YourLife (Maidenhead)

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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

We found the service prioritised and effectively responded to safety concerns. People were kept safe from avoidable harm and staff understood their responsibilities to report any potential concerns for people’s health, safety and welfare. People felt safe and were supported to manage risks in their lives, assisted by staff who had access to personalised care plans and risk assessments. People were supported in a safe living environment and staff understood how to check people’s apartments and communal spaces for potential hazards. Staff told us they received training and support to equip them effectively for their roles, however we identified a concern in relation to one staff member’s recruitment check which the service responded to during our assessment. We also identified areas for improvement in relation to the recording of people’s medicines support.

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.

Staff told us there was open and effective communication when safety incidents occurred, such as falls. For example, a duty manager explained the provider’s process included an accident form, considering whether the incident formed part of a pattern, informing the person’s family where appropriate, and exploring what further actions may be required, such as a GP review. Staff consistently told us they were promptly updated following safety incidents via verbal and written handover processes. Leaders described having oversight of accidents/incidents to ensure they were satisfied sufficient action was taken to reduce the risk of recurrence.

Records showed the service’s culture promoted a duty of candour when responding to incidents, for example, informing people’s families when accidents/incidents occurred. The provider’s processes encouraged the effective sharing of information and learning following incidents. This included an accident/incident form which was submitted to service and provider management, alongside written and verbal handover systems to ensure staff were kept updated. We identified a varying level of detail in the completion of accident/incident forms. The registered manager informed us this had been identified and that staff would be offered additional support and guidance to ensure documentation improved.

Relatives told us the service prioritised and effectively responded to safety concerns. Feedback also confirmed the service was working openly and honestly with people and their families when safety incidents such as falls occurred. Relatives advised, “They [staff] let me know when [person] has a fall. The response was fantastic, they sat with [person] until the paramedics came as we could not get there”, “[Person] has had a couple of falls and they helped them out” and “Whenever there are any problems they are on the phone or send an email.”

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 understood their responsibilities to keep people safe and demonstrated knowledge of safeguarding and whistleblowing procedures. All staff we spoke with were fully satisfied people were safe and protected from harm, and had confidence service leaders were accessible and would act on any concerns raised. Staff also consistently told us people were not subject to any restrictions, explaining people were encouraged to be independent wherever possible. Leaders understood their responsibilities to report potential safeguarding concerns to the local safeguarding authority, and had access to local reporting guidance. Leaders explained they continued to promote awareness of safeguarding through staff meetings and the display of visual information for staff.

People were kept safe from avoidable harm because staff knew them well and worked with people to protect their safety. Relatives told us people felt safe and were well treated and supported by staff. Comments from relatives included, “She feels safe with them” and “She smiles when they come in and says how nice they [staff] are when they leave.”

There were effective systems, processes and practices to ensure people were safe from the risk of harm and abuse. Staff undertook safeguarding training and had access to the provider’s safeguarding and whistleblowing policies and procedures. Records showed there was one potential safeguarding concern in the past 12 months. The local safeguarding authority had noted the potential safeguarding incident was not reported in a timely manner, however we were satisfied records evidenced the service had responded appropriately to the incident, and had used learning to improve the wider service.

Staff managed people’s safety well by maintaining oversight of risks whilst enabling and encouraging independence. Staff were updated when people’s support needs changed, and all staff consistently told us they referred to care plans and risk assessments before delivering support. Staff knew people well and demonstrated their knowledge of risk management arrangements. For example, staff described encouraging hydration, monitoring for signs of health deterioration, supporting people to use showers safely, ensuring safe food preparation for a person who required bitesize food, and assisting people whose mobility was impacted by physical or sensory needs. Staff also demonstrated understanding of how to sensitively support people whose behaviour communicated feelings of distress or confusion, including where people were living with dementia. A staff member described supporting someone who experienced distress, explaining they gave the person time to express themselves, acknowledging the person’s feelings and offering distraction via a drink or snack.

People felt safe and were supported to manage risks in their lives. The service engaged with people and their families in decisions about safety as part of care planning. Relatives were also satisfied the service responded to update care and support arrangements when people’s needs changed. Relatives advised, “They will reassess as [person’s] mobility needs change” and “[Reviewed] as needed, if they feel it [care plan] needs any amendments and vice versa, it is sorted. They are adding laundry to it as well.”

Care plans and risk assessments provided relevant information to keep people safe and were personalised, for example, reflecting the level of support a person may need on a good or bad day, and what tasks people could be encouraged to undertake more independently. This approach promoted empowerment and positive risk taking. We identified one person’s risk assessment and care plan had not been updated promptly following 2 falls. We were satisfied this had not impacted on the person’s support, as staff we spoke with were aware of the potential risk of falls and how to mitigate this. The risk assessment was updated during our assessment, and we noted other care plans and risk assessments had been subject to recent reviews.

Staff feedback demonstrated their understanding of ensuring people were supported in a clean, safe, and well maintained environment that met people’s needs. Staff confirmed they had received fire safety training and had participated in fire drills to enable them to respond effectively in emergency situations. Staff were satisfied maintenance matters were promptly addressed. Staff described undertaking daily cleaning and safety checks to monitor the safety of people’s homes and communal spaces. Staff told us the call bell system was operated effectively to ensure a prompt response for people who needed urgent assistance.

People were supported in a retirement community which included communal spaces. Records showed risk assessments and checks were in place for the facilities, equipment and technology to promote a safe care environment. This included the internal and external environment. Staff daily work schedules included mandatory safety checks of the environment to identify and act on potential hazards.

People were supported in a safe living environment. Relatives highlighted that equipment was well maintained and some people had received occupational therapy (OT) input to identify equipment or adaptations to meet their needs. Relatives explained the use of technology, including an alarm call system, supported people to feel safe and secure, and to live more independently. Comments from relatives included, “She feels safe living here. Someone is near at hand, she can ring the bell”, “He uses a walker and the rails along the corridors. He feels safe and secure” and “He has aids and all are maintained. The OT came and made suggestions for some adaptations to be carried out.”

All staff we spoke with were satisfied required pre-employment checks were completed before they delivered care. Staff explained opportunities for shadowing, in addition to mandatory training, had enabled them to gain the knowledge and experience required for their roles. Staff told us they received ongoing support through refresher training, supervision, staff meetings and spot checks. Staff advised staffing levels were safe and they worked together as a team to cover any unexpected staff shortages, such as staff sickness or if a person’s visit took longer than anticipated. A staff member advised, “There is great team work and flexibility in working hours.” Leaders advised they followed a values based recruitment approach to identify “motivated potential staff” with “values and character traits like compassion and care.”

Relatives told us staff delivered good quality care to meet people’s needs. We were told staff developed a rapport with people and were alert to potential changes, or concerns for people’s safety. Comments from relatives included, “He is very happy. They are lovely with him, respectful. They use gentle persuasion”, “They will alert me to minor things. The carers are excellent” and “Very nice and always chatty, if they have a concern, they will give feedback to the manager.” Relatives were also satisfied sufficient staff were deployed, advising, “All care calls are covered” and “Not missed a call and are fairly punctual.”

Staff submitted an application form, completed an interview process and pre-employment checks were undertaken. These included references from previous employers, a medical declaration and disclosure and barring service checks (DBS). DBS checks provide information including details about Police convictions and cautions to promote safer recruitment. We identified an error had been made on one staff member’s DBS application, which invalidated the result. This could have placed people at risk. The service responded and a new clear DBS check was received during our assessment. Staff received training to carry out their roles; the training matrix confirmed this. The service had improved induction processes and was working on improving staff access to the Care Certificate. The service monitored required staffing levels and recruited 2 additional staff which ensured the service was not reliant on agency staffing.

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.

Assessments identified the level of support people needed to safely manage their medicines. Daily audits monitored whether medicines were correctly administered and documented. Audits had not identified some recording errors we found, such as one person’s medicines record labelled with the wrong month, and where medicines were administered from a monitored dosage system, the service had failed to retain a list of medicines administered for some weeks within the month. Following medicines recording errors in November 2023, the service identified some staff required re-training. The training matrix showed staff had not undertaken re-training and we were advised the previous manager held formal conversations with staff, however this was not evidenced. The service agreed to conduct additional spot checks to ensure staff were working safely.

Relatives told us people received safe medicines administration, with comments including, “They do medication and there are no problems” and “[Medicines] given as prescribed.” Relatives were also satisfied appropriate arrangements for the safe management of medicines were in place. Relatives told us, “On the odd occasion I have forgotten to reorder they will let me know when they are running low” and “We have to go through with management when new [medicine] items are added and these are put on the care plan.”

Staff confirmed they received medicines training, and had their competency assessed, before administering medicines. Staff described following their training and could confidently explain checks they were required to undertake to ensure safe medicines administration. Staff confirmed people’s care records contained the information they required to deliver safe medicines support, such as instructions for ‘as and when required’ medicines, and information about where to apply prescribed topical medicines such as creams. Staff were aware of their duty to report potential concerns, such as any suspected medicines errors.