Taunton Deane Support Services

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

At our last inspection of the service, published in April 2023, we found staff had not protected people from poor care and abuse. Staff did not always support people with their medicines in a safe and effective way and risks to people had not been fully considered and planned for. Staff did not always have the skills, experience or knowledge to meet people's needs. The provider was therefore in breach of regulations in relation to safe care and treatment and safeguarding service users from abuse and improper treatment. At this assessment we found significant improvements had been made and the provider was no longer in breach of regulations.

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 were using a service where the current management team were continually looking at improvements and enhancements to the care and support people received.

Staff told us there was an open and honest culture which enabled any errors to be discussed and learning could then take place. One member of staff said, “The [care plans] needed to be more detailed. We have now got good guidance on what good records should look like and how they should be recorded.”

The service has worked closely with both the local authority quality team and the safeguarding team to support improvement.

The registered manager took action to make sure any shortfalls in the service lead to improvements for people and/or staff. For example, there was a current focus on improving and personalising care plans, risk assessments and daily records.

People who wished to use the service had their needs assessed to make sure it was the right service for them. People already using the service were also consulted and their opinion considered if anyone new wished to share their home. People were supported to attend medical appointments. One relative told us, “Yes [staff support] is brilliant, and they email if [name’s] unwell or had to go to the GP. They keep me informed of everything so I’m happy they’re on top of it.” Some people attended outreach services and staff worked together to make sure people were able to access activities they enjoyed.

The registered manager told us the assessment process was effective and comprehensive. People were given as much information about the service and accommodation as possible to help them make a decision. Two staff members told us, “One person was considering moving here [into 1 care setting] but has decided against it. We both feel this was the right decision as they were not particularly suited to live with [the people who currently lived in this setting].”

Professionals felt that staff in each setting worked well with them to meet people’s needs.

All assessments of need were carried out in partnership with other professionals and with people’s relatives if people wanted them to be involved. This helped make sure people’s needs and risks were fully understood, and appropriate plans of care put in place.

People felt safe and told us staff treated them very well. Relatives felt their family members were safe. People told us they liked and trusted staff. They would be comfortable raising concerns with staff or they could tell their relatives. Safety was also discussed at ‘tenant’s meetings’ in some settings. One person told us they felt safe with staff because, “They [staff] are all nice to you.”

Staff spoke affectionately and respectfully about people. Staff told us they received safeguarding training and were asked questions by service managers to make sure they had understood the training. Staff said they would be confident to report any concerns. One member of staff said, “I would speak with [manager’s name], they would definitely do something.” Staff told us people had capacity to make most day to day decisions. They were aware of the need to complete a best interest process with people and those close to them for more complex decisions.

People looked comfortable and relaxed with staff who supported them in all the care settings we visited. We saw people chatting and laughing with each other and with staff.

Staff worked with appropriate agencies to ensure all safeguarding concerns were fully investigated. They also worked with other professionals to ensure that any restrictions were kept under review and remained appropriate.

People were aware they had care plans and risk assessments. One person told us they liked to go out without staff support. They were aware of some risks and how to avoid them. One person told us, “When I go out, I go with staff. This helps to keep me safe.”

Staff had a good understanding of the risks to and from people who used the service. Staff were able to tell us about the action they took to minimise risks and promote people’s quality of life and their independence.

We saw people received care and support in accordance with their risk assessments.

At the last inspection we found that risk assessments were not always in place, kept up to date or reflective of people’s needs. This had led to people being harmed. At this assessment we found many improvements had been made and were continuing. Risk assessments were now clearer, comprehensive and up to date. However, the registered manager told us there was still work to do, and they had an action plan to address this. For example, we found where people chose to go out without staff support in 1 setting there were no risk assessments in place. We discussed this with staff and with 1 person who used the service who all felt improvements could be made in this area.

People lived in settings which were well maintained and appropriate to people’s needs. People we spoke with were happy with their homes. Each person had a tenancy agreement with their landlord. This meant any house repairs and health and safety issues were the landlord’s responsibility. Both people and staff on behalf of people contacted landlords to organise and be kept up to date with the progress of any requested repairs.

Staff did not raise any issues about the safety of any of the settings we visited. Staff did say that some landlords were more responsive than others and occasionally they needed to chase landlords on people’s behalf.

Since the last inspection there had been improvements to some of the settings. For example, people had chosen new carpets and the colour schemes in their homes. In 2 people’s home new windows had been fitted.

Staff carried out health and safety checks to ensure that all settings and equipment were maintained to a good standard. This included checks on fire detecting equipment. A full environmental audit was completed every 6 months in each setting.

People were cared for by staff who knew them well. People said they liked and trusted staff who supported them. Overall, relatives said their family members were well supported, although they preferred permanent staff rather than agency staff. One relative said, “Yes on the whole [staffing was good]. Sometimes with holidays and illnesses they seem a bit down on staff, but it’s always the same set of carers.”

Staff felt there had been real improvements in staffing. In 1 setting staff told us they now had a fully recruited permanent staff team. They had not had to use agency staff this year [2024]. One member of staff said, “This is the most stable staff team we have ever had.” Staff were very happy with the training they received and said it gave them the skills needed to effectively support people. Staff felt well supported. One member of staff said, “We have supervisions and team meetings now.”

During our visits, we saw people had enough staff to support them with their care needs and with trips out.

At the last inspection we found in some settings staff training completion rates had been very low and regular 1:1 meetings or performance observations of staff had not been taking place. At this assessment, we found significant improvements had been made. Staff now had a 1:1 meeting with their line manager every 6 to 8 weeks. Team meetings were now held regularly. Staff training completion was very good with a compliance rate of 98%. In addition to any mandatory training, staff were also able to access training relevant to people’s specific needs. Safe staff recruitment processes were followed.

People lived in clean and pleasant settings. One person had agreed with a family member that they would take a COVID-19 test before every weekly visit to their relative’s home as their relative was at higher risk of infection.

No staff raised any concerns with us about infection control practices.

All areas of the settings we visited were clean, fresh and hygienic.

Each setting had risk assessments in place including infection control, legionella and safe handling of food. A range of audits were completed either weekly or monthly to identify infection risks.

People had medicines administered safely. One person told us, “I get my tablets at the right time.” Relatives told us support with medicines was good and any minor issues were resolved quickly. One relative said, “I’ve got no concerns [with medicines]; the staff are excellent. They always tell me if there’s any problems.” Some people received medicines, such as pain relief, on an as required basis. There were protocols in place to give staff guidance about when these should be offered.

Staff said they received training in the safe administration of medicines and had their competency assessed on an annual basis.

Each person had a safe place to keep their medicines. Staff were confident in supporting people with their medicines.

People had their own medication administration record; these were completed by staff. We looked at 5 people’s records in 3 settings and they were all well completed. A record was kept of the number of medicines in stock for each person. Sample checks showed these to be accurate.