Leicester City Council Shared Lives Service

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

This means we looked for evidence that people were protected from abuse and avoidable harm. At our last rated inspection we rated this key question Good. At this inspection the rating has changed to Requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

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.

Lessons were not always learnt to continually identify and embed good practice.

Systems to monitor safety concerns and promote learning from incidents were continuing to develop. The registered manager had begun to strengthen oversight processes; however, reviews were not always completed in a timely manner. This meant opportunities to identify themes, trends and areas for improvement were sometimes missed.

Whilst some action was generally taken following incidents, learning was not always consistently recorded, fed back to Shared Lives carers and staff, or used to inform wider service improvements. Reviews of people's care plans following incidents were not always undertaken promptly to ensure changes in needs, risks and support arrangements were reflected. Further embedding of these processes would support a stronger learning culture and help ensure lessons learned were consistently used to improve people's safety and experiences.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Shared Lives staff and Shared Lives carers had completed safeguarding training and were able to describe their responsibilities for recognising and reporting abuse, neglect and poor practice. They understood the importance of reporting concerns to relevant agencies to help keep people safe.However, weaknesses remained in the provider's oversight of safeguarding and protective legal frameworks

Shared Lives carers and Shared Lives staff had not recognised and recorded all of the restrictions people were subject to and ensured applications were made. This meant people were at risk of being subject to ongoing restrictions without the appropriate legal safeguards being in place to protect their rights, ensure decisions were proportionate and necessary, and provide independent oversight of arrangements affecting their freedom. This exposed people to the risk of unlawful restrictions and reduced assurance that safeguarding arrangements were operating effectively to protect people's rights, wellbeing and safety

The provider did not work well with people to understand and manage risks.

The provider's arrangements for involving people in the assessment and management of risk were ineffective. We found widespread, insufficient risk mitigation for people with known identified risks, including risks to manage people’s safety when going out on their own and managing risks when presenting with distressed behaviours, placing people at risk of receiving unsafe care and support. Risk assessments were not always robust, person-centred or reflective of people's current needs and circumstances. In addition, there was limited evidence people, or those important to them, had been meaningfully involved in decisions about how risks should be managed in a way that balanced their safety, independence and preferences.

Records were not consistently reviewed or updated when people's needs changed. For example, 1 person's risk assessment had been completed in 2019 and had not been reviewed despite their needs having changed significantly over time. This meant Shared Lives carers were relying on outdated information which did not accurately reflect the person's current risks or the support required to keep them safe.

Systems were in place to assess and manage environmental risks within Shared Lives households. In line with the provider's policies and procedures, comprehensive assessments were completed before Shared Lives carers were approved by an independent approval panel. These assessments considered the suitability and safety of the home environment to ensure it could meet people's needs. Appropriate checks were undertaken, including health and safety assessments, insurance verification and other relevant compliance requirements

While assessments were completed for Shared Lives carers’ homes, we found risks associated with pets living in the household had not always been fully considered to ensure people were protected from potential harm. For example, assessments did not consistently identify and mitigate risks relating to the behaviour, size, or access of pets within the home, nor did they always demonstrate how individual people's needs, vulnerabilities or anxieties had been taken into account. This meant the provider was not always assured some of the home environment had been considered to promote people’s safety and wellbeing.

Arrangements to ensure Shared Lives carers had the skills, knowledge and competencies required to provide safe care were not consistently effective. Competency assessments for the administration of medicines had not been completed, which meant the provider could not be assured Shared Lives carers were administering medicines safely and in line with best practice.

Training records for Shared Lives carers showed gaps in essential learning, including learning disability and autism training, limiting carers’ understanding of the specific needs and experiences of some people using the service. A manager within the service told us, “We have sourced a new training platform for the Shared Lives carers to use, this is available to them now. We have a schedule set up for carers to complete training and it is on the list for them to do over the coming months, alongside the other e-learning.”However, Shared Lives staff had received this training, alongside the providers mandatory training.

We also found some Shared Lives carers did not have a sufficient understanding of the scheme’s policies and procedures, including the reporting, recording and management of medicines errors, In addition, knowledge of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) was inconsistent, and some Shared Lives carers were unable to clearly demonstrate how they would support people to make informed decisions, assess capacity where appropriate, or recognise when restrictions on a person’s liberty may require legal authorisation.

The provider operated a structured recruitment and approval process for Shared Lives carers, which included comprehensive assessments, background checks, references, home safety assessments and scrutiny through a formal panel approval process. This helped to ensure only suitable individuals were approved to provide support and reduced the risk of unsuitable Shared Lives carers being recruited into the scheme.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Shared Lives Staff did not involve people in planning.

The provider's arrangements for medicines optimisation were ineffective and did not ensure people received safe, person-centred support with their medicines. We found care plans relating to medicines were not consistently in place, meaning there was insufficient guidance available to support Shared Lives carers to safely manage and administer medicines in line with people's assessed needs.

People's mental capacity to make decisions about their medicines had not always been assessed. Records did not consistently demonstrate people's preferences regarding how they wished to receive support with their medicines, or whether this had been explored. This meant the provider could not be assured people's rights, choices and independence were being promoted and respected.

Although Shared Lives carers had completed training in the safe administration of medicines, they had not undergone competency assessments to verify their knowledge, skills and ability to safely apply this training in practice. As a result, the provider could not be assured Shared Lives carers were competent to manage medicines safely and in accordance with best practice.

Medicines management practices were not in line with the provider's own policy. Where people were prescribed medicines to be taken on an 'as required' (PRN) basis, PRN protocols were not in place to provide clear guidance on the circumstances in which these medicines should be administered. This increased the risk of inconsistent decision-making and unsafe administration practices. In addition it did not assist Shared Lives staff to review records to ensure people the learning disability and autistic people were not over medicated (STOMP).

In addition, Shared Lives carers did not demonstrate a consistent understanding of the procedure to follow in the event of a medicines error, including how incidents should be reported, escalated and managed. This meant the provider could not be assured medicines were being managed safely, risks associated with medicines were appropriately mitigated, or that people were receiving support in line with their individual needs and preferences, placing people at risk of avoidable harm.