Rapid Review & Resettlement

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

People received safe care from staff who were well trained and supported by the provider. The environment had been adapted to meet people’s specific needs, with the provider addressing any maintenance issues promptly, to ensure people’s continued safety. Accidents, incidents and complaints were documented and reviewed appropriately, with actions created and lessons learned considered. Relatives told us staff had developed positive working relationships with the people they supported, which had resulted in good outcomes. As placements at the service were temporary, the provider had developed systems and processes to support people to transition safely and successfully onto their next placement.

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.

The provider was able to demonstrate how they learned from incidents and/or accidents and used this information to drive improvements. Relatives had identified examples of good practice which they shared with us. One relative stated, “Where [relative] was before, they just shut him in his room if he was challenging. Here they have noticed an epileptic pattern, and that [relative] tends to have a seizure after any caffeine, so only has decaffeinated drinks now.” Relatives also told us they knew how to complain but had not needed to. If they had any concerns they would speak with the area manager or the nominated individual.

Staff told us how accidents and incidents were logged. One staff member stated, “We report incidents for supported people on our access online system which is then reviewed by the service manager and registered manager. For accidents, we have accident reports in our health and safety file that we can fill out and then these are investigated.”

All incidents, accidents and complaints were reviewed by management, with actions generated and learning shared with the wider staff team, including where improvements to practice could be made to reduce the risk of a reoccurrence. A lessons learned file had been introduced, with staff encouraged to reflect on any incidents, what could have caused this and what they could do differently. These were then reviewed by management who added comments. Lessons learned was also a standard agenda item at monthly team meetings.

Relatives told us they were fully involved in transition planning and were keen for longer term placements to be with the current provider, due to their positive experiences. One relative stated, “We are very much involved and working towards the next placement. We very much want it to be with the same provider.”

We reviewed the transition process of the last person to move on from the service. The transition process had been gradual over a period of 5 weeks. Steps included staff from the new placement spending time at Rapid Review and Resettlement shadowing existing staff and starting to develop relationships with the person, to spending increasing amounts of time at the new placement to get to know people there. A review was completed 2 weeks after the person had transitioned to review how the process had gone. It was documented the person had settled well, was completing a varied activity schedule and attending the learning hub college.

Placements at the service were short term; initially for 12 weeks, albeit some people stayed longer to ensure a suitable longer term placement had been identified.

Regarding the transition process of the last person to move on from the service, early contact with the new placement had been made and a formal assessment of risk and service compatibility completed. Staff from Rapid Review and Resettlement, along with the person’s family had been involved in the process and a best interest meeting was held to determine if the move with in the person’s best interest. A detailed transition checklist was drawn up and agreed with all parties, to ensure all steps had been taken to ensure a successful move.

People using the service were unable to tell us if they felt safe, however, their relatives stated the service provide safe care, which met their loved one’s needs. We asked one relative why they felt their son was safe. They told us, “High staff ratios. They also immediately ‘got him’. He is non-verbal but they are recognising all the vocalisation signs, such as when he is happy or not. It is like he has had a reset, he has blossomed there which is great, as he has so much potential. He has obsessions, but they are managing these with distraction techniques.”

Staff confirmed they completed training in safeguarding and were able to demonstrate they knew how to report and escalate concerns. One staff member told us, “I have completed safeguarding training on [e-learning platform]. I would report issues regarding abuse or mismanagement to my manager or directly to safeguarding.”

Our observations indicated staff had a good understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). One staff member stated, “You have to presume a person has capacity until proven otherwise. They [people] need to be given appropriate help and support before you conclude they can’t make a decision and have the right to make unwise decisions. Any decisions made for a person who lacks capacity, needs to be in their best interest and be the least restrictive option.”

The provider had reported any safeguarding concerns to the necessary professional bodies. A log was used to document referrals, outcomes and actions. Where incidents had resulted in any potential injury to people, medical attention had been sought. The provider created 'restriction' documents, which were shared with relatives; these explained any restrictions in place at the service, deemed necessary to ensure people’s safety. Relatives were asked to review and confirm if they were in agreement. Due to restrictions being in place, the provider had submitted DoLS applications for both people living at the service, in line with guidance.

Risk assessment was a collaborative process, which involved people, if they were able, but more often their relatives. One relative told us, “Yes, I had been involved in the risk assessment process and am very happy with how they have been done.”

As placements at the service were temporary, the provider had developed systems and processes to support people to transition safely and successfully onto their next placement.

We noted good examples of positive risk taking being promoted. People using the service had positive behaviour support (PBS) plans. These were developed over time, as the service got to know people and their needs better. For one person, their PBS plan was now 23 pages long and included proactive strategies for managing all identified risks to ensure they could engage in activities of their choosing, along with action to take if things went wrong.

Care records contained a number of individualised risk assessments, covering areas such as verbal and physical aggression, property damage, self-harm behaviour, accessing the community and completing activities. For example, one person had risk assessments for cycling, community walks and trampolining, as well as for the use of vehicles, to ensure they travelled to and from activities safely.

Each person had a personalised evacuation plan, to ensure staff knew what to do in an emergency. Fire drills had been completed every 3 months, and this was also a topic at monthly staff meetings.

The provider explained the service had effectively been split in 2, as the needs of both people living there were very different. One person had a tendency to damage fixtures and fittings and preferred a sterile, clutter free environment, whereas the other person did not. The service had been adapted accordingly.

The environment was safe and had been adapted to meet the needs of people living at the service.

The provider had ensured all required safety checks had been completed, this included fire safety, water safety and infection control. Certification was in place and up to date, to confirm equipment and utilities had been serviced in line with guidance and were safe to use.

Enough staff were deployed to meet people’s needs and support them to complete activities safely. Relatives we spoke with confirmed staffing levels were appropriate. Comments included, “Yes, most definitely, there’s more than enough staff,” and, “Yes, there are [enough staff]. [Relative] is well looked after; they are thriving here.”

The provider told us they had trialled the Government’s preferred and recommended training on learning disability and autism, but felt their own course was more in depth and better suited the people they supported. Staff confirmed they received enough training, support and supervision to carry out their roles safely and effectively. Staff new to care, were required to complete the Care Certificate. The Care Certificate is an agreed set of standards that define the knowledge, skills and behaviours expected of specific job roles in the health and social care sectors.

Due to supporting people with a learning disability and autistic people, we looked at the specific training provided to ensure staff had the necessary skills to do so safely and effectively. The service had a developmental learning manager, who had completed in-depth training in learning disability and Autism. This person designed and facilitated training. The course was split into 3 ‘tiers,’ tier 1 for support staff, tier 2 for service managers and tier 3 for upper management.

Safe staff recruitment processes had been followed when new staff commenced employment. This included requesting a full employment history, seeking references from former employers and completing checks with the Disclosure and Barring Service to ensure applicants were of suitable character to work with vulnerable people. Staff training and supervision completion were monitored by managers; these showed staff were up to date with training which the provider considered mandatory, and supervision had been completed in line with the company policy, which were 3 meetings per year as well as 1 appraisal.

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.

Staff were aware of people’s preferences regarding how they took their medicines. ‘When required’ protocols contained sufficient detail to enable staff to administer medicines appropriately in order to meet people’s needs. One person was prescribed diazepam tablets ‘when required’. The tablets were dispensed on 02 March 2024 and expired on 30 June 2024. A ‘when required’ protocol and MAR were in place. We were told the person had not needed the medicine since moving to the home, but staff had not asked the prescriber if the medicine could be discontinued. There was no ‘when required’ protocol for this person’s laxative in their MAR file. A protocol had been prepared and was printed during the site visit.

Managers understood the principles of 'Stopping the over medication of people with a learning disability, autism or both [STOMP]. All staff received medicines training. We were shown the presentation used to train staff and saw that it contained the necessary information. Staff completed medicines competency assessments.

Medicines were stored safely. Medicines prescribed for people no longer resident at the home were kept locked in a separate cupboard but had not been disposed of promptly. The service had a comprehensive medicine policy which followed national guidance on managing medicines in care homes. A comprehensive medicine audit was conducted every six months. No required actions were identified in the last audit, done in May 2024. Senior staff carried out daily medicine checks.