HF Trust - Avon DCA

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 told us they felt safe living at the service and could approach staff when they needed help. Staff knew people well and understood how to protect them from avoidable harm and abuse. The service worked closely with other agencies and had effective procedures to support this. If there were restrictions on people’s freedom for safety reasons, these were monitored and reduced wherever possible. People were involved in discussions about risks and were supported to take positive risks in their daily life. There was a person centred approach to the management of risks and records gave staff up to date guidance. Staff were proactive in identifying and managing risks to keep people safe. The service managed incidents affecting people’s safety. Staff shared examples of how lessons and been learned and changes made following incidents and accidents. This showed the provider was willing to listen, investigate and make changes to improve the service and keep people safe. Staff supported people safely with their medicines in the way people preferred. Staff who gave medicines had regular training and checks to ensure their practice was safe. Learning from errors had been implemented to ensure there was a focus on safety and good practice. People were positive about the staff who supported them, and staff were caring and respectful when speaking about or to people. People and staff felt there were enough staff to meet people’s needs and keep them safe. Staff were safely recruited and received induction, training and supervision to ensure they were skilled, which helped keep people safe.

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.

People told us they felt safe and could speak about concerns with the manager or staff. One relative noted, “I’m sometimes not sure who to go to, as the management structure has changed”. Another relative said, “I keep a close eye on everything and am happy with what I see. If I wasn’t I would know who to discuss it with.” Two people told us about a meeting they attended called Voices to be Heard. This was a regional forum run by the provider where ideas were shared, and people could raise concerns. People also told us there were individual and house meetings where they could discuss issues. Meeting notes showed these were inclusive and encouraged people to participate.

The Care Quality Commission (CQC) and the local authority had received concerns about the management structure. Staff felt changes which had been made had not been effective. However, they told us the decision had been reversed and the new management arrangements were working well. This showed the provider was willing to listen to staff and make changes to improve the service. Staff told us about an incident in another service where a person had choked. Lessons were shared with HF Trust – Avon DCA and care plans and risk assessments had been reviewed, all staff received specific training and competency checks were carried out. Specific training was provided to ensure staff had the skills to be able to safely support people. For example, some people recently admitted to the service had complex needs. Training was provided and changes made, and one staff member told us it had been a learning curve to ensure the person received the right support. Staff confirmed regular team meetings and supervision were used for the sharing of learning. Staff felt confident to raise concerns with managers and deputies.

Professionals felt there was an open and honest culture at the service with meant concerns were listened to action taken where necessary to keep people safe. Professionals told us staff contacted them for advice or to update them about changes and followed their guidance to deliver best practice.

Processes were in place to monitor standards and identify, record and learn from incidents that happened within the home. This included regular audits, supervision, meetings with staff and external checks. This helped to ensure changes could be made where necessary to improve care for people.

People told us they were supported to attend health care appointments such as hospital and GP appointments. As necessary, other professionals were involved, such as occupational therapists, physiotherapists, podiatry and neurological services. Relatives shared mixed views about people’s access to health professionals and specialists. One relative told us, “They could do more for [Name]. For example, they lost her dentist because they assumed I was still doing it and I wasn’t. I really think she should not have lost her dentist.” The provider was made aware of this issue. One person told us they received support from another provider as well as HF Trust – Avon DCA. We saw there was effective communication and a co-ordinated approach between the two providers for the benefit of the person.

Staff described how they supported people when they first moved to the service. Assessments of need were carried out before people moved to the service, but the change could be difficult for some people. When there were challenges, these were reviewed, changes were made and learning shared. Staff confirmed that people received support and treatment from health professionals and specialists. They told us one person had missed appointments because they would refuse to go. We heard how staff tried different techniques and adjustments with the person to encourage them to attend appointments. The registered manager told us they were requesting additional funding for some people to receive higher levels of support. There was evidence that they were being proactive in identifying and managing risks to keep people safe.

Professionals were complimentary about how the service worked with them to ensure people were safe and received the support they needed. One professional said, “The team has been very cooperative, particularly in ensuring that the safety of people is safeguarded and sharing the risk assessment to ensure they are managing people’s risks."

Systems and procedures were in place to support staff in working with other professionals. Policies and processes about safety reflected joint working with other key partners to promote shared learning and drive improvement.

People told us they felt safe living at the service. Comments from relatives included, “Yes, absolutely [Name] is safe” and “Totally safe.” People were supported to raise concerns and relatives told us they would speak with staff if necessary.

Staff received training about how to recognise and respond to safeguarding concerns. Staff also received training in relation to hate crime. They knew how to recognise signs that a person may be at risk and what they should do about this. The provider had a safeguarding team who could give support, advice or raise concerns. Relevant agencies such as the local authority and police were informed as necessary. Relationships had been built with the local police force, and managing relationships, coercion and sexual safety had been explored with some people.

During our visits to people’s homes, we saw positive interactions between staff and people and there was an open and inclusive atmosphere at all the services we visited. We observed a handover during one of our visits. Staff shared important information about people and their changing needs. Staff spoke positively about people and in a respectful way. It was evident that staff aimed to support people to stay safe. People were given a choice whether they wanted to speak to the inspector on their own or with a member of staff. When staff supported people, they encouraged them to speak up. Some people were anxious when we were visiting the services, and staff took time to provide reassurance and explain what was happening. Staff listened and acknowledged how people were feeling.

There were effective systems, processes and practices to make sure people were protected from abuse and neglect. Information about safeguarding was clearly displayed to aid staff in their responsibilities. Easy to read information was available to help people know what to do in different situations.

People were supported to take positive risks as part of their daily life. One person spent a lot of time away from the service, but a risk assessment was in place and plans had been agreed with them to support the person to stay safe. This helped them to lead the life they chose without restrictions, but with safeguards in place. One person showed us they had a new walk-in shower and a toilet that washed and dried. It was evident that these modifications promoted the person’s independence and maintained their dignity. The changes enabled the person to continue to live in their flat safely. Some people were at risk because there was a potential they might choke on certain foods. Staff received additional training and an alarm enabled them to discretely monitor when the person accessed the fridge. This gave the person more control but managed the risks in the least restrictive way. The person, their family and other professionals had been involved in agreeing this decision.

Managers and staff knew people well and understood the risks they faced. They demonstrated a positive approach to managing risks and respecting people’s dignity. Staff and managers shared examples of a positive, person centred approach to the management of people’s risks which considered people's capacity. They told us about different ways in which they kept people safe. Staff told us people’s risk assessments contained enough up to date information to support people safely.

Our observations raised no concerns about staff practice or the management of people’s risks, and staff had a good understanding of people’s needs. We saw staff supporting people in line with safe practice and their individual risk assessments.

Support records were regularly reviewed with the involvement of people, relatives, and staff to ensure they contained the most up to date information. Care plans and risk assessments described risks which might be faced by people, and outlined what staff should do to manage or reduce these risks.

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 their relatives described positive relationships with staff. Comments from people included, “Amazing” and “Great.” However, relatives also noted that there had been a lot of staff changes and felt this had impacted on their family members. People had regular and familiar staff who knew them well. People told us about their key workers and one person said, “The staff are really good. They help me to do the things I need to do but allow me to do it for myself. We have a laugh and a joke. Staff are there when you need them.” People were involved in the recruitment of staff. During our visit to one of the homes, one person was showing a potential new member of staff around the service. The registered manager said this formed a regular part of the recruitment process.

Staff we spoke with told us there were enough staff to meet people’s needs and keep them safe. Staffing levels varied depending on people’s planned activities and in response to people’s changing needs. People received a combination of individual and shared staff support. Staff said they received regular supervision, appraisal and training and felt well supported by the management team. Training and regular refresher courses helped ensure staff knowledge and skills remained up to date. Comments about training included, “Lots of training, we do it every year or three years depending on the topic” and “I receive an email prompting me to do training and this is discussed in supervision.” During one of our visits, some staff told us they had not received formal training about supporting people with diabetes. There were no concerns about the staff members’ knowledge and the person supported managed their own needs. In addition, care plans provided good guidance. We told the registered manager about this training gap. They confirmed training was online and told us staff would be supported to complete it. New staff who had recently completed their induction told us the process prepared them to support people and was comprehensive. During a probationary period, staff shadowed more experienced staff before they worked alone with people. Some agency staff had worked at the service for several years. They knew people well, took on key worker roles, participated in training and worked as part of the staff team. The registered manager told us each of the services were recruiting to ensure they had 10% more than the essential staffing numbers. This helped to reduce agency usage and gave people more consistent support.

During our visits, we saw there were enough staff to provide people with the support they needed and there were no concerns about their practice. Support was person centred and available when people needed it. Staff were confident when talking about their role, safeguarding and risks, and spoke passionately about the people they supported.

Staff were recruited safely by the provider, and relevant checks were carried out before new staff started working at the service. This included criminal record and employment checks to confirm staff were suitable to care for people. Systems and processes were in place to monitor and ensure training and supervision were up to date and supported best practice. Training records showed staff were up to date with essential training in subjects such as fire, manual handling and safeguarding.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Some people received support with their medicines and others managed this independently. No concerns were raised by people regarding medication management. One person said, “Yes, the staff help me and give me my tablets and they get a glass of water.” People had a locked medicines cabinet in their flat. This gave more privacy and reflected current best practice.

Staff described the training they completed to be able to safely administer medicines. As well as the training, staff practice was observed and checked by a competent person each year to confirm their practice remained safe. Staff confirmed that each person had a medication profile which included important information about their medicines. For example, side effects, contra indications and the reason the medication was prescribed. This profile included information about how each person liked to take their medication. Staff told us how people’s medication was reviewed, and they shared an example where a person’s medication had been reduced and this had positive impact on the individual. Staff had no concerns in respect of medication and said this had recently improved with a change of pharmacy for people at one of the supported living settings.

We did not specifically observe medicines administration during our visits to people’s homes. We had no concerns about medicines optimisation and staff were knowledgeable in their discussions with us.

Quality assurance measures were in place to ensure medicines were managed safely. This included staff training and regular audits. Two staff always signed to confirm when medicines had been given. This extra check had been introduced after a mistake was made. It showed there was a focus on safety and lessons were learned to continually identify and embed improvements and good practice. The medicines policy was up to date and reflected current and relevant best practice and guidance. The policy included information about the principles of STOMP (stopping over-medication of people with a learning disability, autism or both). This helped staff ensure people’s behaviour was not controlled by excessive and inappropriate use of medicines and medicines were reviewed by prescribers in line with these principles.