Bristol City Council Shared Lives

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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment 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. The service was in breach of a legal regulation relating to safe care and treatment.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Incidents and lessons learned were not always well documented to evidence learning, actions taken, and embed good practice. Actions taken in response to incidents were not always clearly documented. For example, we found follow-up discussions and actions recorded in case notes rather than within incident records, limiting oversight and opportunities to identify learning. We identified a delay in an incident being referred to the local authority safeguarding team and notified to the CQC. We raised this with the registered manager, who told us this was an oversight. Staff told us learning was discussed during meetings; however, this was not well recorded. Despite this shortfall, the provider demonstrated aspects of a positive safety culture. Staff and shared lives carers we spoke to demonstrated an understanding of their responsibilities to record incidents and monitor people’s safety. They spoke positively about communication within the service and told us regular meetings supported the sharing of information. Shared lives carers told us they had regular opportunities to discuss their experiences of providing support. A shared lives carer said, “We have meetings, people share their experiences.” A staff member said, “Communication is really good.” People and their relatives told us they felt able to raise concerns with the provider. A relative said, “I’ve no concerns.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. When people received support from different services, the provider helped to maintain continuity of care. The service supported people to move into shared lives from family homes and fostering arrangements. We heard positive examples of how transitions were planned and supported when people moved between shared lives carers or when their shared lives support ended. The provider had procedures to support staff to work alongside other professionals to match and introduce people to potential shared lives carers. The registered manager also told us how the service worked with local day service providers and other professionals to identify daytime opportunities for people. People’s care records included a hospital passport, which provided key information about their care and support needs and the role of their shared lives carer in the event of an emergency. Professionals told us they experienced good communication and positive working relationships with the service, which supported continuity of care for people. A professional said, “I have found that management have always been easy to reach, and it always feels like we’re on the same team, advocating for the people we both support.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. People and their relatives told us they felt safe while being supported by the service. A relative said, “Yes, never had any concerns.” The provider had systems to identify and investigate potential safeguarding concerns. Despite some shortfalls in the timely reporting of incidents, the registered manager shared examples of how the service responded to concerns, including actions taken to increase monitoring and help keep people safe. Staff and shared lives carers had completed safeguarding training and understood their responsibilities to report concerns. The provider had an appropriate safeguarding policy, which provided clear guidance on how to safeguard people from abuse. The registered manager and staff had developed positive relationships with people, their shared lives carers, and others involved in their support. These relationships helped staff monitor people's wellbeing, identify concerns, and help keep people safe. A professional said, “I’ve been really impressed with how well management have spotted and addressed any potential issue and I feel very comfortable that the people in their care are safe.”

People can only be deprived of their liberty to receive care and treatment where there is appropriate legal authority in place. Shared lives is a community-based social care arrangement where people receive care and support within a shared lives carer's home or through community support. Where restrictions amounted to a deprivation of liberty, appropriate authorisation had been obtained through the Court of Protection. These authorisations were monitored and kept under regular review to ensure they remained appropriate.

The provider did not always work well with people to understand and manage risks. The provider did not always effectively assess and manage risks to people. For example, risk assessments relating to people’s epilepsy varied, and some were not sufficiently detailed or up to date, lacking information about the seizures people experienced and monitoring arrangements. Where people displayed specific behaviours, these needs were not well documented and lacked clear written guidance. The service did not have a positive behaviour support (PBS) policy to guide staff and shared lives carers on best practice in this area. We found PBS plans were either not in place or had not been reviewed. Where people had been assessed by a healthcare professional, this information was not always referenced or integrated into people’s support plans. This meant shared lives carers did not always have access to complete, up-to-date and consistent written information. Records showed, and the registered manager confirmed, shared lives carers had not completed training in epilepsy, diabetes or positive behaviour support. This meant we could not be assured they had the up-to-date skills and knowledge needed to support people safely.

The registered manager and staff acknowledged improvements to people's risk assessments were needed and told us they would take action. Despite these shortfalls, shared lives carers and staff knew people well and demonstrated and understanding of people’s risks. There was a positive culture of risk taking within the service, with people encouraged to pursue their interests and travel independently in the local community. For example, staff told us about a person who was supported to walk independently to a local social group using a GPS device, enabling them to maintain contact with their shared lives carers if needed.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Staff assessed shared lives carers’ homes during the initial assessment and through regular monitoring visits, which included an annual health and safety check. These checks considered the suitability of the home, including fire, gas and electrical safety. People and their relatives told us homes were safe, and people had their own space and access to shared communal areas. A relative said, “very well maintained.”

The provider did not always make sure staff received effective training and development opportunities.We found shared lives carers had not undertaken training to meet the specific needs of people using the service, such as training in epilepsy, diabetes, and positive behaviour support. Following the assessment, the provider told us they would conduct a full training analysis to ensure all training needs were identified and met. The provider had not always fully explored and documented gaps in staff employment histories and staff inductions were not always well documented. The registered manager told us they would improve recruitment and induction records. Despite these shortfalls, shared lives carers had completed mandatory training and staff told us they completed an induction before working in the service. A staff member said, “Induction is incredibly thorough, took me weeks to complete. In this job I have been guided.”

The provider made sure there were enough skilled and experienced staff and had systems to support safe recruitment and assess individuals’ suitability before they began providing support. These included criminal record checks to help ensure individuals were suitable for their roles. There was a thorough process for recruiting shared lives carers, which included an in-depth assessment and a range of checks. Prospective carers were required to be approved by a panel, including a range of professionals, some of whom were independent of the provider.People were supported by a team of dedicated staff and shared lives carers. Staff and shared lives carers told us they felt well supported in their roles and received regular supervision. The service organised coffee mornings where shared lives carers met with other carers, shared their experiences and discussed topics including internet safety, positive risk-taking and the Mental Capacity Act (MCA). Shared lives carers told us staff were responsive and out-of-hours support was available when needed. A shared lives carer said, “I feel supported by them all. They’ve gone above and beyond.” A staff member said, “[Registered manager] listens, she is happy to discuss things with us, always available.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.Monitoring visits included checks on the hygiene and cleanliness of shared lives carers’ homes and discussions about infection prevention and control. Shared lives carers confirmed they had completed training and discussed their responsibilities during monitoring visits. People were encouraged to take part in household tasks, such as cleaning their bedroom, to promote their independence. People and their relatives told us homes were kept clean and well maintained. A relative said, “Absolutely spotless.”

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning. Medicines were not always managed safely in line with national guidance. Support plans did not always contain sufficient information regarding PRN ‘as required’ medicines, in line with the provider’s procedure. For example, where a person was prescribed PRN medicines to support behaviour, there was a lack of clear guidance on when the medicine should be given. Where people managed aspects of their own medicines or were prescribed anticoagulants, we found the associated risks had not been assessed. Where a person received their medicines covertly, not all required steps had been completed and documented in line with national guidance. This included reviewing the covert administration arrangements, making decisions specific to each medicine, and obtaining guidance from a pharmacist. This meant we could not be assured the arrangement remained in the person's best interests or shared lives carers had sufficient information to administer medicines safely. Checks on medicines were completed during monitoring visits. However, records of these checks were not always detailed and were not always completed at regular intervals. The registered manager told us this had been identified as an area for improvement. During the assessment the provider took action to make improvements. Despite the shortfalls identified, shared lives carers had completed medicines training, and their competency had been assessed. People and their relatives told us they were satisfied with the support they received with medicines. A person said, “Yeah, no problem, I show my carer and take them.”