Independent Living Alternatives

On this page

• 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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The provider was in breach of legal regulation in relation to ensuring staff were competent and trained.

This service scored 47 (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 have a proactive and positive culture in relation to safety. Lessons were not always learnt to continually identify and embed good practice.

There was not a learning culture when events happened as there were no established processes to review what actions had been taken and what could be done differently next time. Two safeguarding concerns had been identified by the registered manager. They had informed the person’s assigned social workers but had not reviewed how these safeguarding concerns were managed. During our assessment, we identified these people were still at risk which the registered manager agreed with. The provider’s approach had not identified these issues or learnt from them to improve their systems.

The provider did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

The provider and registered manager had not established systems to respond to incidents and accidents. This would have helped to promote people’s safety when something went wrong. No one had come to harm because of this, but this was a risk for the future. The provider did not have a process to support people when their needs changed, and they were no longer suitable for the ‘service’. We directed the registered manager about what to do for 1 person they were concerned about, who would be leaving their care. They did not have a process in place to guide them, to ensure people move on in a safe way.

The provider worked well with people to understand what being safe meant to them and how to achieve that. They had concentrated on protecting their right to live in safety, free from abuse, and discrimination. But improvements were required to their safeguarding processes.

The provider had ensured staff were trained about discrimination and people’s disability rights. Staff were familiar with different types of abuse, and they said they would speak with the person they supported and then the registered manager if they identified concerns. However, staff were not aware of the outside agencies both they and the person could go to if they wanted to report the potential abuse outside of the Independent Living Alternatives. The registered manager had raised a safeguarding concern but was not satisfied with the response. They had not taken further action to advocate for this person. The registered manager had not made a formal referral with all the information to the local authority safeguarding team as directed by the provider’s policy.

The provider had a process in place to guide the registered manager and staff about receiving a safeguarding concern, but this did not acknowledge the role of the local authority in overseeing the investigation of safeguarding concerns. They had not considered they needed to seek advice from the local authority before they started their investigation.

The provider did not always work well with people to understand and manage risks. The provider was not assured staff always provided care to meet people’s needs that was safe.

People identified risks with their care and informed staff how to support them safely. However the registered manager and provider had no system to assess risks associated with people’s care and ensure that the steps staff were taking to mitigate risks were appropriate, or that staff had skills and competence to support people safely with these risks.

People had risk assessments in place however, these were limited in scope with the risks not being explored. Some people faced certain risks which were not identified, such as when they used certain equipment to help keep them safe. Risk assessments were generic and lacked any evidence people had been involved in these risks assessments which the registered manager and provider needed to complete. The registered manager acknowledged they needed to employ a member of staff to make these necessary improvements.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The registered manager considered the person’s home environment when they conducted people’s risk assessments. However, these were generic with no personalised detail to show an individual’s own home environment in relation to the delivery of care had been assessed. People often had equipment in place to enable them to move which staff would need to operate or be present when the person used the equipment. How this impacted on the environment were not explored and considered.

The provider made sure there were enough staff to support people. But they did not always ensure these were qualified, skilled and experienced staff.

The provider ethos was to only provide care in block hours which people needed. The person would select their staff, so people saw a regular care team of staff. However, training and the provider oversight into the training was not sufficient. Staff had received little training. The provider ethos was people trained their selected staff when using their equipment to move and transfer from one position to another. But the provider and registered manager had no oversight how effective this was, to ensure the person was safe and the member of staff was competent. The registered manager could not evidence the training staff received during staff inductions. Staff had not been trained in administering and managing people’s medicines. The registered manager agreed the training was limited and they were currently looking for a new training provider.

Some safe recruitment checks were completed for new staff to promote people’s safety when they were with staff. However, there were shortfalls with the verification and references received. A member of staff did not cite their current employer for a reference. This should have been explored and considered with a documented rationale by the manager or member of staff assigned to recruit this member of staff.

This meant the provider had placed people at potential risk of harm. The provider was in breach of the legal regulation of Staffing; they had not ensured staff had the qualifications and were competent to do their work in a safe way.

The provider assessed and managed the risk of infection.

The registered manager assessed the potential risk of infection when people had their first assessment. They did not provide personal protective equipment (PPE) this was the responsibility of the person, which staff said was provided. However, the provider could not evidence all staff had received training on safe staff practice regarding infection control and how to use PPE.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

The provider’s policy was that staff were not to administer any medicines. However, they and the registered manager were not checking this aspect of people’s care. The registered manager was unaware staff were administering people’s medicines. One person told us staff were fully administering their medicines. But staff were not trained by the provider to do this. Nor were there any systems in place to ensure staff did this safely. Staff were also involved in secondary dispensing of medicines. This is when staff place the medicines from their packages in another container, a dossett box and then either leave this for people to access themselves or dispense and pass the medicines to the person (which is also the act of administering a medicine). This is not safe practice, as an error could take place, which makes the staff and person, vulnerable. The provider had not taken actions here to ensure everyone was safe when administering and managing people’s medicines.

When we spoke to the registered manager and members of the provider board about this, they saw this as an infringement of people’s rights, as people who do not receive care do not need this level of oversight and processes to take their medicines. But, the provider was unaware of their legal responsibilities here.