriate training and worked well with other agencies to do so.

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.

We visited the homes of 6 patients using the service at the time of our assessment. We spoke with 5 patients and 1 did not want to speak with us but allowed us to visit their home and speak to the staff caring for them. Patients told us they could raise concerns with the managers and staff directly and these were dealt with quickly. We reviewed patient feedback forms gathered by the service for the 3 months preceding our on-site visit. We found that patients reported they felt safe and supported at the service. Patients told us that staff debriefed with them after any incidents they were involved in.

Staff understood how to raise concerns and report incidents. They demonstrated knowledge of accessing the service’s incident reporting systems, knowing what to report and how to report it. Staff said they were encouraged to report incidents and raise concerns. All staff described a positive, safe working environment with the service emphasising an open and transparent culture. Staff told us incidents were discussed in handover, supervision and staff meetings. Team meeting minutes showed that staff discussed learning from incidents and actions required to improve patient care.

There were processes for dealing with complaints, accidents, incidents, and other adverse events. For the 12 months prior to our assessment there had been 6 complaints and 3 compliments about the service. The staff were encouraged to report all incidents. Incidents were reviewed at each multidisciplinary team meeting. Learning from incidents were shared directly with staff through email bulletins and team meetings. Managers reviewed and analysed incidents at clinical governance meetings to understand themes and trends, how to reduce these and implemented actions. Staff understood the duty of candour. They were open and transparent and gave patients and families a full explanation if and when things went wrong.

Patients were involved in the development of their care plans and risk assessments. They were invited to multi-disciplinary team meetings to discuss their care and chose to attend some of these meetings. The meetings included discussions about goal setting and how to support people to move forward in their treatment.

Leaders told us that they assessed referrals into the service to ensure the care and support available was suitable for the patients. Staff told us that their opinions were valued and that they were able to share their views about patient care and risks. They gave examples of collaborative working with external agencies to keep people safe.

We received concerns from partners prior to our assessment which we followed up during our visit. Our assessment provided assurance that systems, pathways and transitions were safe. We spoke to 6 professionals including social workers, care coordinators and commissioners who had placed patients under the care of the service. They gave positive feedback about the provider, joint working and managing of risks.

Processes that we observed were effectively managing the safety of patients. These included handovers and regular multi-disciplinary meetings. Systems that we looked at also ensured a good use of information which was accessible to staff to enable them to deliver safe care.

Patients we spoke with told us they understood why they were working with the provider; they were given information about the provider when they were assessed by them. All patients we spoke with said they felt safe, and they could speak to staff if they ever felt threatened.

The provider had a clear policy on the Mental Capacity Act, which staff could describe and knew how to access. Staff knew where to get accurate advice on the Mental Capacity Act. Staff knew how to make a safeguarding referral and who to speak with if they had concerns. At the time of the assessment, 100% of staff had completed mandatory safeguarding training. During the assessment we spoke with staff members, including managers, nurses and healthcare assistants. Staff were able to describe examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act. Leaders told us they had taken steps to reduce the risk of closed cultures developing, including inviting external agencies for visits, and encouraging patients to speak out about any concerns. There was a safeguarding audit that was undertaken by the safeguarding lead.

We observed patients being supported by staff who understood how to protect people from harm.

Safeguarding policies were in place and up to date and staff had received safeguarding training at a level appropriate to the needs of those using the service. Minutes from governance meetings contained evidence that managers had considered safeguarding concerns, and any actions required. As part of the assessment, we reviewed the safeguarding log which was up to date and included details of the safeguarding incident, the incident date, Local Authority referral date and any outcomes.

All patients we spoke with confirmed they were involved in their risk assessments.

Staff confirmed that they involved patients in their risk assessments. Staff also ensured the environment was clean and safe and any damage to items or the building were reported to the maintenance teams at the housing provider. Staff told us that they had received training in restraint and restraint was only used as a last resort. Staff were able to discuss patients’ individual preferences and how to de-escalate patients to avoid the need for physical restraint.

We reviewed care records for all 6 patients we visited and 3 others we requested following the on-site assessment. Staff completed risk assessments for patients, these were updated frequently and mostly updated when risk changed, for example following an incident. Risk assessments were comprehensive and contained details on how to manage identified risks. Risk information relevant to each patient was clear and consistent which ensured staff were up to date, this included detailed discussions at handovers and multi-disciplinary meetings.

Although we visited patients in their own homes, the accommodation was not provided by Positive Care Solutions, and they are not registered with CQC to provide accommodation. Therefore, we did not have a full in-depth tour of properties but were able to see houses were clean and well maintained at the time of our visits.

Although we visited patients in their own homes, the accommodation was not provided by Positive Care Solutions, and they are not registered with CQC to provide accommodation. Therefore, we did not have a full in-depth tour of properties but were able to see houses were clean and well maintained at the time of our visits.

Although we visited patients in their own homes, the accommodation was not provided by Positive Care Solutions, and they are not registered with CQC to provide accommodation. Therefore, we did not have a full in-depth tour of properties but were able to see houses were clean and well maintained at the time of our visits.

Although we visited patients in their own homes, the accommodation was not provided by Positive Care Solutions, and they are not registered with CQC to provide accommodation. Therefore, we did not have a full in-depth tour of properties but were able to see houses were clean and well maintained at the time of our visits.

Patients we spoke with, told us that staff knew them well. Staff supported patients to access the local community and attended various local activities including equine therapy, recording studios and visiting local restaurants. Patients told us activities were being planned in advance and with their input on where they wanted to go.

Staffing levels were dictated by the funding package the patients had from the local authority. This meant for some patients they were funded to have 3 staff at all times, others had 1 and some had more staff in the day and less at night. Staff told us that they felt staffing levels were sufficient, they felt they always had time to provide one to one support and enough staff to support patient’s activities outside of the house. Staff also told us that the staff team was supportive and that they received debriefs following incidents. Bank and agency staff were very rarely used and if needed were nearly always regular staff, we checked staff records for those on the rota and all had completed an induction. Staff said that the skill mix of their teams was helpful, there were enough skilled staff to respond to incidents and they attended quickly where needed. Robust vetting procedures ensured they had the right background and skills to work.

We saw that staff did engage with the patients; we saw them encouraging them to join them in activities. All staff could describe the patients and their needs, likes and dislikes. The close relationship between staff and patients was clear.

Staff told us, and rotas showed, that staffing levels were at an expected and safe level. They told us that where gaps might appear, because of sickness for example, they were easily filled. Staff said that the skill mix of their teams was helpful, there were enough skilled staff to respond to incidents and they attended quickly where needed. Robust vetting procedures ensured they had the right background and skills to work.

We saw that cleaning was part of the daily routine in each property, patients were encouraged to do this independently but where this was not achievable, staff assisted and had oversight.

Managers had oversight of the environment and could escalate issues as appropriate. Managers and staff spoken to, did not generally raise any issues regarding the environment.

We observed staff washing their hands as per guidance at appropriate times such as before dispensing medicines and making food.

We saw that cleaning was part of the daily routine in each property, patients were encouraged to do this independently but where this was not achievable, staff assisted and had oversight.

Patients understood their medicines and most felt involved in medicines reviews through multi-disciplinary team meetings. We reviewed patients’ records and found that they were involved when making decisions about their treatment. We spoke to one patient who was unclear about changes that had been made to their medication, we raised this with the provider and found that the type of medication the patient was receiving had been changed but the patient was not made aware. The provider spoke with the patient and explained the changes that had been made.

Staff did not prescribe or make changes to medication, but they did dispense medication or oversee the patient doing this themselves. Staff carried out work to ensure that medicines continued to be administered in line with best practice and guidance. All staff had up to date medication training.

We reviewed the medicines storage in each house and for the most part medicines were stored correctly. We found one example where a controlled drug was not stored separately to other medications. Although this was not a requirement, the providers own medicines policy stated that this should be the case. Therefore, the staff had not followed the providers policy on this occasion. This was rectified before we left the on-site assessment.

There were effective processes in place to ensure that medicines were administered safely. Staff had undertaken the necessary training to ensure they were competent to carry out these processes.