Living Glory Social Care

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

Effective – 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 assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service remained in breach of 1 legal regulation in relation to gaining people’s consent to their care.

This service scored 46 (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.

Whilst most people or their relatives told us they had been involved in the assessment of needs, we found support was not always delivered in line with current standards. We continued to find that people's care and support did not always achieve effective outcomes.

Plans for Positive Behaviour Support (PBS) were not sufficiently detailed to guide staff. This is a document which helps staff understand and support people appropriately where their behaviour may challenge. A PBS plan provides care staff with a step-by-step guide to making sure the person not only has an excellent quality of life but also enables care staff to identify when they need to intervene to prevent or reduce the likelihood of an episode of challenging or distressed behaviour.

The provider failed to review people's support plans to ensure these reflected people's current needs, ensuring the support staff were providing was as they required. For example, for 1 person who now had a hoist in their home this had not been reflected in their support plan or risk assessments.

Where people expressed themselves with distressed behaviours there continued to be a lack of guidance for staff to follow in relation to how to respond to each type of behaviour they displayed. This meant the approach taken not be effective in all situations leading to distressed behaviours lasting for much longer than necessary or placing people at extended risk due to ineffective techniques being applied leading to the need to use methods of restraint.

This meant that support plans were not reflective of the people as individuals, to demonstrate a holistic, person-centered approach.

The provider did not robustly plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The provider continued to fail to ensure people’s changing needs were consistently assessed and support plans fully reflected all of the person’s needs, including health, personal care, emotional support, social interests and activities and cultural, religious and spiritual needs.

Whilst many people and their relatives told us they had been asked for feedback on their care, the provider’s processes for ensuring people were consistently involved in their care planning and the information recorded in support plans was accurate, were not effective. Important information about people’s care and support needs had been omitted from some support plans. Some people’s support plans did not reflect national and best practice guidance in relation to support with specific health care needs, such as epilepsy, restraint, home oxygen therapy and diabetes.

For people whose support plans indicated they required enhanced monitoring in relation to their skin integrity, there was a lack of evidence this had been consistently provided. People's care and support did not always achieve effective outcomes.

Records and staff rotas demonstrated that people did not consistently receive their care calls for the correct length of time or at the correct time to meet their support needs. Some people and relatives told us they experienced late and shortened calls. However, many people told us they were happy with the call times including the length of time staff were there. The provider failed to operate a robust system to monitor for short, late or missed calls. They told us that if a staff member had not attended, the person would call them. However, 1 person told us that on at least 2 occasions in recent months staff had failed to turn up leaving them without food, drinks or support with personal care. This did not reflect a robust or effective system as staff delegated to monitor late and missed calls, particularly at the weekend, had failed to do so effectively. This placed people at risk.

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.

The lack of robust systems and documentation meant that information available to share with other services and health professionals was not comprehensive. For example, we found for 1 person who was a high risk of developing pressure sores and needed support with pressure relief, their support plan did not include reference to their skin condition or how this was to be monitored. This meant in the event of a deterioration of the skin condition, the information available to help others understand how, when and why the skin had deteriorated was not available. We also found incidents of distressed behaviours leading to the use of approved restraint techniques were not consistently recorded to allow clear information to be shared and analysed to improve the effectiveness of the guidance for staff to follow. Effective treatment could be delayed due to this lack of information when transferring between services.

We were told by staff and the provider that team meetings took place regularly. Staff told us that often supervisions were in group settings. This meant there were missed opportunities where areas of concern or positive feedback could be discussed on an individual basis. However, staff told us they felt supported by the registered manager.

There was positive feedback overall from people and relatives about the service. One person told us, “They [care staff] are kind and caring. They treat me with respect. They laugh and joke with me. They talk and listen to me and when they give me a wash, they cover me up.”

All people and their relatives told us they knew who the manager was. However, some appeared to be unaware that the registered manager was female and not male as they had only met with male ‘managers’. One person told us, “[Male name] is the manager. I have spoken to him. On weekdays, it is easy to contact the office, on weekends it’s not so easy.” Other people and relatives told us, they knew who the manager was and had spoken with them.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

The provider's system and processes to ensure care records and risk assessments reflected the support needs of people were ineffective. This meant staff did not always have the correct guidance on how to support people appropriately to manage their health and wellbeing, whilst encouraging independence.

Records demonstrated the office staff had completed part 1 of the Oliver McGowan training. Whilst we saw care staff had received online training to support people with learning disabilities, the Tier 2 Oliver McGowan training had not been completed by the care team, who supported people. The Oliver McGowan Mandatory Training on Learning Disability and Autism (Oliver's Training) aims to provide the social care and health workforce with the right skills and knowledge to provide safe, compassionate, and informed care to autistic people and people with a learning disability. The provider had not assessed the learning and competency of how staff applied this learning when supporting people. The lack of competency assessments was not in line with the guidance which has been relevant to providers since 2022. This states ‘all staff’ should receive training in how to interact appropriately with people with a learning disability at a level appropriate to their role. Also, staff must receive appropriate supervision in their role to ensure they demonstrate and maintain competence in understanding the needs of people with a learning disability and autistic people, including knowing how to support them in the best way.

Staff could tell us how they would contact the office staff to access additional support from healthcare professionals to help people manage their health, should this be required. However, records demonstrated that staff had not received training to support people with all their specific health or lifelong conditions known to the provider, such as home oxygen therapy and using nebulisers.

People told us they were able to make choices and decisions, but not all people were involved in reviewing or consulted about their health and well-being needs.

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.

Health action plans had not been developed for people with learning disabilities or autistic people. This meant they could not evidence how people’s outcomes would be improved.

Compliments and complaints about the service were recorded. However, the analysis of these did not always result in improvements in people’s care. For example, people who had raised missed calls as a concern had continued to experience these, due to the need for provider oversight to be improved to prevent the recurrence.

We saw supervisions and appraisals had taken place. However, a large number of staff had not received supervisions and those that had were not always provided with an opportunity to discuss any concerns they may have about people’s care or how it could be improved.

Although the provider carried out investigations when incidents occurred, lessons had not been learnt. This meant changes to drive improvements for positive outcomes for people had not been implemented. Such lessons could be used to ensure people using the service were safe and received appropriate care and support.

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

The provider was still not compliant with the Mental Capacity Act (MCA) 2005. The provider had not consistently obtained evidence that those making decisions on people’s behalf had the necessary legal authority to do so. This meant the provider could not assure themselves people were being supported in the least restrictive way and decisions were being made on their behalf appropriately.

We remained concerned in relation to the registered manager’s and staff members’ understanding and application of the MCA. They were not adhering to current requirements in relation to MCA, deprivation of liberty and best interest decisions. For example, where people over the age of 18 lacked capacity, the MCA and best interests were not applied to each specific decision; this was a blanket approach to all aspects of their support needs. This did not reflect people’s rights under the MCA.

There was a lack of recorded evidence that people using the service consented to their care and the sharing of information on their behalf.

The provider’s training matrix indicated that most staff had received training in relation to consent, MCA and deprivation of liberty. Staff members we spoke with could tell us what applying this training meant for their care of people using the service.

All the people and relatives we spoke with told us that staff gained consent prior to supporting them.