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. 

Improvements were needed to improve the learning culture as management information provided to stakeholders was not always consistent with the facts following serious incidents. Where legally required the registered manager did not ensure statutory notifications were submitted to CQC following serious incidents such as safeguarding incidents, incidents and those involving the police.

People told us when they started using the service, an assessment was carried out. Not everyone we spoke with had access to their care plan and involved in any review unless they had access to IT and the provider's PASS system.

Senior staff told us of incidents and accidents that had occurred which they were unaware of. 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.

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. 

Effective systems, processes and practices were not always in place in relation to recording and handling of people's money. Whilst the provider told us they did not currently to handle money for people in receipt of domiciliary care services they did so for people in receipt of supported living. 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 these were not all received. There was no formal system external financial auditing system in place where the provider handled people's money. 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 for business use, these same staff told us they did both when supporting people with transport and when travelling from one domiciliary call to another. Where the staff who told us they used their cars staff did not all have the required car insurance to do so. This put people at risk.

People’s risks were not always assessed and updated as effectively as required. There was a lack of systems in place for recording accidents and incidents other than staff recording on daily notes and ABC charts which were not being used as designed. Improvements were needed to ensure a robust system of oversight with records maintained of investigations, outcomes and actions taken to reduce the risk of harm to people.

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. 

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. Following our review of the management teams response to incidents we identified further work was needed to ensure the provider operated a robust system of detecting and controlling potential risks in people’s homes.

Following our review of the management teams response to incidents we identified further work was needed to ensure the provider operated a robust system of detecting and controlling potential risks in people’s homes.

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.  

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.

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. 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. 

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 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.