Below is a detailed description of how the CQC would characterise an ‘outstanding’ service from the point of view of safety. It begins with an overall definition of ‘Safe’ and then gives an overall ‘outstanding’ characteristic of a ‘Safe’ service. Then it breaks down this overall characteristic into a number individual parts using the Key Lines of Enquiry (KLOEs) for this domain (S1, S2, etc).
|By safe, we mean people are protected from abuse and avoidable harm|
|People are protected by a strong, empowering and distinctive approach to safety and a focus on openness, transparency and learning when things go wrong.|
|S1: How do systems, processes and practices safeguard people from abuse?|
|People are involved in developing a comprehensive and innovative approach to safeguarding, which enables positive risk-taking to maximise their control over their lives.
People are involved in decisions about their safety to the maximum possible extent and their wishes are respected. The service does so creatively and works with people and their supporters using imaginative and innovative ways to understand their wishes. Where children use the service, flexible new approaches to practice are developed with them and their families, which prevent abuse and enable possible problems to be detected early, taking particular account of groups who lack a voice. Children, external agencies and families participate in innovative ways of safeguarding. The service looks for and uses new and existing good practice and research findings in child- centred practice to deliver person-centred safe care and support. The service is particularly creative in the way it involves and works with people to understand their diverse circumstances and individual needs. It challenges discrimination and encourages staff, people who use the service and others to do the same.
It seeks ways to continually improve, puts changes into practice and sustains them. Staff are exceptionally well-trained in safeguarding people. They are highly skilled at recognising when people are at risk of abuse or feel unsafe, and they are comfortable and proactive when challenging and reporting unsafe practice. Staff develop positive and trusting relationships with people that help to keep them safe; staff have the time they need to do so, or make the time. People who use the service and staff are actively encouraged and empowered to raise their concerns and to challenge risks to people’s safety. There are no recriminations when they do so; it is seen as a normal and desirable part of day-to-day practice.
|S2: How are risks to people assessed and their safety monitored and managed so they are supported to stay safe and their freedom is respected?|
|There is a transparent and open culture that encourages creative thinking in relation to people’s safety. The service seeks out current best practice and uses learning from this to drive improvement for all people, including those with particular protected equality characteristics. People are enabled to take positive risks to maximise their control over their care and support. They are also actively involved in managing their own risks along with their relatives, friends and other carers.
There is a comprehensive ‘safety management system’, which takes account of current best practice models. This helps the service to sustain outstanding practice and improvements over time.
Staff, people and their relatives, friends and other carers are engaged in reviewing and improving systems. Innovation is encouraged to achieve sustained improvements in safety and continual reductions in harm.
Staff show empathy and have an enabling attitude that encourages people to challenge themselves, while recognising and respecting their lifestyle choices. The service helps people to have a full and meaningful life by using imaginative or innovative ways to manage risk, while supporting people to stay safe. It helps people to make decisions that may have elements of risk, by sharing information about risk in imaginative or innovative ways to help inform choice and control. The service actively seeks out new technology and other solutions to make sure that people live with as few restrictions as possible. Learning is based on a thorough analysis and investigation of things that go wrong. All staff are encouraged to participate and apply learning to improve safety as much as possible to reduce risks of harm to people using the service. This includes participating in any relevant local and national safety programmes.
The service proactively engages with people and other organisations to assess and minimise risks to the environment, premises and equipment and it anticipates issues. It does so innovatively and mitigates risk creatively to maximise people’s autonomy and independence.
People are provided with a range of accessible information about how to keep themselves safe and how to report any issues of concern. This information is on prominent display and is easily accessible.
|S3: How does the service make sure that there are sufficient numbers of suitable staff to support people to stay safe and meet their needs?|
|Whenever possible, people are actively involved in decisions about the staff who will provide their care and support, for example in relation to recruiting or choosing the staff who will work with them.
Staff proactively anticipate and mitigate risks to people’s safety and feel their skills are being used effectively.
The service is recognised as having an exceptional and inclusive approach to promoting the safety of its staff, and is seen as a good place to work by staff and external organisations.
Staff and people help to develop innovative safety training that is inclusive and comprehensive. The impact of this is evaluated and feeds into continuous improvement. Staff report that they have been provided with excellent training and ongoing support to support people to stay safe and empower them to take appropriate risks.
The service deals with issues of poor performance immediately and ensures staff are supported to improve.
|S4: How does the provider ensure the proper and safe use of medicines?|
|Where the service is responsible for medicines, staff work creatively with people to closely involve them in the management and administration of their medicines, including medicines that are not prescribed. They look for new ways to promote independence, and work closely with other agencies and advocates in doing so.
The service is particularly creative at supporting people to manage their own prescribed or over-the-counter medicines, or supporting them to take responsibility for some of this. The provider continually assesses this in partnership with the person.
The service is also creative and innovative when administering medicines to people who may lack mental capacity to make decisions about medicines.
|S5: How well are people protected by the prevention and control of infection?|
|The service involves people in identifying and managing risks relating to infection and hygiene, and promotes awareness and independence in doing so.
Where food preparation is part of the service, staff promote people’s independence and autonomy by involving them in understanding and following good food hygiene practice, or use other creative and proportionate means to do so.
|S6: Are lessons learned and improvements made when things go wrong?|
|There is a genuinely open culture in which all safety concerns raised are highly valued as integral to learning and improvement.
All staff are open and transparent, and fully committed to reporting incidents and near misses. The level and quality of incident reporting shows the levels of harm and near misses, which ensures a robust picture of quality.
Learning is based on a thorough analysis and investigation of things that go wrong. All staff are encouraged to participate in learning to improve safety as much as possible, including working with others in the system, and, where relevant, participating in local, national, and international safety programmes. Opportunities to learn from external safety events are identified.