Lav Care Services- East of Anglia

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• 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

People were at risk of receiving inconsistent support as an effective care planning system was not in place. Not all care plans contained sufficient information to ensure staff knew how to deliver people’s care in a safe and person-centred way. For example, people with complex support needs did not all have sufficient guidance for staff about how to support them to ensure theirs and others safety. People’s care and support did not always take into account current legislation and consider relevant nationally recognised evidence-based guidance. For example, plans to promote people’s independence and reduce the risk of social isolation. This information is important so that people's individual wishes are considered and planned for. The system in place to manage concerns and complaints was ineffective. Where people had raised concerns and formal complaints, these had not always been effectively recorded, managed, investigated, and/or responded to in accordance with the provider’s own policy.

This service scored 43 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Although relatives told us people received person centred care and support, our assessment found that this was not always the case. People were not always involved in planning their care or creating their care plans. Care plans did not always highlight what people could do for themselves or prompt staff to encourage people's independence. For example, one care plan stated that the person needed support with meal planning, but it did not state what the person could do for themselves or any goals the person had around gaining independence in this area. Promoting people’s independence in planning their personal care needs was not always evident.

Although staff told us they delivered person centred care, records we reviewed evidenced this was not always demonstrated. Daily records of care and support were brief in detail. For example, records to evidence personal care support had been provided were brief in detail without a clear description of what support had been provided and what action to support independence.

Care plans contained varying levels of detail. For some people there was comprehensive information as to the initial assessment of people’s health and welfare needs. However, daily records of care support were often brief, a tick box system, lacking in detail and not completed in a timely way. For example, when recording personal care support staff had recorded, ‘personal care done’ but did not say what had been provided by staff and how independence was promoted. Other records stated ‘shower/bath’ but did not say which of the two choices had been provided.  This meant information was unclear and could be misleading.

There was a lack of arrangements in place to ensure consistent, external oversight in relation to the monitoring of how people’s personal money and possessions were managed and safeguarded. There was a lack of contractual information available to all people who used the service. For example, people in receipt of supported living were not provided with information in their tenancy agreements as to what extra fees they were expected to pay for such as paying for staff car fuel expenses.  There were no provider care agreements in place as required.

People living in supported living premises were found to live in remote, rural areas without adequate access to public transport and local amenities. Care plans did not reflect consultation with people in planning to ensure people’s needs and preferences had been considered in relation to where they lived, accessibility, and proximity to community resources, family and friends.

Staff told us they knew people well and had access to all the information they needed to provide support to people. However, they also told us the handover processes in place were ineffective in providing staff with the information they needed when accidents, and when incidents had occurred. Senior staff we spoke with were not aware of two recent incidents where people had sustained harm. This meant staff had not been provided with changes in people’s care needs and advised of any monitoring needed.

Where people’s care plans recorded, they did not want family members to be notified without their consent of incidents and changes to their care arrangements, stakeholders told us of incidents where the provider had disregarded the wishes of people.

For people in receipt of supported living, the provider was both the care provider and the landlord. People had not been provided with separate tenancy and care agreements as required. The provider showed us evidence that some people in receipt of supported living had been provided with a tenancy agreement, signed and agreed by them but not everyone. As the provider was acting both as the landlord and also the care provider people had not been provided with separate tenancy and care contractual agreements as required. The provider had previously been advised this was required when registering the service with CQC. Tenancy agreements had not been provided in easy read formats to enable people with learning needs to read and understand these.

People told us they were not always informed as to which staff would be supporting them. Where people expressed a wish not to have certain staff they told us this was not always acknowledged when allocating staff to support individuals.

Stakeholders told us they did not always receive a timely response to requests for information needed in relation to the changing needs of people.

Some people and their relatives were given access to the electronic care plan system. However, for people without access to IT there was no effective system in operation to enable people to review information regarding the planning and review of their care.

There was a system in place for responding to complaints and concerns. However, some of the issues we identified during the assessment and issues raised by people and their relatives had not been addressed through these channels. This meant we could not be assured that the complaints system was being implemented effectively and so did not comply with the provider’s policy on handling complaints. For example, where people had submitted a formal written complaint there was no audit trail to evidence this had been investigated with a formal response detailing any actions taken.

None of the staff we spoke with were aware of any formal complaints policy and how they would access this to signpost people should they wish to complain. Staff told us they were instructed by the management team to direct complaints from people who used the service and their relatives to the registered manager.

Relatives were happy to contact the registered manager if they had any concerns. However, they could not recall if they had received a written complaints policy or if there was a formal process in place they could follow, and which would set out expectations.  

We were not assured that the provider carried out regular care and support reviews with people. We could not identify from looking at the care records that there was any involvement from people using the service or their relatives and advocates in regular reviews of their care and support.

People living in supported living housing told us they had limited access to activities and hobbies of their choice given the extremely rural locations they lived in. One person told us, “The nearest shop is about 10 minutes away by car. You can’t walk there; you have to rely on staff to take you in their cars. It gets boring here without much to do.”  After our assessment of this service had been concluded the provider sent us documents detailing outings people had been supported to access. However, this information was not available in the planning of people’s care documents we had previously been provided with.

People told us they were supported by staff to make sure that their care needs were being met when referrals were needed to access clinical support from healthcare professionals.

Although staff and the registered manager told us they promoted equality, we found this was not always the case. For example, safeguarding concerns were not always appropriately raised, there was no consideration on how this impacted all the people involved in incidents.

Staff told us how they would make referrals through to GPs, district nurses or other healthcare professionals if required. Staff told us they informed relatives of concerns and escalated matters to the management team to follow up where needed. 

We found people did not all feel completely consulted in the planning of their care. Further improvements were needed to ensure all people had full independence, choice and control in line with nationally recognised good practice guidance such as REACH standards for people with a learning disability. Staff showed a good understanding of their responsibility to offer choices when delivering care, however, people were not always well-supported with regards to their specific mental health needs and risks to their health and safety. This was not always respectful of their equality and diversity.  

The provider did not always evidence in the planning and review of people's care what action had been taken to encourage creative ways of delivering equality of experience, outcomes and quality of life for autistic people and or people with a learning disability to ensure the model of care been aligned to current best practice guidance including, Right Support, Right Care, Right culture. After our assessment had been completed the provider submitted emails where they showed discussions with stakeholders as to possibilities to support people with holidays and other activities.

We recommended a review of care plans to ensure they reflect fully processes to ensure people's physical, mental, emotional and social needs, including those related to protected characteristics under the Equality Act 2010 evidence people had been involved in creating and updating their care plans. 

While the people we spoke to expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. For example, we could not be assured that systems were in place to support people who may be at risk of experiencing inequalities in experience or outcomes.

The management team and staff told us they considered and promoted equality; however, we found littler evidence that human rights had always been considered for people. For example, in relation to the use of CCTV and the movement of people from one location to another.

People's care plans were inconsistent and lacked evident input from people and their families. Where people did not have capacity to make a particular decision, the provider did not always follow the principles of the mental capacity act. As a result, we were not assured people had equity in access and outcomes given their individual needs.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future. For example, the provider did not work to a recognised model that would support people to explore options around moving from one location to another. Further work was needed to explore people’s dreams and aspirations for any work and education opportunities they may have.

It was evident from discussions with staff and the management team there was a lack of proactive approaches used to address barriers in access to care and support. This was particularly noticeable where people had low or no funding in place to support them with activities and community outings. There was a greater need for staff and leaders to explore alternative activities and engagement within the service, or ways to support those people without fundings to still become an integrated member of the community.

Decisions people had made were recorded and known by staff, however we did find for some people, planning was not always in place to show how staff could support people in achieving their wishes.

There was little evidence seen of the provider learning lessons when things had gone wrong. We found the management team reactive as opposed to learning and making improvements based on incidents.