St Anne's Community Services - Norfolk Road

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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 were safeguarded from the risk of abuse because there were effective systems in place. People’s experience of being involved to manage risk was extremely positive; staff understood people’s needs and how to support them stay safe, whilst respecting people’s choices and rights. There were enough suitably skilled staff to meet people’s needs. This all helped ensure the service was meeting the principles of Right Support, Right Care, Right Culture.

This service scored 78 (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.

Staff had a good understanding of safeguarding procedures. They were very confident any concerns raised would be dealt with appropriately. They told us, “There is nothing concerning or I would say. I feel I can raise concerns” and “If ever saw somebody do anything - even the smallest thing – I would raise it. I would go over the manager's head if need be. But I am confident in [Registered Manager]. She does have an open door policy.”

People told us, and showed us, they felt safe with staff. Relatives had no concerns and felt people were safe. Relatives were happy with the care and support people received, and confirmed they would feel very confident raising any concerns. They felt any issues would be dealt promptly. Relatives told us, “I feel [Name] is safe there. They look after them well” and “I certainly feel that [Name] is safe.”

People appeared very relaxed and comfortable with staff. People indicated they liked living at the home and raised no concerns. Staff and the registered manager were very open and welcoming.

The provider had effective systems, processes and practices in place to make sure people were protected from abuse and neglect. Records showed safeguarding issues had been investigated and action taken to mitigate future risk. This included close liaison with partner agencies and police. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We found the service was working within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty. Any conditions related to DoLS authorisations were being met. Mental capacity assessments and best interest decisions were made where required, involving people and relatives as appropriate.

Staff knew people really well. They told us they worked together as a team to review people’s needs and risk assessments. It was evident staff understood how to support people in managing individual risks. Staff understood people’s communication methods and were able to explain how they learned about people’s preferred communication. Staff were able to tell us what people meant by different noises and facial expressions.

Risks were extremely well managed. There was a positive and proactive approach to risk identification and mitigation. Staff and the registered manager were proactive in identifying risks and supporting those who were vulnerable and at risk of exploitation, whilst respecting and valuing people’s wishes and rights. Clear risk assessments were in place to guide staff on how to minimise risk. The registered manager had supported people around education and development of the person’s own risk awareness and reduction methods. Staff had worked very closely with partner agencies and police. No restrictive practices were used. Staff and managers were very skilled at preventing and de-escalating potential risks and issues. The provider was meeting the requirements of the Accessible Information Standard. Great care had been taken to identify and respect people's individual communication methods. Detailed person-centred communication plans were in place and there was a long-standing staff team who knew people well. This meant people were involved in decisions about risk. Where health conditions posed a risk to people, there was good liaison with healthcare professionals to manage risks well.

We observed staff discussing with people about keeping safe. For instance, checking people had their mobile telephone before going out, discussing their plans and what time they anticipated being home. The interactions were encouraging and supportive, without being restrictive. Where other people needed more physical assistance to assist with keeping safe, we observed staff intervening appropriately.

People’s experience of being involved in managing risk was extremely positive. Staff were highly respectful of people’s wishes and rights, which meant risks were managed whilst avoiding unnecessary restrictions. This had led to very positive outcomes for people. People confirmed staff listened to them. Relatives told us people’s communication styles were respected and encouraged. One relative told us how delighted they were with their loved one’s progress in this regard. Relatives told us they were kept informed of any changes and involved in decisions about care needs. One said, “The communication with staff is really good. They let me know of any problems” and, “If there were any issues they would ring us. [Registered Manager] is a fantastic leader.”

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

Staff told us there were enough staff and they felt very supported in their roles. One told us, “I like [Registered Manager] a lot. She's a people person. If ever I have a problem, I'll ask her. You can go to her no matter what.” Staff confirmed they attended regular team meetings and could raise any issues.

We observed calm, unhurried, support. Staff were patient, caring and had time to spend with people. Interactions were friendly and person-centred. Staff knew people really well and responded to their needs and preferences.

Staff were recruited safely. The provider completed all required checks prior to staff starting work at the service. Sufficient staff were deployed to provide personalised care and support to people. Staff completed a range of training to help them undertake their roles effectively. This included positive behavioural support and training in relation to people’s communication systems. Staff also completed training on how to support people with a learning disability and autistic people.

People knew the staff and had access to support when they needed it. Relatives told us there was a regular team of familiar staff. One told us, “Staffing is consistent yes. Seems to be the same staff working there. And they know her.” Another said, “I’m very, very happy with [my relative]’s care. I can’t praise them enough. They are a wonderful team.”

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.