The Old Vicarage

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 was the first inspection for this service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 78 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. A staff member said, “I'm involved in looking at how well the service works and where lessons can be learnt.” The registered manager closely monitored the service and analysed data around incidents to see what had led to people experiencing distress and how staff could work differently. Staff used this information within their reflective practice and used all of the information to assist them with designing people’s support planning and risk management. The team had found using this approach to determine what changes should be implemented had significantly reduced the number of episodes where people became distressed.

The service always worked with people and healthcare 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. Since the service opened the team had successfully assisted people with very complex needs to transition to the home. Previously people had experienced failed placements and therefore the team had used a process of extensive transition to assist them learn exactly how to support each person. Since moving in the number times people displayed distress behaviours has significantly reduced. They have also successfully widened the range of activities, the types of foods and ways to engage with people. The team were currently closely supporting a person move to another service and had worked hard to link in with the new team. This ensured learning about what worked well for the person and what did not, was passed on and the positive outcomes they had seen were maintained.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They 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 service shared concerns quickly and appropriately. Staff understood how to effectively work with people when they became distressed. The registered manager had monitored the frequency of incidents, and supported staff to use safe and person-centred interventions with people. This had resulted in a reduction of restrictive practice, including physical interventions and people receiving ’as required’ medicines as a way to manage their distress. The management team ensured, Deprivation of Liberty Safeguards (DoLS) authorisations were sought when needed and any conditions imposed by them were followed.

The service worked with people to understand and manage risks by thinking holistically. People were supported and empowered to take risks in areas they wanted to and to enhance their lives. When people’s needs changed, or staff picked up changes in people’s mood or communication style, care plans and risk assessments were reviewed. Action was taken to understand why a person had become distressed or why an incident occurred and what could be changed to prevent further occurrences. A relative said, “Risk is managed very well. [Person’s name] has extra sensory needs due to sight and hearing deficits, so staff have to manage these risks on a daily basis, and they do this well.”

The service detected and controlled potential risks in the care environment. Environmental risks were assessed and addressed. The provider adhered to the Capable Environmental Policy and Autism Environmental assessment to assess the building and equipment. The registered manager used information from this assessment to inform the person-centred planning and positive behaviour strategies. The registered manager knew who to contact when people might benefit from additional equipment or needed to have those in place reviewed, to make sure they were still safe and effective. People were supported to be as independent as possible within the environment.

The service 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. The registered manager promoted a learning culture and ensured staff had access an extensive range of training. For example, the provider used a Complex Needs Learning and Development Pathway for training. This offered personalised workshops linked to autism practice, onsite training such as Positive Behavioural Support (PBS) techniques. A staff member said, “During the day, we have between 6-8 staff, which is in working well. It is rare that there is staff sickness but this is covered very quickly with other bank staff or with agency. There always seems to be enough staff.”

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff appropriately followed the required infection control guidelines.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff who administered medicines had the appropriate training and competency checks. People’s medicines were regularly reviewed to ensure they were prescribed for the right reason, in the right dose and for as short a time as possible. Staff were aware of the principles of STOMP (Stopping Overmedication of People with a learning disability, autism or both). Guidance was in place for as and when required medicines (PRN), so it was clear when to give a medicine and the outcomes were assessed and recorded to ensure they were effective and the least restrictive.