Lav Care Services- East of Anglia

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The registered manager is also the nominated individual for the organisation and company director.  Quality assurance systems had failed to identify the areas of concern we highlighted during our assessment. Audits had not been effective in identifying shortfalls in relation to the oversight and monitoring of risk and evidence learning with planning to improve the safety and quality of the service.  We experienced some difficulty when requesting information from the registered manager. Information received was not always provided without repeated requests and within the timescales specified. People were not supported by a provider who prioritised people’s safety. There was a lack of openness and transparency when reporting incidents to stakeholders and CQC. Incidents and accidents were not always reported appropriately and when reported contained inconsistent information which put people at risk of harm.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The culture of the service was not always effectively supporting delivery of good quality specialist care. Although the registered manager told us of their expectations for the service, there was very limited assurance on how this was monitored and discussed with staff. 

We were not assured the provider was fully aware of the requirements of their registration with CQC and fundamental standards. Notifications were not always submitted to CQC as legally required. For example, notifications were not submitted when events stop the service running safely, injuries to people in receipt of the service and safeguarding incidents including where people had gone missing.  

Discussions with staff and management team demonstrated a lack of understanding as to their awareness of responsibilities in relation to fundamental standards and best practice working in line with current methodology.   

The service was not consistently well led. The registered manager did not ensure governance systems were effectively used, and they had failed to independently identify shortfalls in the service. Statutory notifications were not always submitted to CQC as legally required.

Staff told us they were assured that if concerns were raised internally the registered manager would take appropriate action. However, we identified several instances where this had not occurred.

Not everyone we spoke with had been provided with a copy of the provider’s complaints policy and procedure. People also told us they would complain to staff directly or phone the office. 

 There was a lack of a clear audit trail describing how complaints and concerns received had been responded to. Where people had formally written to the provider with a complaint there was no written response provided with an audit trail of actions taken.  

The compliance manager told us staff had verbally responded to this complaint from a person who used the service, but no record had been made of this describing what member of staff, when the complaint had been resolved and the outcome including what if any actions taken. This meant the provider did not comply with their own policy on managing concerns and complaints.  

Staff told us the current system for handover of information from one shift to another was in need of improvement. They said they were not always made aware of important information such as accidents and incidents which had occurred previously. Not all staff understood what if any system was in place for reporting accidents and incidents.

There was ineffective oversight of accidents and incidents. There was not a clear system of how and where to report and document incidents and accidents other than daily notes and ABC [Antecedent, Behaviour and Consequence] forms in use. An ABC chart is used to gather information about behaviour that may challenge. However, these forms were being used to record accidents also.

Incidents had not always been reviewed by the registered manager to ensure appropriate action had been taken. When incidents occurred, care plans had not always been reviewed and updated to inform staff of any new concerns, potential triggers, or de-escalation techniques. There was a lack of system to ensure a regular review of incidents to look for patterns and trends.

Governance systems and processes in the service were inadequate. The registered manager was not using appropriate and effective governance processes to monitor quality and safety of the care provided.

There was a failure to ensure systems of safe and effective management oversight of the service. Systems to audit the quality and safety of the service were not consistently carried out to ensure follow up, analysis and monitoring of trends. This meant there was ineffective oversight of the quality and safety of the care provided and planning for improvement.    Governance processes had failed to ensure accurate and up to date records of relevant matters were documented and actions taken. Incident and safeguarding records had not all been completed where people sustained injuries and safeguarding incidents not always reported as required. This was not in accordance with the provider's own policies for management and oversight of incidents and protocols for safeguarding adults at risk of harm.  The provider failed to submit notifications as required by law to CQC following safeguarding incidents and events which stop a service running smoothly. This demonstrated a breach of Regulation 18, (registration regulations).  In response to our findings the provider demonstrated a lack of understanding and compliance with fundamental standards. We experienced some difficulty throughout the assessment when requesting information from the registered manager. Some Information received was not provided without repeated requests within the timescales specified. We found the registered manager and management team presented in a defensive manner, and lacked openness and transparency.

While people and their relatives expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. There was a lack of evidence to assure people there was an established system to seek feedback from service users, relatives and stakeholders.

Team leaders were known as ‘senior staff in training’. It was not clear how long training took place and what this entailed as these staff did not have knowledge of any formal induction programme of training. When asked what their roles and responsibilities were whilst managing a shift within supported living houses, responses included, “Well staff can come to us if they need anything.” And “We tell staff what to do.” They also told us they did not have access to staff rotas, safeguarding reporting logs, accident and incident reporting systems other than electronic care plans and daily recording of care provided.  

Partners told us of some inconsistencies and shared some of the concerns we had about the leadership of the service.   

For people in receipt of supported living support, the provider was both the landlord for accommodation as well as the registered care provider. In such cases there is a requirement for clear separation between the accommodation and care provided.  

Whilst there was a tenancy agreement in place for accommodation provided, there were no care agreements in place for people in receipt of personal care support. This meant there was no clear separation between provision of care and treatment and accommodation, run separately, without reliance on each other. Tenancy agreements did not highlight the extra fees people were required to pay, for example, car mileage payments when people were escorted to appointments and activities. Not all tenancy agreements had been signed to evidence people and or their representatives had all received these and agreed to their contents. 

While people expressed general satisfaction with their care, our assessment found elements of care did not meet the expected standards. The service did not focus on continuous learning, innovation and improvement across the organisation. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for services used by an autistic person or person with a learning disability to ensure the model of care aligned to current best practice guidance right support, right care, right culture.  There were ineffective processes in place to ensure that risks were identified and managed in a proactive and effective way. The registered manager had not identified that assessments were not robust and taken action to ensure improvement. Management audits failed to identify inconsistent standards in care planning and ensure plans in place to prevent isolation and promote people’s independence. Quality checks and audits were not operated effectively. For example, staff use of cars without appropriate insurance when transporting people, management of people’s money and possessions, systems to analyse safe record keeping and monitoring of incident and accident trends. There were insufficient systems to identify learning from incidents and planning for improvements were ineffective. This meant the provider had failed to ensure a complete and accurate account of people's care and treatment, placing people at risk. 

The provider used surveillance cameras in supported living premises. The provider failed to display prominent notices warning visitors of the type of surveillance that was in operation, and who can be contacted about the scheme. It must be made prominent and clear to people including visitors when, how and why surveillance is taking place, and who they can contact about it. 

The provider stated on their website the service provided support for people with complex physical and mental health care needs, however, evidence was not provided with assurance staff had received training to meet these needs.  

Whilst the provider had a duty of candour policy in place, we were unable to see that the provider had always followed this. This was because accidents and incidents and the provider's responses and actions to them were not recorded.  

The provider was not acting in a transparent manner. The providers immediate family worked at the service. Arrangements were not documented and available to Inspectors during our assessment to evidence that appropriate training had been provided, and potential safeguarding risks and conflicts of interest had been considered in the recruitment and ongoing monitoring of family members. We were not informed during our assessment of any risk management systems and assessments in place restricting a key senior member of the management team from unsupervised access to people who used the service without another member of staff being present. We were not assured staff were aware of this arrangement.

There was a lack of robust auditing of people’s finances with a system of regular external oversight in place. Directors had access to the bank account of one person who used the service. Money from this account was being transferred to the personal account of another senior member of staff. We were informed by stakeholders that this account had since been closed following the conclusion of our assessment.