Archived: Independent Options Central Support Service

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.

This is the first assessment for this service. This key question has been rated 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 service was in breach of legal regulation in relation to people’s safe care and treatment including the way people’s medicines were managed.

This service scored 50 (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 of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons learnt were identified. However, these had not always been embedded in good practice.

There were policies and procedures to support learning culture, however these had not been effective.

Areas of improvement were followed up. However good practice had not been consistently embedded. For example, an internal quality assurance audit had identified concerns regarding how people’s finances were managed by staff. However, no actions had been taken to mitigate this concern and this meant people had been placed at the risk of financial abuse. Relatives and staff told us they felt they could not always raise concerns. One relative told us, “There are some issues with the management. I’m worried to raise concerns.” One staff member told us, “Things happen here, but we can’t raise it.”

Following our feedback the provider had taken steps to address these concerns.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They 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.

People’s needs were not always reviewed periodically and this included people’s care plans. For example, we saw an epilepsy care plan for one person which had not been reviewed since October 2019. People received support from other healthcare professionals to in meet their needs. However, at times this was infrequent. We received mixed feedback from relatives regarding people’s medical needs being met. One relative was positive about the support received and they told us, ”In the first weeks they sorted out their doctors and dentist.” However, another relative told us, “My loved one’s review of medicines was refused by the manager. They only agreed to it when I said I will sort it out.”

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

The provider had policies and procedures in place. However, these had not been effective. People were not always protected from avoidable harm and abuse. Lessons from safeguarding incidents were not learnt. We saw examples where people were subjected to financial abuse as no initial action and learning was undertaken contributing to future occurrences. Relatives told us that they did not always feel staff kept people safe. One relative told us, “We don’t have even 80% confidence in them that my loved one is safe because of the experiences we had.” Another relative told us, “I feel my loved one’s safety depends on who is on duty.” Staff received safeguarding training but did not always have a good understanding of how to keep people safe. One staff member told us, “We are against abuse, we keep people safe.” Another staff member told us keeping people safe meant stopping people from talking to strangers and having the door locked. We also received feedback from stakeholders and partners expressing concerns regarding people’s safety. Once stakeholder told us, “There have been concerns raised from a number of families in the past concerning how people’s finances were managed.”

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People’s risks were not always identified, and assessments were not always reviewed and person centred. For example, one person’s individual risk assessment had not been updated since July 2020.Another person needed support with their moving and handling needs, however, their risk assessment had not been updated since November 2023. We saw no evidence people were involved in managing their risks to support their independence and include them in decision making. Staff did not always understand risks to people and how to keep them safe. One person who chose to enjoy alcoholic drinks needed this to be thickened due to the risk of choking. The staff member we spoke with told us person’s drink did not need to be thickened as they thought it was thick enough, ignoring the care plan. Another staff member found difficult to explain how they would support person if they were choking. However, another staff member was able to explain what procedure they would follow if the person required first aid. Stakeholders and partners also shared their concerns with us regarding how people’s risks were managed. One stakeholder told us,”I view that staff at the supported living setting did not have the effective training in place to manage behaviours through a Positive Behaviour Support Plan. They were often reactive and scared and this increased person’s aggressive behaviour towards them as they picked up staff’s lack of confidence in supporting them.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Individual supported living houses were managed by separate landlords and housing providers. Staff told us repairs were raised with landlords when required.

In the properties we visited people’s personal spaces were mostly adapted to their needs.

People were encouraged to personalise their rooms and staff supported people with this task. People and their relatives did not raise any concerns regarding the environment with us at the time of this assessment.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development.

Staff did not always work together well to provide safe care that met people’s individual needs.

There was not always enough staff available to meet people’s needs. We have received mixed feedback about staff. One relative told us, “Staff get borrowed from other houses, so they don’t know what they are doing. It’s deteriorated a lot recently. They are saying there are going to sort this out or reassure us by recruiting more permanent staff, but they haven’t.” One staff member told us, “Most of the people are 1:1 and we are finding it difficult. There used to be 4 staff. It dropped back to 3 staff. It can be difficult.” Another relative told us, “Staff are consistent, they are making a great effort to get to know him well.”

Staff records did not always demonstrate suitable recruitment practices. Not all the appropriate references for staff were obtained and gaps in employment were not always followed up. For example, when staff worked in a social care environment prior to working for the provider, these references were not requested. Instead references from a workplace not relevant to social care were asked for. Following our feedback, the provider took an action in addressing concerns regarding recruitment practices.

Staff received training. However, training was delivered mostly online and staff had limited opportunities to participate in face-to-face sessions. Staff competencies were not always assessed and when this took place it was not always effective. For example, staff had their medicines competencies assessed during telephone calls. Staff did not always the have the right skills and knowledge to support people safely, for example when with their medicines. People’s relatives expressed concerns regarding staff lacking skills, knowledge and training. One relative told us,” Staff do not have training in supporting my loved one with their medicines. There were loads of medicines errors.” Another relative told us, “With autism, I think staff don’t really understand it even though they are getting better.” People’s relatives shared their concerns about staff communication with people where their first language was not English. One relative told us, “My loved one had difficulty understanding staff because of the culture differences.”

Staff did not always have regular supervisions and appraisals. For example, one staff said, “Supervision rarely goes ahead. They are not two-way thing.” Staff had limited opportunities or professional development. Stakeholders and partners shared their concerns regarding staff. One stakeholder told us, “Family members report to us management training is insufficient, with inexperienced staff promoted to leadership roles. There is persistent lone working in properties without adequate supervision or support for people, causing unsafe environments and neglect of people’s well-being.”

Following our feedback the provider had taken prompt action regarding staff recruitment and ensuring staff had the right skills and knowledge to provide safe care to people.

The provider did not always assess or manage the risk of infection.

Most areas such as bedrooms and communal areas of the services we attended were clean and tidy.

Staff supported people to make sure that their homes were clean and tidy and we observed staff completing cleaning tasks when we visited.

Staff had access to personal protective equipment when they needed it, and we saw staff using it at the time of the assessment.

During this assessment we found no concerns regarding infection control.

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

During the inspection we reviewed medicines and records relating to medicines for people living in 6 different households.

We spoke with senior carers who were responsible for the administration of medicines during the inspection in the individual houses.

We found no evidence that people were harmed at the time of the inspection because the harm is not always immediate. However, people were placed at increased risk of harm by not managing medicines safely. This demonstrated a breach of regulation.

It appeared that people did not always have their medicines administered safely or at the right times either because the prescribers’ and manufacturers’ directions were not always followed or because there were no records made to show what time medicines were given to people.

Medicines were supplied in packs, compliance aids, where multiple tablets were in a single blister pod. Staff could not always identify each tablet because the description of the tablets were not always available. Therefore, staff did not have guidance to what the individual tablets were when administering these to people.

The records about medicines we checked were not always accurate and could not always show that all medicines could be accounted for or that medicines had been given as prescribed.

Some people were prescribed medicines to be taken ‘when required’ (PRN) or with a choice of dose. There was no information recorded, in a PRN protocol, to help staff to decide how to determine when the medicines prescribed in this way were needed or what dose to give if there was a choice of dose. This meant the medicines may not be administered safely and consistently.

When people were prescribed thickener to be added to their fluids, to help them swallow the fluids safely, we found the records made about how much thickener was used were not always accurate.

When medicines were needed to be given in an easy to swallow formulation or needed to be hidden in food no advice was obtained from relevant health care professionals. There was a medicines policy in place including covert medicines. However, this had not always been followed. No advice was sought from the GP or pharmacist when simple homely remedies such as Paracetamol were supplied by a relative to make sure they did not conflict with prescribed medicine or health conditions.

Medicines which needed to be accessed rapidly in the event of a medical emergency were not always stored appropriately or safely.

Medicines which had been discontinued or were out of date had not been disposed of which placed people at risk of being given medicines that were no longer prescribed for them or were out of date.

Following our feedback, provider had taken prompt action to ensure medicines for people were managed and administered safely.