Live in Care

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 remained good.

This meant people were safe and protected from avoidable harm.

This service scored 66 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Safety incidents were accurately recorded, thoroughly investigated and appropriate action taken. These were reviewed to consider themes and trends and used to inform future training plans.

The registered manager told us they had clear recording of accidents and incidents and a matrix with an analysis so that they can see patterns and trends. They explained they tracked progress of where they were on all those matrixes, for example safeguarding, complaints, accident and incidents. Inspection of these documents showed they carried out lesson learnt evaluations identifying improvements and shared these with the team.

The registered manager provided us with examples of learning they have implemented in the service, for example, improving their documentation in relation to Closed Circuit Television (CCTV) usage in people’s homes and supporting people with positive risk-taking choices.

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.

Information was shared with people, staff and partners to ensure people’s needs were well-known and understood by all. Records showed how people had been supported to engage in the planning process.

The registered manager told us each person had a client emergency pack in place which included an overview of their health conditions, medicines and emergency contacts to be used specifically for hospital transfers.

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. The provider shared concerns quickly and appropriately.

Safeguarding procedures were in place and the service had made appropriate submissions to the local authority and to CQC as required. The registered manager told us they learnt from every safeguarding referral. The learning was shared with the staff member involved, with the person and the wider team. They also provided examples of actions they have taken in relation to safeguarding concerns.

People and their relatives told us they felt safe while supported by the service. Comments included; “They’re very, very good for me, excellent! The company is so supportive – and caring.” and “We had quite lot of different people last year, and all but one were really good. The exception was replaced very quickly. “[Loved one] has substantial care needs, and communication issues, so is hugely dependent on them to understand his needs and to respond. So, yes, [loved one] is very safe with them.”

We received very positive feedback from one health and social care professional about their engagement with the service following a safeguarding referral the service made to the local authority. They told us; “Live in Care service understands and embrace ‘working together to safeguards vulnerable adults.’ Live in Care service engages well with their client, understands their needs and promote the client’s independence, autonomy and thereby empowering their client.”

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. However, we identified some areas of record keeping which required improvement.

Although risks relating to aspects of people’s care were individually assessed and mitigated against, some improvements were needed to ensure all risk assessments consistently provided carers with the same level of information in relation to mitigation. For example, in relation to the risk of choking. We discussed with the registered manager about strengthening and clarifying the information given to staff related to risks such as some medical conditions, falls and moving and handling. The registered manager provided assurance that all care documentation we referred to had been updated following our feedback.

The service supported positive risk taking and enabled people to be as independent as possible. Staff supported people to understand risks and how to remain safe. Although the management team reviewed people’s care notes daily, it had not been identified that, where a person opted to take a positive risk, carers did not consistently document the process of advising the individual about the associated risks to support them to make an informed decision, as required by their risk assessment.

Where people were at risk of displaying distressed behaviours, information was provided to staff in relation to how they should support people safely and to remain safe. Staff were aware of people's risks and were positive about the information available in the care documentation.

A health and social care professional told us; “I was impressed with their [office team] knowledge of all their clients and their professionalism.”

People and their relatives were happy with the support they received from staff to manage any risk related to their health and care. Comments included; “They know when to just be there ‘in case’, but to be active if there’s any risk.” and, "It'sbecome a partnership. I still do what I can for myself, but she does have to gently push me along to get to breakfast!”

The registered manager told us, “We're also talking about potential risks, their [people’s] understanding how we limit them [risks] and what their preferences are around that. And that's reviewed regularly as well as the care plan.”

A health and care professional working with the service told us, “I found Live in Care service to be knowledgeable of the risk to clients and the service/staff’s role in supporting managing the risks by working collaboratively with other services and agents. I found the Live in Care service pro-active in the care management of the clients they serve."

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Environmental risks related to people’s homes were assessed and staff were provided with information in relation to these.People and their relatives were content with the support they received from staff to keep their homes safe. Comments included; “They look after things very well. They clean up and keep everything nice.” and “They keep the place nice and tidy – actually, it’s always immaculate. I think they take pride in it, and, of course, it’s their home too.”

The registered manager provided examples of working with local fire services to support people keep their homes safe; “We've got a partnership with the home safety checks. That normally happens from reviews and assessments.” They also created Personal Emergency Evacuation Plans (PEEP) for each person to provide staff with information about how to support them in the event of a fire.

Where people had equipment used to aid with moving and handling tasks, risk assessments contained robust information in relation to safety checks staff should carry out before using the equipment.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. However, some improvements were needed in relation to records of staff training, systems of checking staff competencies and safe recruitment.

The management team ensured staff completed the mandatory training as identified by the provider. We saw evidence that some specific training to meet people's individual needs was provided to staff. However, improvements were needed in record keeping so the service can clearly evidence if staff supporting the specific person had received training on how to support their individual needs. For example, checks of staff competencies of using the moving and handling equipment and catheter awareness.

Staff were receiving a yearly visit from office staff, aiming to observe their practice, for example in relation to moving and handling and medicines administration. However, records did not clearly and robustly indicate what exact practices were observed in relation to these tasks, or if no observation of practice took place, what professional conversation was held to assess staff’s competency in line with recommended national evidence – based guidance and the provider’s policy.

Staff we spoke with were positive about the training required by the provider. They were offered periodical supervisions and a yearly appraisal. They praised the management team for their supportiveness. The management team were also supporting staff and people through weekly phone calls.

People and their relatives did not share any concerns in relation to staff training and knowledge. Comments were positive and included; “They’re all so competent and careful.” and “So far, there’s nothing she [staff member] can’t do.”

The registered manager told us that there was a shared ethos across the service, reflected in all aspects of their recruitment practices. While their carers may have been self-employed once registered, they still underwent a rigorous recruitment process.

The service had a recruitment policy in place that aligned with regulatory requirements, covering both the onboarding of carers and the employment of office staff. However, safe recruitment practices were not always followed in line with the provider’s own policy. We signposted the provider to review their policy in relation to processes followed for recruiting staff who were not involved in the delivery of the regulated activity during the probation period.

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.

People were protected from the risk of infection. Staff received training and there were good supplies of Personal Protective Equipment (PPE). Staff confirmed they were asked by the office staff on a regular basis if they had enough PPE available.

People and their relatives confirmed that staff were using PPE. Comments included; "Yes, she gets her supplies from Live in Care. Gloves and aprons always, a mask only if one or other of us has an infection.” and “When they’re doing personal care they wear gloves and aprons. Live in Care supply more when they start to run out.”

Medicine management systems were in place however, some improvements were required to ensure people's medicines were managed safely. Staff involved people in planning, including when changes happened.

Medicine administration records (MAR) were in place. These were written by the management team and were detailed and accurate, however, a countersigning process was not in place as per best practice guidance.

Protocols for “when required” (PRN) medicines were in place providing staff with the necessary information; however, some improvements were needed to ensure these were updated when people’s speech and language therapy (SALT) guidance related to textured modified food and thickened fluid changed. Staff had access to records which provided them with up-to-date information in relation to updated guidance for people, such as SALT plans.

Risk assessments for some types of anticoagulant medicines required more robust information such as review frequency, interaction with other medicines or foods/drinks and risk related to falls. Records showed that people on these types of anticoagulants were receiving reviews from medical professionals. Staff knew what to do if a person on anticoagulant medicines sustained a head injury

Care plans did not always contain personalised information about how people liked to take their medicines. Staff talked us through how they supportted people to have their medicines safely.

Staff received medicines training, however competency to administer medicines safely and through different routes was not always assessed when starting to work for the service as per the provider's policy and best practice recommendation. Records did not robustly indicate how periodical observations of practice were carried out, for example what areas of administration were observed or what practice conversations took place.

The provider was aware of the requirement to have risk assessments in place for flammable creams, however the electronic MAR system had identified some creams/ointments as flammable which had not been robustly risk assessed as per best practice guidance. We discussed this with the registered manager who told us that risk assessments in this area will be improved. They provided assurances that a detailed internal action plan, including all medicines shortfalls we identified, had been developed and was being implemented, with progress reviewed regularly by the leadership team.

The service had a medicines policy in place and the registered manager demonstrated to us they were knowledgeable about the legal framework and best practice national guidance for medicines management. Systems were in place to monitor administration and medicine errors were recorded and investigated and actions taken were evidenced. Stock checks were conducted during staff handovers.

People received their medicines as prescribed. Comments from people and relatives included; “The care teams manage the meds. I check from time to time, but their records are good, and we never seem to run out.” and “I can’t do it safely myself now, so she [staff] manages the dosette boxes and ensures I get my meds on time.”