Lav Care Services- East of Anglia

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Although staff told us they understood the principles of the Mental Capacity Act (2005), they had not always been adhered to. Staff understood their responsibilities to ensure that people made less complex decisions about their lives. However, staff had failed to identify and report that people's capacity around more complex decisions had not been assessed, or appropriate processes followed.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People didn’t consistently feel that staff knew how to support them if they were unwell or had a personal crisis. One person said, “Sometimes carers don’t know what to do if I have a crisis and don’t know how to respond. Sometimes I feel safe but I don’t always as quite a few of the carers fall asleep when they should be awake to care for me.”

People's care plans did not always highlight in sufficient detail any planning considering people’s strengths, goals and aspirations to enhance their quality of life.

Where care plans stated people required regular repositioning to prevent the risk of skin damage there was a lack of records maintained to evidence this had been carried out. This meant there was a lack of oversight to prevent the risk of harm.  

One person told us, “My needs are complex and specific, so I don’t want to keep explaining myself to staff who don’t know what to do. My key worker knows me very well, if there is a change of staff I would be told.” Another said, “‘I have a team of three staff but sometimes it’s a little unpredictable who will be coming to me.” 

 Where care plans stated people required regular repositioning to prevent the risk of skin damage there was a lack of records maintained to evidence this had been carried out. This meant there was a lack of oversight to prevent the risk of harm. 

Staff told us they worked well with other health and social care professionals such as community nurses, GP and social workers when needed. Comments from staff included, “We send information to the local authority when needed and contact the GP when people need a doctor.”  

Stakeholders told us staff made contact with them when incidents had occurred and when increased funding was needed. However, they also told us they did not always receive important information they requested in a timely manner and with sufficient information to inform what actions had been taken to safeguard people, for example, when following up on safeguarding concerns.  

People told us communication was in need of improvement. One person said, “Occasionally I will be told if one of the staff is going to be late but I am not always communicated with.” Another person said, “They [staff] don’t really understand my needs as there is a language barrier.” A relative told us, “[Person’s relative] would not know if there was a change of carer. On some occasions they [management] have sent carers who did not know what they were doing, and we had to send them away but eventually replacement staff came.” 

Staff told us they were not always informed of incidents and accidents that had occurred where further monitoring of people was required. Systems to ensure effective communication and handover of information from one shift to another were in need of improvement.

A recent audit carried out by one local authority confirmed our findings, identifying further improvements were needed in the systems needed to improve communication and ensure staff had the up to date information needed to meet people’s current needs.

The majority of staff employed had been recruited from overseas via the Government sponsorship scheme. Despite repeated requests to view a system of planning and regular oversight to ensure staff were provided with training in effective communication and meeting the needs of people with complex physical and mental health care needs, this was not provided other than a random selection of training certificates provided. After the conclusion of our assessment the provider produced further documents which they claimed were in use to monitor training but had not been made available when previously requested.

Not all people we spoke with required support with meal preparation or assistance to eat. There were inconsistent standards in care and risk management plans where people had been assessed as at risk of choking and or insufficient food and fluid intake. This meant people could not always be assured staff had the guidance to support them as needed.

Staff told us they knew what to do if they had concerns about a person's health or if there was a medical emergency. However, care and risk management plans were inconsistent in the quality of guidance provided for staff in meeting people’s health and wellbeing needs.

There was a lack of effective system to ensure regular planning for reviews of people’s health care needs. For example, systems to ensure a regular review and planning for health checks, screening and dental checks.

People’s care was not always reviewed to improve their health and wellbeing outcomes.

Staff were unaware of any system in place to review the quality of care people received with systems for planning improvement.

The provider did not have an effective system to ensure detailed audits were carried out to capture the experiences of people and implement planning with actions to improve the quality of care delivered and the outcomes for people.

People had not always been empowered or included to make decisions about their care and support.This provider failed to evidence a robust system of regular reviews across both their supported living and domiciliary care service services which would demonstrate the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them. Please see our comments throughout the rest of this assessment report.

Although staff told us they understood the principles of the Mental Capacity Act (2005), they had not always been adhered to. Staff understood their responsibilities to ensure that people made less complex decisions about their lives, for example what to do or what to wear. However, staff had failed to identify and report that people's capacity around more complex decisions had not been assessed, or appropriate processes followed. The registered manager told us they understood the principles of the MCA but could not explain why appropriate processes had not been followed.

Processes were not always in place to assess people's capacity and ensure the Mental Capacity Act (2005) was complied with. Not all staff who worked across both the supported living and the domiciliary service had been provided with the necessary training and knowledge to understand their roles and responsibilities relation to the Mental Capacity Act (2005).
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