QUALITY LIVING CARE LIMITED

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

This is the first assessment for this service. This key question has been rated requires improvement.

This meant people’s needs were not always met.

This service scored 39 (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 did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

We found records did not always provide staff with detailed guidance about people’s individual needs. A lot of work was required on improving support plans to make them more person centred, and to more fully involve people and their relatives. Some relatives told us they had not been asked for their feedback, but they had no concerns in relation to the service. One relative told us that the registered manager had contacted them a few weeks ago to hold a review meeting, but this still had not taken place.

The registered manager, who carried out assessments and wrote support plans and risk assessments, had not received appropriate training and support to be able to complete person centred support plans. They were provided with guidance of where to seek such training.

Some people’s care records lacked detail. This included where people’s support plans referred to the use of oxygen and there was a lack on guidance on its safe use and the associated fire risks. When we spoke to the registered manager about this, they told us they would improve the guidance for staff to refer to.

We were told no people using the service were subject to any forms of restrictions or restraint. This meant we could not assess the provider as to their approach to mitigate the use of restraint.

People told us that care was responsive to their needs.

There were significant shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not joined-up, flexible or supportive of choice and continuity.

The provider failed to ensure support plans were detailed and reflective of people’s known health conditions and support needs. This posed a risk when people were moving between services, such as during hospital admissions, where clear, accurate information may be needed, including when the ambulance service attend people in their own homes.

We saw that care records maintained for people required improvements, to ensure they were more robust and reflective of what support took place. For example, for 1 person who required observations in relation to their skin due to the known risks, these were not clearly or routinely recorded and there were no support plans with clear guidance for staff to follow.

The provider’s training matrix indicated 4 of the 7 staff had received training to support people with mental health conditions. At the time of the assessment neither of the 2 people receiving support with personal care lived with a mental health condition.

Records demonstrated that overall people received the same staff which provided a continuity of care and meant that people and staff built good, supportive relationships where trust was developed. Relatives told us they felt the service worked with them when they were required to do so.

The provider did not supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Since 2016 all organisations that provide publicly funded adult social care are legally required to follow the Accessible Information Standard. The Accessible Information Standard tells organisations what they have to do to help ensure people with a disability or sensory loss, and in some circumstances, their carers, get information in a way they can understand it. It also says that people should get the support they need in relation to communication.

We found that the provider did not always meet the Accessible Information Standard. People's communication needs were not always assessed or met to enable effective communication between staff and people using the service.

The provider failed to ensure staff had clear information about people's communication needs. Records relating to people’s communication needs and preferences lacked detail. For example, 1 person was unable to effectively communicate with us due to a hearing impairment. We found they did not have a communication care plan which informed staff how to clearly and effectively communicate with them. Relatives told us that staff knew people well and understood what they wanted.

The provider gathered feedback and ideas; however, they did not use this information effectively. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

The provider had a complaints policy; however, they told us they had not received any complaints, so it was not possible for us to assess how they recorded and responded to complaints. In addition, we were unable to gauge how they would drive changes and improvements to prevent occurrences of the same things. The registered manager told us they would, “approach complaints respectfully and take action to put things right”.

Whilst some feedback forms were sent to people, feedback received on the service was analysed or reviewed. This meant we could not be assured people’s feedback and views were listened to or acted upon.

People and their relatives told us they knew how to make complaints telling us they would call the registered manager. People and relatives told us they had no complaints about the service at this time.

The provider did not demonstrate their knowledge would ensure that all people could access the care, support and treatment they needed when they needed it.

People were supported to access healthcare professionals, attend appointments and request emergency healthcare as needed. This included support from GP’s, opticians and other healthcare professionals.

Where people may lack capacity, the registered manager was unable to clearly describe the approach they would take to assessing the ability of people to make decisions about their care. This meant opportunities could be missed to support people, enabling them to have a say in their care and treatment.

Staff and leaders did not always act on information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

The provider failed to recognise the inequalities people they supported may face. These inequalities and people’s needs were not always considered. Although 1 person was supported to participate in the community, others had not been supported with barriers they faced. For example, people living with a physical disability were not supported to address and remove barriers. This included a lack of steps taken to make everyday enjoyment of getting out of bed more accessible and enjoyable. Instead, this person was confined to their bed for the majority of the time due to their concern in using mobility equipment provided. The provider could not demonstrate they had taken steps in working with the person to improve their confidence in use of the equipment nor had they accessed support from health professionals to achieve a positive outcome.

The person who was supported to access the community and participate in hobbies and interests was very positive about the staff. We saw that this person would call the registered manager when they wanted to support to go out.

People were not supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

At the time of the assessment the provider told us they were not supporting anyone on the end-of-life pathway. However, their framework stated they planned to support people at this stage of their journeys. The staff had not received end of life training which would place people at risk of not having all of their needs and wishes met.

For both people using the service whose support plans we looked at there was no evidence of advanced care planning for when they approached the end of life. Some people using the service were supported by loved ones, but others were not. There were no records to demonstrate people, or their relatives/advocates had indicated they did not wish to discuss their end-of-life journey. There was no record of when this lack of information should be revisited with the person or their loved ones. This meant if end of life support was needed unexpectedly, something which was important to that person may not be actioned.

Where people had made the decision not to receive active treatment in the event their heart should stop, this was not recorded in people’s support plans, but the provider told us this was accessible by staff on the electronic care management system.