Engage Support, a supported living service for autistic people and people with learning disabilities, was rated Requires Improvement overall, with a breach of Regulation 12 identified due to undocumented use of room-locking as a de-escalation technique and absent Court of Protection authorisations following a change in service type. Caring, effective and responsive domains remained Good, supported by strong person-centred practice and staff culture.
Concerns (5)
criticalCare planning: “Positive behaviour support plans for 1 person did not include all the actions taken by staff as part of a de-escalation technique.”
criticalRecord keeping: “There were occasions where this person was being locked in their room...This was not included in the plan...this lacked the detail required for decision-making.”
criticalConsent / capacity: “The people at the service had not been reassessed and there was no involvement from the Court of Protection.”
moderateGovernance: “We found this document did not include the restriction around locking someone in their room.”
moderateIncident learning: “For one person the registered manager referred to the actions of staff being in line with a person's care plan however...this was not clearly outlined.”
Strengths
· Staff treated people with dignity and respect, supporting them as individuals with person-centred care around likes and dislikes.
· Care plans were highly personalised, including details around people's likes, dislikes and communication needs.
· Staff received thorough induction including shadowing, Crisis Prevention Institute training and positive behaviour support training.
· Staff had regular supervisions and felt supported by management.
· Medicines were administered safely with no recent medication errors and clear 'as required' protocols.
Quality-Statement breakdown (25)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving careGood