The Reeds

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

We found a breach of the legal regulation in relation to environmental restraints. There was no clear plan or review process in order to reduce restrictions as soon as possible. Staff received training about how to keep people safe. Risks were identified but support plans were not always followed by staff. There were enough staff to meet people’s needs and staff received the support and training needed to provide safe care.

This service scored 72 (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 saw people who lived at the service were engaged and confident around staff. Relatives told us they were sure their loved ones were safe at the service and staff kept them up to date with any incidents. One relative told us “They let us know when anything happens, it’s a good set up. We visit regularly and know staff and management.”

Staff told us they had received training in how to keep people safe from abuse. Staff knew how to report any concerns they had both to the provider and to external agencies. Staff worked collaboratively with the local authority safeguarding team to investigate concerns raised. While there are no planned physical restrictions, all staff were trained in how to safely restrain a person if there was an immediate need to keep them and others safe. Any physical restraint was monitored at the provider’s board level to ensure it was appropriate and safely carried out. However, whilst staff told us about practices which constituted restrictions and restraint, they had not identified the environmental restrictions such as the airlocks in the same way.

People appeared to have a good relationship with staff. Staff knew how they liked to be greeted and used this to develop relationships with people. We saw some people were subject to environmental restrictions by way of locked doors into and out of their private apartments. This meant they did not have free access to communal areas. Regular reviews of the appropriateness or the psychological impact upon service users was not always undertaken. We saw one person had a low stimulus environment; this had been in place for them since moving into the service in 2016. Their care records showed they had developed positively in the time they had been living at the service and had recently been on holiday. However, while on holiday they had stayed in a more homely environment with less restrictions and risks had been effectively managed. There was no evidence of plans being in place to review the restrictions in their personal environment to increase their comfort.

The provider had a safeguarding policy in place and staff received safeguarding training when they first started to work in the service. This ensured staff were aware of when and how to raise concerns. People had Deprivation of Liberty Safeguards (DoLS) in place. These outlined the restrictions health and social care professionals thought were needed for the safety and comfort of the individuals. Despite the level of monitoring, environmental restrictions were not always considered and were not monitored at board level. The registered manager and staff had relied on the yearly DoLS authorisation reviews as a way of monitoring the appropriateness of environmental restrictions.

Relatives felt risks to people’s safety and that of others were identified and managed. They gave us examples of actions staff had taken to reduce risk. One relative told us, “[Name] used to get up on the roof. Staff were proactive and suggested they take [Name] rock climbing. [Name] no longer goes on the roof.” Another relative said, “Soon after moving in [Name] took the kitchen apart. Now they have fixed and tough furniture and fittings to meet their needs.”

Staff told us when people wanted to do something they would not stop them due to risk but would look instead at what needed to be done so the person could undertake the activity safely. Staff told us they had a debrief after every incident to look at what had gone well and what they could do differently in the future to improve the quality of care they provided for people.

Staff were required to wear alarms and to carry a communication radio while supporting people. This was so they could summon help quickly if needed. However, we saw one member of staff who had taken a person for a walk around the outside of the service and left both their alarm and radio in the person’s room. This meant there was no way for them to summon help quickly if needed, placing the person and the member of staff at risk.

Records were completed by staff involved in any incidents and also any staff who had witnessed the incident. This ensured the provider had an accurate view of the incident. Staff involved in incidents should receive a debrief to review what had happened and if there was anything which could have been done differently. However, records of debriefs were not available for all incidents. In addition, de-briefs did not always fully describe the incident and the function of the behaviour was not always identified. In addition, learning outcomes did not always focus on how reduce the risk of the incident happening again This meant that de-briefs did not always support a learning approach to people’s support. Shift handovers were in place and fully documented so that any changes in people’s needs were known to all staff.

One person showed us around their apartment. They had a small kitchen area, seating area, bedroom and private bathroom. They indicated to us they liked their rooms and had arranged it as they wanted. Relatives told us the private areas of the service were supportive of their loved one's sensory needs.

Managers told us how they assessed and managed risk in any environment where people spent their time. They gave an example of fitting forward facing cameras to company vehicles to ensure driving events could be accurately captured and lessons learned to increase people’s safety when travelling.

During a tour of the environment, we saw some areas were in need of maintenance. For example, one person’s bedroom flooring was scuffed and their air conditioning cover was rusty. We raised this with staff who provided evidence that all the concerns we found had already been identified and action was being taken. One person was required to have certain items in their apartment locked away for their safety. We found a cupboard marked as ‘COSHH’ (Control of Substances Hazardous to Health) was unlocked and had cleaning products in it. This placed the person at risk of consuming substances which may be harmful to them.

Health and safety audits were completed to ensure any risks to people from the environment were identified and action was taken. Weekly fire checks were completed. However, as noted above oversight of people's environment had not been effective in identifying the risk of ‘COSHH’ (Control of Substances Hazardous to Health) being left unsecured.

Relatives told us they were confident staff had the skills needed to provide safe care to people. One relative told us, “All staff are well trained.” Another relative said, “They (new staff) shadow to get familiar with [Name]. [Name] must feel comfortable with staff, otherwise his anxiety will increase.” Relatives said there are enough staff to support people. They explained how staffing was organised to meet people’s individual needs. For example, some people liked staff they knew while others were happy to have a change in staff. A relative told us, “I think a change of staff is okay, they all get to know him and he is not reliant on one person.”

Staff told us the safe minimum staffing levels were always met. There was always extra members of staff to call upon if more support was needed, such as staff on administrative shifts, the registered manager or deputy. However, the service shares a site with two of the provider’s other services and staff are required to move between those services in times of need. There was no day to day recording of when this happened and therefore it was not possible to determine the impact this had on people living at The Reeds. Staff told us that at times it was difficult to find a member of staff who was able and willing to drive the company vehicle and so at times this made it difficult for people to leave the site for activities. Staff told us they were confident that in an emergency other colleagues would be able to come and support them to keep them and people safe. Staff received regular supervision to support their well- being and development.

Staff communicated well with people. However, at times staff could have been more proactive in managing known risks and preventing incidents. For example, one person had known behaviours and whilst we were on the visit we saw these behaviours displayed. Their 1:1 staff did not anticipate or redirect the person to avoid an incident.

The provider worked on a model of care delivery that focused on outcomes. This was based on individuals needing different levels of support through the day and on different days. The provider’s level of staffing for an average day was set at 200.75 hours and safe minimum staff levels was set at 171 hours. The provider told us the staffing model allowed them to add more staff hours or to provide staff with a higher skill level to support people at any given time. From our review of 4 weeks of staff rotas we found staffing levels did not fall below the safe minimum staff levels. The staff levels for an average day varied. For example, 8 days were staffed above average day levels and 20 days were staffed below average levels. The provider told us about issues they had identified when arranging and monitoring staff rotas and the actions they were taking to resolve those issues. For example, they told us they were improving the ways in which skill mix and the registered manager’s shift pattern were indicated on rotas.

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.

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