Select Support +

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

Risks to people's safety were not always assessed and mitigated. Appropriate recruitment checks were not always carried out before staff started work to help ensure they were suitable to work with vulnerable people. Processes to ensure the safe use of medicines and to ensure staff had the skills and competencies they needed were not always robust. The provider had a process for the reporting and investigating of safeguarding concerns, incidents and accidents, however the provider had failed to notify CQC of any allegations of abuse as required by law. There were sufficient staff deployed. Staff knew how to recognise and report abuse, including how to report concerns externally. The provider worked with heath and social care professionals to ensure people’s needs were met.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

While people and their relatives we spoke with expressed that they were generally happy with their care, our assessment found elements of care did not meet the expected standards as the service did not always demonstrate a learning culture. People’s experience was improved because learning from incidents was reviewed and implemented as a team approach.

The concerns we identified regarding the system in place to support a learning culture were discussed with the management team who started to address the issues during the assessment. Staff told us they documented all incidents and accidents on the electronic system. and that any learning from incidents was shared with the team. One staff member told us, “If we had an incident we report it on an incident report, we talk about it, how the incident went and how we feel about it. They are a very supportive, company, good at looking at what caused it to happen what can we do to stop it happening in the future.”

We found improvements were needed to ensure there were effective systems in place to support a learning culture. The service had not learnt from an external audit that was completed in December 2023, and shortfalls identified during this audit had not all been addressed at the time of our assessment. There were processes in place to monitor, report and make improvements following incidents and accidents. Incidents were logged on an electronic system, there was oversight of this to identify patterns or trends. The service recorded any use of restrictions on people’s freedom, and managers reviewed the use of restrictions to look for ways to reduce them.

People and their relatives were involved in their assessment of needs prior to them being supported by the service. One relative told us, “They came to my house and spoke to me to complete an assessment and staff shadowed the previous care provider to ensure safe.”

Staff and the management team provided us with examples of how they worked with heath and social care professionals to support people’s needs.

One professional provided the following feedback to the service, “Select support + work in a way that is very understanding to the individual client which is a leading factor in the success we have seen in [persons] transition as the staff have taken the time to get to know [the person], [the persons] likes, dislikes and factor these into the care given.”

There were pre-assessment processes in place. These were completed by the registered manager prior to a person using the service. People also had hospital passports in place, in case of the need to transfer to hospital.

People told us they felt safe. One person commented, “Yes” when we asked them if they felt safe with staff. People looked comfortable and relaxed in the company of staff.

The concerns we identified regarding failure to notify CQC of any allegations of abuse were discussed with the management team who started to address the issues during the assessment. Staff knew how to recognise and report abuse, including how to report concerns externally. One staff member told us, “I would report anything to management, and would take it to CQC if I needed to. I have never had to report anything, but I would if I had to.”

There were systems in place to report safeguarding incidents and staff were aware of these, however the provider had failed to notify CQC of any allegations of abuse as required by law. People can only be deprived of their liberty (DoL) to receive care and treatment when this is in their best interests and legally authorised under the MCA. When people receive care and treatment in their own homes an application must be made to the Court of Protection for them to authorise people to be deprived of their liberty. Where required, DoLS were either in place or we were told they had been applied for in line with legislation and local practice. One person had several restrictions placed on their liberty. These had been authorised in the persons DoLS and was under a review process with the Court of Protection, family and other relevant professionals.

While people and their relatives we spoke with expressed that they were generally happy with their care, our assessment found elements of care did not meet the expected standards and risks to people were not always assessed and mitigated. People’s relatives confirmed risks were discussed with them with any concerns discussed. One relative told us they were “very involved” with this. People and their relatives were positive about the support received from staff. One relative told us, “Because or [relatives] poor posture they are always mindful [relative] is comfortable to prevent sores.” People’s freedom was restricted only when they were a risk to themselves or others, as a last resort and for the shortest time possible. Staff considered less restrictive options before limiting peoples freedom.

The concerns we identified regarding risk management were discussed with the management team who started to address the issues during the assessment. Staff told us risks were assessed and they had all the information they needed to support people safely. The registered manager told us they involved people, their relatives and social workers when completing people’s care plans and risk assessment.

We found that processes in place to ensure that all risks to people were assessed and mitigated were not robust. Care plans we reviewed were not sufficiently detailed to inform staff how best to support people with all of their complex health conditions. For example, for one person who had a diagnosis of epilepsy, there was generic information in place which the registered manager told us was completed on advice from a health professional. However there no evidence of who wrote this, when it was written or last reviewed. There was also no risk assessment in place. There were no risk assessments in place for the use of bed rails. We did not find that these shortfalls had impacted on people's care as staff knew people well. Please see our judgement under the Well led key question in relation to this. Risk assessments were in place for moving and handling, accessing the community and support with catheter care. When people could become distressed, guidance was in place to inform staff how to support people to de-escalate or reduce their anxiety.

People and their relatives did not share any concerns in relation to way they are supported to maintain their environment.

Staff were aware of how to access information related to the any environmental risk of the home they worked in.

There were processes in place to ensure people’s homes were safe, this included risk assessments, personal emergency evacuations plans (PEEP) and guidance for staff.

While people and their relatives we spoke with expressed that they were generally happy with their care, our assessment found elements of care did not meet the expected standards and staff did not always have the skills and competencies required. There were sufficient staff deployed at the time of our assessment to meet people’s needs, although on some occasions this meant staff worked long hours. This was discussed with the registered manager who provided assurances regarding support and a system in place to ensure staff received regular breaks. People confirmed they were involved in the recruitment of staff. Staff would visit people as part of the recruitment process, then feedback would be sought from the person as to whether they would like the staff member to support them. Relatives told us their loved ones were supported by a consistent team of people who had been matched carefully with staff with similar interests.

The concerns we identified regarding staff skills and competencies were discussed with the management team who started to address the issues during the assessment. Staff told us there were enough staff available and shifts were covered. One staff member told us, “We have enough staff, it’s going great, [name of person] has a core team of staff supporting them. [Name of person] says they are happy with their team.” Staff told us the training they received was good. One staff member told us, “The training we receive online and face to face is probably better than any other company I have worked for before.” The registered manager told us people were involved in recruiting their staff. The registered manager told us, “Its led by them, person centred care, if the is client not happy they don't pass probation.”

Processes to ensure that staff were recruited safely, and had the skills and competencies they needed were not always robust. One person was being supported with a delegated clinical task. Best practice guidance was not being followed as competency assessments had not been completed by a health professional. The management team addressed this immediately. Competency assessments had not been completed by a health professional for another person being supported with a different clinical task. During the assessment the provider explained the difficulties in trying to access these, with competencies booked for the near future. Staff had not received up to date training in physical intervention. This was also booked for the near future. The risk was reduced as staff had received some training and clear positive behaviour support (PBS) plans were in place for staff to follow to inform them how best to support people. We were told new staff received an induction when starting. This included reading policies and procedures and shadowing more experienced staff until they felt confident lone working. However, there was no record of this. Staff had received training in areas considered by the provider as mandatory. These included first aid awareness, medication management, infection prevention and control, moving and handling and safeguarding. There was a recruitment process in place, however staff records lacked some relevant documentation. Not all staff received 2 references prior to starting. The registered manager advised they thought 1 professional and 1 character reference was needed. Following an external audit of the service in December 2023 they were made aware this was incorrect and have since been chasing outstanding references. It was also not always clear that a full employment history for all staff was available. The registered manager started to address this during the assessment. Please see our judgement under the Well led key question in relation to this.

People were supported by staff to live in a clean home. There was personal protective equipment (PPE) available in people's homes for staff to use.

Staff confirmed they had access to enough PPE. Staff were able to tell us how they used PPE in accordance with best practice guidance.

People had infection control risk assessments in place. Staff were trained to use PPE effectively.

People and relatives told us that staff supported them with their medicines. While people and their relatives we spoke to expressed that they were generally happy with their care, our assessment found elements of care did not meet the expected standards and the medicines processes in place were not always safe.

The concerns we identified regarding medicines were discussed with the management team who started to address the issues during the assessment. Staff told us they had medicines training, and their competencies were assessed to ensure they were competent to administer medicines. One staff member told us, “Yes, I have had training and observations. [Name of staff member] observed and made sure I was confident and knew what I was doing before signing me off.”

There were processes in place to support people to receive their medicines. This included medicines profiles, guidance for staff and electronic medicines administration records (MARs). We found information on people’s MAR, medicines boxes and their care plan did not always match. Some people had medicines to be administered ‘as required’ (PRN). PRN protocols to guidance staff on their use was not always in place. Where people were prescribed medicines to support them with their bowel movements, there were not always clear plans in place to guide staff on how and when to give them. Where people were prescribed creams and ointments, there were body maps and guidance in place describing where they should be applied and why. We did not find that these shortfalls had impacted on people's care as staff knew people well. Please see our judgement under the Well led key question in relation to this.