Leicester City Council Shared Lives Service

On this page

• 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

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last rated inspection we rated this key question Good. At this inspection the rating has changed to Requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent. The provider was in breach of the legal regulation relating to Need for consent.

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This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

The provider had a Matching Policy to support effective placement arrangements within the Shared Lives scheme. Prior to any arrangement being agreed, Shared Lives staff undertook a matching process to assess compatibility between the person and prospective Shared Lives carers, taking account of people's needs, cultural diversity, preferences, interests, routines and desired outcomes. Shared Lives staff developed a Person Plan to ensure important information about people's care and support needs for supporting people was shared with Shared Lives carers in advance of the placement.

However, assessments and care planning documentation did not consistently capture the full range of people’s needs, preferences and desired outcomes, which meant Shared Lives carers did not always have access to complete information to support people in a personalised and consistent way.

The registered manager recognised these shortcomings and was in the process of developing and implementing a new care planning tool intended to strengthen assessments and capture information that had previously been omitted.

The provider did not consistently ensure care and support was informed by comprehensive assessment, monitoring and review processes. Essential assessments had not always been completed or updated to ensure support arrangements remained appropriate to people's changing needs and risks. This limited the provider’s ability to demonstrate care was consistently planned and delivered in line with current best practice and individual requirements. Governance systems had not identified these gaps in a timely way and there was insufficient oversight to ensure assessments were completed, reviewed and used effectively to inform care planning.

One person had recently received a Positive Behaviour Support (PBS) plan from a Learning Disability Nursing Team. However, the provider had not ensured the plan was fully embedded into practice or updated the ‘person plan’ to ensure risks were managed. Recommended monitoring tools, including Antecedent-Behaviour-Consequence (ABC) recording, had not been consistently implemented and there was a lack of clarity regarding responsibilities for reviewing and analysing information collected. As a result, the provider could not demonstrate behavioural trends were being effectively mitigated or monitored, that interventions were being evaluated, or that care and support strategies were being adapted in response to emerging information. This reduced assurance people were receiving consistently effective, evidence-based support and increased the risk that opportunities to understand, prevent or reduce behaviours of concern could be missed.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Partnership working and communication across the Shared Lives scheme and the wider health and social care systems were not always effective. There was a disjointed approach to roles, responsibilities and accountability between teams involved in supporting people, which meant important information was not always identified, shared or acted upon in a timely way.

Staff and Shared Lives carers did not consistently demonstrate a clear understanding of who was responsible for specific aspects of people's care and support, increasing the risk of delays in responding to changing needs, risks or safeguarding concerns.

Leaders were unable to demonstrate consistent collective oversight of people's journeys through the service, which reduced assurance that emerging concerns would be recognised and escalated promptly. As a result, people were exposed to the risk of fragmented support and inconsistent decision-making. Improvements were required to strengthen multi-agency working, clarify responsibilities and establish more effective systems for communication, information sharing and joint oversight to ensure people received coordinated, safe and person-centred care.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Systems to monitor, review and improve outcomes for people supported through the Shared Lives scheme were not consistently effective. Reviews of people's care and support arrangements focused primarily on current placements and immediate needs, but did not always evidence meaningful consideration of longer-term progression, aspirations, independence or personal goals. As a result, opportunities to support people to develop new skills, increase their autonomy, strengthen community connections or achieve outcomes that were important to them were sometimes missed.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.

The provider's arrangements for obtaining and recording consent to care and treatment were ineffective. People's mental capacity to make specific decisions had not always been assessed when concerns regarding their ability to consent had been identified by either Shared Lives staff or Shared Lives carers. Where people lacked capacity, there was insufficient evidence to demonstrate decisions had been made in accordance with the principles of the Mental Capacity Act 2005, including consideration of the least restrictive option and involvement of those important to the person where appropriate.

Shared Lives carers and Shared Lives staff had completed MCA in Shared Lives training, However Shared Lives carers told us they had not been involved in assessments of people's mental capacity and had not received support necessary to enable them to understand or contribute effectively to capacity assessments and best-interest decision-making processes.

This limited their ability to recognise when a person may require a capacity assessment or to ensure decisions were being made in line with legal requirements. One Shared Lives carer told us, "I didn't know about the assessments. We have a person we support who requires a lot of support in their best interests." This demonstrated a lack of understanding of the Mental Capacity Act 2005 and raised concerns regarding the oversight and implementation of consent processes within the service.

Care records lacked clear information regarding people's capacity to make decisions and the support they required to do so.