Burrow Down Community Support

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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

People and their relatives told us they felt safe. People were supported by staff that had received adequate training and knew how to raise and report safeguarding concerns. The registered managers and senior leaders were committed to ensure people were safeguarding from avoidable harm. We found examples of where concerns had been reported to the appropriate local authority safeguarding teams. People were supported to have maximum choice and control of their lives. Where the service supported some people to make decisions about different aspects of their care there were mental capacity assessments to show these decisions had been made in a person's best interests or with appropriate consent. Without exception all registered managers, staff and the provider had in depth knowledge of people’s individual risks and the action they needed to take to mitigate the risk of harm associated with people’s care.The registered managers carried out Individual risk assessments of people’s environmental needs. The provider had effective systems in place to ensure people were protected from untoward incidents.The provider and registered managers were aware of the staffing ratios needed for every person the supported. They described what contingency plans they had in place to support staffing shortfalls they could happen due to sickness and holidays. Relatives told us staff used personal protective equipment and good Infection prevention and control techniques.

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 did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We spoke with people living at the service. They told us, "(Staff members) keep (Person's name) safe," "Yeah, it's my home, I am happy there," "Well cared for and safe yes. The staff offer wonderful care." Relatives told us, "(Person's name) has best interest meetings," "He's getting on really well (at Burrow down),” "(Person's name) can communicate what they like and dislike. The staff are really tuned into their routines, I cannot fault them" and “There are no worries or concerns."

All 3 registered managers understood their responsibilities to identify, report and investigate allegations of abuse. The operations manager was able to articulate the systems and processes and how these systems were aligned to the providers policies and procedures. The managers demonstrated a commitment to ensure people were safe. IMCA’s and community advocates were involved with people who used the service. Staff understood their responsibilities and knew about The Mental Capacity Act 2005. They told us, “If I had a safeguarding concern, I would contact my line manager with my concern, ensuring I gathered evidence and complete a statement” A health care professional told us, “From a safeguarding perspective, the team are quick to raise concerns regarding issues they identify and there is no reluctance to refer to safeguarding.” Staff records confirmed that all staff had received safeguarding training.

Safeguarding systems and processes were in place to identify report and investigate, allegations of abuse. The provider had logs and records that showed appropriate action had been taken where necessary. Systems were aligned to the providers policies and procedures.

There was a robust system for reviewing and updating care plans to take account of any changes in people's risks. Staff were provided with all the information they needed to support people safely. There were details falls and moving and handling risk assessments in place for people living with epilepsy. Seizures were monitored and recorded so that any increase or decrease was reported to epilepsy specialists. Body maps were in place to monitor any wounds and there was clear guidance for staff on when to refer to external professionals.

All care plans were up to date and contained details of people's care and support needs. The risk management plans demonstrated people, relatives and representatives were involved in managing people’s individual risks. Relatives told us people’s risks were well managed. Relatives told us, “(Person's name) epilepsy is well controlled. There is a risk of a seizure but it's well controlled, (person's name) has a comprehensive care plan and the staff deliver that," “If (person's name) is taken to doctors’ appointments and the dentist, then staff relay this back. Staff take (person's name) to all appointments and to the podiatrist on a regular basis for specialist equipment." Care plans contained risk assessments for moving and handling, and related tasks. Guidance for staff, was provided, on the correct way to meet people's needs and on the appropriate use of moving and handling equipment. The care plans indicated that peoples relatives had been involved in the planning process and subsequently the risk management plan.

The registered managers, staff and the provider had in depth knowledge of people’s individual risks and the action they needed to take to mitigate the risk of harm associated with peoples care. Staff we spoke with told us, “All the information in peoples care plans is up to date and very helpful, if any staff have any questions all we need to do is look on our electronic system and our questions are answered”, “Support plans are updated and reviewed every 3 months and sooner if they need it” and “Risk assessments and care plans are up to date and I feel the information in them is correct.”

The registered managers carried out Individual risk assessments of people’s environmental needs. The provider had effective systems in place to ensure people were protected from untoward incidents.

Relatives we spoke with told us, “The environment is clean, and it's well maintained” and “(Person's name) has been shown the fire risk procedure and knows what to do if a fire broke out,” Another relative described how the service was not satisfied with one piece of assistive technology and acted immediately to have it replaced with a better system. Senior leaders carried out quality assurance site visits which included maintenance and safety checks. The leadership team and staff fully understood their responsibilities to keep people safe within their homes.

All 3 registered managers told us what systems they had in place to keep people safe within the supported living settings. All 3 were able to explain to us how they carried out regular risk assessments on people’s environmental needs and how they would respond in the event of any incidents.

Observations from three sites confirmed sufficient and safe staffing levels were in place. Some people had commissioned 1-2 and 2-1 support and these staffing levels were being maintained. Where the service needed to use agency, it used the same company and staff that were familiar with peoples living at the service. People were consistently receiving their commissioned staffing levels. Staff commented, “I have had practical epilepsy training the first week I started. I have done some online training and done my mandatory,” “So, we have supervision every 3 months and the spot checks,” “We get training around the needs of the people we support. We get manual handling training, autism, epilepsy and that is a big one for the people we look after. I think the training is very good. We can always ask for more and management have been happy to give extra if people need it,” “I feel that we have enough staff, our service users are funded accordingly as they’re in separate supported living flats. We as a team arrange days out/ evening activities. We also plan group activities also” and "I’ve always found the training provided helpful and relevant to the service users we support. We have a number of online training courses and also face to face training”.

Records showed that staff completed required training. Newly appointed care staff went through a comprehensive induction period. This included training for their role, shadowing an experienced member of staff and having their competencies assessed prior to working independently with people. People were protected against the employment of unsuitable staff because the provider followed safe recruitment practices. Staffing rotas confirmed there were sufficient staff to meet people's needs. Staff personnel files showed that staff received regular supervision, including safeguarding, development, and performance concerns. There was a training matrix in place. This provided an overview of all staff training requirements for the managers to monitor. Training was up to date, and it was clearly recorded when the updates would be due. Staff have spot checks on their practice and annual medicines competency checks.

Relatives told us there were sufficient staff to meet people's needs. All relatives we spoke with told us staff were well trained caring and compassionate. Comments included "I am very confident with the care at Burrow Down, the carers are brilliant," “The staff are well trained," "Very robust care plan, the care plan works, (person's name) has skilled carers and it works," “Staff are well trained,” "I generally see the same faces when I go in,” "The staff are pretty static, occasionally there is someone new, but (person's name) is accepting of that" and "I have the highest opinion of them, his staff team are stable”. The majority of staff we spoke with told us there were enough staff to meet peoples needs. Whilst some staff told us they felt the service could benefit from more staff, they also told us that these concerns did not have a impact on people receiving safe care and peoples quality of life.

One staff member told us “We have access to PPE, and we have hand-gels everywhere and anti-bacterial wipes. We do the cleaning and (night staff) do deep cleaning like skirting boards and radiators”.

All parts of the service without exception were immaculate. The leadership team described the measures that were in place to support best practice Infection prevention and control practices. Staff told us staff they had free access to PPE and were able to describe types of PPE alongside describing best practice Infection prevention and control techniques. Staff expressed pride in this and that people’s personal spaces were very well maintained. Cleaning rotas were in place. Relatives told us, “(Person's name) home is clean and tidy" and “PPE (Personal Protective Equipment) is worn all the time."

The service managed the control and prevention of infection well. Staff were trained in infection control and had access to PPE such as gloves. The environment was clean and well maintained. People had Individual infection prevention and control risk assessments in place. Managers were able to describe and demonstrate that staff had easy access to PPE. We observed staff accessing and using PPE appropriately. The provider's infection prevention and control policy was up to date.

Staff told us they received medicines training and had their competencies checked regularly by the provider. One staff member told us, “I have had medication training, and we all have to be shadowed 3 times and signed off to be able to administer medicines. This is renewed every year.” The registered managers and staff described how they created electronic medicine charts on the electronic system and how they recorded when they supported people with their medicines. The system told staff which medicines were due at each visit and this was recorded. However, robust checking systems were not in place to ensure that these records were accurate. When people’s medicines were changed there was not always an audit trail or checks to ensure the change was accurately recorded. A new system was introduced during the assessment visit to ensure suitable checks were carried out in future.

There was a medicine policy held at the service. Regular medicines stock counts helped staff know when people needed medicines to be ordered to ensure they did not run out. All prescribed medicines were available. Unwanted medicines for disposal were recorded and returned to pharmacy. Medicines were kept in people’s individual houses and locked/ stored appropriately and safely. The medicines room was locked when not in use, and the keys were held by team leaders. People were supported to take their medicines in a way that was matched to their wishes or needs. Medicines support care plans and risk assessments in place, e.g. for emergency meds. The registered managers and staff created medicine charts on the providers electronic system, this ensured people received their medicines as prescribed. Medicines were ordered, checked and available when people needed them. Medicines were stored, administered, recorded and disposed of safely. Seniors and staff were trained and assessed as competent to administer medicines. They were regularly supervised to make sure they were following best practice. Staff knew how people liked to take their medicines and supported safe administration in a caring manner. Additional information was available to support staff make consistent decisions about when to give a when required medicine or where to administer emergency medicines. These records were accurate and fully completed.

Relatives told us people received their medicines as prescribed and our observations and checks confirmed this. Relatives told us, “Staff support (person's name) to take medications," “There have been no medication errors. They receive all their medicines."