Lav Care Services- East of Anglia

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

Safeguarding was not well managed to ensure people were protected from the risk of harm and abuse. Incident and accidents were not always well managed and reported as legally required. There were ineffective systems in place to ensure appropriate action was taken with management analysis with oversight of themes and trends. Staffing and recruitment processes were not robust. Risks to people's health and safety were not always assessed or guidance provided to staff to reduce the risk of harm. People’s care plans did not always guide safe practice with effective review. Where incidents and safeguarding concerns had been highlighted, there was a lack of staff knowledge, skills and management oversight to ensure lessons were learnt and improvements made.

This service scored 31 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

While people expressed that they were generally happy with their care and treatment, our assessment found care did not meet the expected standards. There had been a lack of openness and transparency from the management team. We identified incidents which should have been reported as safeguarding where people had sustained harm, gone missing and had not been notified to CQC as legally required. Incidents of harm when reported to stakeholders contained inaccurate and contradictory information compared with people’s care notes. There were ineffective processes to monitor, report and improve following incidents and accidents. Incidents were logged on daily records within an electronic system, however there was no oversight of this to identify patterns or trends with actions to avoid a repeat occurrence. There was a lack of effective processes in operation to learn lessons from events and actions planned to improve the quality and safety of care provided.

There were ineffective systems to enable staff to log accident and incidents with management review and follow up. Staff told us they reported any incidents and injuries in daily notes and also verbally to the registered manager. Handover processes from one shift to another were ineffective at communicating and monitoring the needs of people who had sustained injuries. Staff also told us there was no system to ensure consistent feedback to staff with investigation and outcomes which could help the organisation and staff to learn lessons with robust guidance to reduce risk and improve the safety of people who used the service.

Information we observed provided to stakeholders, for example, in relation to injuries people had sustained contained conflicting, contradictory information compared to what had been written by staff in people’s daily notes.

We identified one incident where a person had sustained a serious injury which had not been recorded within their daily notes until 10 days after the incident. Whilst action had been recorded as taken to contact a GP, there was a lack of recorded evidence of any timely staff monitoring of this person with regular checks on their safety and welfare.

Where people were required to move from one supported living setting to another we found a lack of evidence to show people had been sufficiently consulted. We identified people required to move long distances from where they were currently living. Despite our repeated requests during our assessment, we were not provided with evidence which would show people had been sufficiently consulted with, that the reasons for the move were in the best interests of the individual and consent had been obtained. After our assessment had been concluded the provider produced documents stating consent had been obtained.

Where we identified recent serious incidents that had occurred it was apparent from discussions with some senior staff they had not been made aware of these. Senior staff told us to access up to date information and awareness of people's changing needs if this had not been passed on verbally they would need to trawl through all people's daily notes. This they told us was difficult if they had been absent from work for several days and vital information was sometimes missed. This meant handover systems were not robust to ensure important information was provided to staff. Systems for handover of information and communication were in need of improvement to ensure all staff were aware of when people’s safety and welfare was to be monitored from one shift to another.

The registered manager had not always worked collaboratively with partners to ensure people’s safety and well-being was managed, monitored and assured. Partners told us they were not always provided with the full facts when incidents had occurred and the risks we had identified. They told us of concerns they had regarding the management teams response to serious safeguarding incidents. They also raised concerns as to requests made to move people from one location to another where it was not always evident this was in the best interests of the individual.

Incidents were not always recorded in a timely way, investigated and plans were not in place to reduce the risk of future harm.  One person whilst being supported by staff to wear a seat belt sustained a broken finger. Staff had not recorded this incident in the person’s daily notes until 10 days after the incident. There was a lack of management oversight of this to ensure local safeguarding protocols had been followed. Senior staff we spoke with were unaware of this incident as handover processes from one shift to another were ineffective. The registered manager failed to raise a safeguarding referral following this incident until we requested, they do so.  

Care plans did not fully identify risks associated with people’s care and support needs. For example, where people expressed distressed behaviours which put them and others at risk. Where people were at risk of falls, moving and handling plans did not contain the required information to guide staff in the safe use of mobilising equipment. For example, whilst care plans stated the use of a hoist there was no description as to what type of hoist, which hoist sling hoops to be used and the number of staff needed to ensure people were kept safe and prevent the risk of harm.

People were at risk of abuse and harm.  Accidents and incidents were not consistently recorded, and appropriate timely action was not always taken in response to incidents.

Staff had access to on-line training in recognising and responding to abuse.  However, staff demonstrated a lack of understanding regarding local safeguarding protocols and actions they should take if they had concerns and how to respond appropriately to incidents. Staff told us they would share any concerns about potential abuse with the management team. However, not all staff could demonstrate they understood what would constitute an act of abuse. This had not been identified by the registered manager as a knowledge gap. This meant people were cared for by untrained staff which put them at risk of harm.  We found that systems to identify and report safeguarding concerns to the local authority safeguarding team, and CQC were ineffective. The lack of effective systems, processes and practices meant that people's human rights were not always upheld and they were not protected from discrimination.

At the time of our visits, the local authority was undertaking a safeguarding investigation regarding concerns raised about people’s safety. The outcome of the investigation was not known when we concluded our assessment.  

The registered manager told us they and staff had received training in the Mental Capacity Act (MCA). However, this learning had not been used to support people to understand their rights, including their human rights, under the Mental Capacity Act 2005 (MCA) and their rights under the Equality Act 2010. 

People were placed at risk of harm because the provider did not take appropriate action when abuse had been alleged. Information was not always shared with the appropriate agencies for action to be taken to mitigate the risk of further abuse and or when shared did not reveal all relevant information.

Effective systems, processes and practices were not always in place in relation to recording to evidence invoicing for extra fees charged to people and how they spent their money. We requested records relating to the safe management of people’s finances, that the registered manager told us were in place, with receipts when people’s money was spent, However, we were not provided with all the accounts we requested. There was a lack of system in place to ensure regular, robust external auditing arrangements were n place. The decision making around spending was not always clear with receipts for all transactions. People living in one supported living property told us they visited food banks weekly as they did not have sufficient funds after paying the provider for mileage fees when transported to access the community in staff vehicles and a company car. One person told us, “Most of my money goes on paying for staff petrol. There are no buses.” There was a lack of management oversight to ensure safety checks were carried out and reviewed when needed. Whilst the registered manager told staff we had spoken with did not use their cars to transport people who used the service, these same staff told us they did. Where the staff who told us they used their cars to transport people to activities we found from a review of documentation these staff did not all have the required car insurance to do so. We found a lack of guidance for staff in how to manage distressed behaviours which would identify triggers with de-scalation techniques in managing incidents which presented a high risk. In response to incidents risks had not been considered where people had access to items such as knives.

People’s risks were not always assessed and updated as effectively as required. Where people had sustained injuries whilst being supported by staff, there was a lack of investigation with outcomes and actions taken to look at any root cause analysis or mitigation to prevent a reoccurrence. Following incidents, information provided to stakeholders contradicted that compared to records made by staff.

Staff told us how they supported people with managing risks; however, we found discrepancies in records and a lack of risk assessments in place. Care records were not consistently up to date and sufficiently detailed.

We reviewed multiple care records and noted improvements were required. Risks associated with people’s care had not always been identified with risk management plans in place.

Where there was a failure to provide risk management guidance for staff this put people at risk as staff did not always have the information needed to keep people safe. Care plans did not always contain enough information to support people with their complex health care needs. For example, where people had been diagnosed with complex health conditions such as asthma, risk of choking, Parkinsons and behaviours that posed a risk to the person and others. Care plans were not always clear as to the potential triggers and interventions needed to support people exhibiting emotional distress.

People received personal care and support in their own homes. We received information of concern that one person living in supported living accommodation had been without heating and hot water which staff confirmed had been for several weeks. It was not until we contacted the provider that action was taken to rectify this. Up until we requested this there was no risk management plan in place which would guide staff as to any alternative arrangements in place to enable this person access to warmth and hot water.

In one supported living environment staff showed us a downstairs window in the kitchen that was broken and not closing exposing a wide gap. This meant people were living in a draughty, unsecure home posing a security risk. Staff told us they were unaware of any environmental risk assessment in relation to this. They also told us they had reported the window for repair some time ago but were unable to evidence the length of time, since the need for repairs was reported. Senior staff were unaware of any records which had been maintained to evidence this or any other maintenance issues which needed attention.

Supported living environments were restrictive, and people’s dignity was not always respected. The provider had installed CCTV in multiple areas. Within people’s care plans there was no evidence as to the reasons for the use of CCTV and that people's consent had been obtained or their capacity assessed in relation to this restriction. There were no notices displayed to raise awareness of cameras for visitors. We were not informed of their use whilst present. After our assessment had been concluded the registered manager sent us consent forms signed by people using the service.

There was a lack of robust assessment or explanation in people’s care plans and tenancy agreements as to the use of CCTV and why this was required. This demonstrated a complete lack of understanding of people’s rights and the expectations of supported living with consideration of the appropriate guidance which providers should follow when people live in their own homes. Tenancy agreements failed to mention and inform people regarding the use of CCTV.

Environmental risks within people’s homes were not always identified prior to care beginning. This meant staff did not have access to detailed information about any actions required to keep themselves and people safe.

Not all staff had received the training required relevant to their roles and responsibilities. Without evidence of a robust management monitoring system to assess staff competency we were unable to assess whether or not staff had been fully inducted and trained to meet the assessed needs of people and keep them safe.  People in receipt of care in the community told us staff did not always have the information and training needed to meet their needs.

Staff felt the provider employed enough staff to meet people’s needs. A staff member told us, “There is enough staff most of the time. When staff call in sick there is always someone who wants the extra hours to work.” 

Whilst staff told us there was enough staff to meet people’s needs, feedback from people differed to records which meant we were not assured all late or missed calls were being analysed by the registered manager for themes and trends with action plans to ensure improvement.

There was a lack of competency and oversight of training. There were inconsistent records maintained of staff training received including competencies undertaken such as regular spot checks on performance. This meant the provider had not ensured staff employed were confident and competent to meet people’s needs safely and effectively. People and their relatives told us staff were not always provided with information needed to meet their needs. This put people at risk of being inadequately supported by staff and insufficiently trained to meet their needs.

We repeatedly requested evidence of training provided to staff with systems of management oversight, such as a staff training matrix including evidence of induction with assessed staff competency. Other than provision of a random selection of some staff training certificates we were not provided with the evidence we requested. This meant we were not assured the provider had an effective system for planning, review and oversight to ensure people received training and support from staff who were suitably skilled, trained and had the required knowledge to meet people’s needs. After the conclusion of our assessment, we received a copy of a training matrix. This identified that not all staff had received training relevant to their roles and responsibilities.

Staff told us the majority of training they received was via an on-line platform. They also told us this training was undertaken in their own time, unpaid. For staff on minimum wage this is contravenes the rights of staff as employers must ensure pay does not go below the minimum wage.

Where relatives of the management team had been employed, we found there was a lack of risk assessments in place to evidence consideration had been given to personal and professional boundaries. We also found these staff had not received all the training required relevant to their roles and responsibilities.

We found some staff had gaps in their employment history that had not been explored with them. Another staff member had not had appropriate references undertaken and a third staff member had a reference which had not been verified to confirm the dates of employment.   

The registered manager told us their policy was for all staff disclosure and barring checks (DBS) to be renewed annually to ensure people were protected from the employment of unsuitable staff. However, we found this was not happening in practice. The provider was not following their own recruitment processes

People were supported by staff who did not always have access to the necessary equipment such as paper towels to dry their hands and hand sanitisers to reduce the risk of infection.

Staff did not raise concerns about availability of personal protective equipment, however, audits and checks on staff infection, prevention and control practice was inconsistent.

We reviewed a copy of the provider infection and prevention control audits and found the information to be very brief and a lack of detail about what was scrutinised during the audits and which member(s) of staff were observed to ensure their practice was in line with current guidance.

We visited a supported living environment and met with people, who were in receipt of the regulated activity of personal care, and whose home it was. Areas of the property were tired and in need of improvement to ensure they were safe and hygienically clean. One room had multiple dead flies on the window sill that had been there since the warmer weather and not removed. Maintenance required to broken windows and ensure people had access to heating and hot water had not been carried out in a timely manner.

We reviewed a copy of the provider infection and prevention control audits and found the information to be very brief and a lack of detail about what was scrutinised during the audits and which member(s) of staff were observed to ensure their practice was in line with current guidance.

The provider was unable to demonstrate they had completed capacity assessments in relation to the management of people’s medicines. We were not assured that people’s capacity had been assessed in line with the mental capacity act.

During our visit we noted a discrepancy where a discontinued medicine dosage had been left on the electronic medication administration sheet. In response to our findings the registered manager rectified this and ‘deactivated’ the duplicated medicine.

The provider was unable to demonstrate that people's ability to manage their own medicines had been assessed and considered to support their independence. There was no information provided to people with a learning disability in an accessible way to support their understanding about the medicines they were taking.

The registered manager had medication administration and auditing policies and procedures in place. However, we were not assured this was always followed and processes in place to ensure people received their medicines safely were ineffective. There was a lack of consistent auditing of medicines safety and competency assessment of staff. We were provided with some completed audits and competency assessments which contained very brief information. There was no detail in audits as to what staff were assessed, which service user and where observations had taken place.