Living Glory Social Care

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant people’s needs were not always met.

The service remained in breach of 1 legal regulation in relation to providing person centred-care at the service.

This service scored 43 (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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

At the last assessment we found records did not always provide staff with detailed guidance about people’s individual needs. Although at this assessment work had commenced on improving support plans to make them more person centred, and to more fully involve people and their relatives, we found at this assessment further improvement was still required. Some relatives told us they had not been involved or asked for their feedback. However, other relatives told us they received calls from staff if something happened to their loved one.

Staff members who had been delegated to carry out assessments, write support plans and risk assessments had not received appropriate training and support to be able to complete person centred support plans.

Some people’s care records lacked detail. For example, where people’s support plans referred to approved restraint techniques, guidance on which techniques should be applied for each type of distressed behaviour was not clear to enable staff to support people safely. When we spoke to the registered manager about this, they told us they would improve the guidance for staff to refer to.

People’s support plans and risk assessments did not demonstrate the least restrictive option had been consistently considered prior to any use of restraint. There was no evidence of what had worked well, what was less effective or what the outcome had been when staff had responded to particular behaviours. This meant we could not be assured all options to mitigate the use of restraint had been taken.

Some people continued to tell us that care was not always responsive to their needs and the inconsistency of their call times supported this feedback. One person told us, “The strict time structure [of the calls] does not help with my condition.” Some people told us when they had requested changes to the times of calls, they were told there were no staff to support at different times. This feedback conflicted with the number of care staff members employed in comparison to the number of people using the service and did not demonstrate a person-centred approach.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

The provider failed to ensure support plans were detailed and reflective of people’s known health conditions and support needs. This posed a risk when people were moving between services, such as during hospital admissions, where clear, accurate information may be needed, including when the ambulance service attend people in their own homes.

We saw that where people received 24-hour support, handovers took place between shifts. However, the care records maintained for these people required improvements, to ensure they were more robust and reflective of what support took place. For example, for 1 person who required observations to take place throughout the night, there were no supporting records to demonstrate these took place. These checks were to ensure they were safe during the night. This lack of recording and monitoring had not been identified by the provider.

The provider’s training matrix indicated most staff had received training to support autistic people and people with a learning disability, to ensure they had the knowledge and ability to take appropriate action when supporting such people. Although staff had completed this training, 1 relative told us, “I feel staff should have better understanding and more training in autism as everyone is different.” Where staff had received training, the provider had failed to carry out any competency assessments, as per the legal guidance, to ensure staff applied their learning when supporting people.

Records demonstrated that overall people received the same staff which provided a continuity of care and meant that people and staff built good, supportive relationships where trust was developed. Relatives told us overall they felt the service worked with them when they were required to do so.

The provider did not supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Since 2016 all organisations that provide publicly funded adult social care are legally required to follow the Accessible Information Standard. The Accessible Information Standard tells organisations what they have to do to help ensure people with a disability or sensory loss, and in some circumstances, their carers, get information in a way they can understand it. It also says that people should get the support they need in relation to communication.

We found that the provider continued not to always meet the Accessible Information Standard. People's communication needs were not always assessed or met to enable effective communication between staff and people using the service. Although the provider had added on the front page of some of the support plans the following statement, ‘If you require this document in a different format or require a translator/interpreter please let us know. We can meet any communication need that you may have’, this had not been actioned for people who may not be able to read this statement and make the request.

The provider continued to fail in ensuring staff had clear information about people's communication needs and that they were able to be involved in making decisions. Records relating to people’s communication needs and preferences lacked detail. For example, 1 person was unable to effectively communicate their needs, wishes and feelings verbally. We found at this assessment they still did not have a communication care plan which informed staff how to recognise if the person was happy, sad or in pain. We found this was the case for other people using the service who were unable to communicate their needs and wishes verbally. Relatives told us that staff knew people well and understood what they wanted. However, in the event that regular staff were not able to carry out calls, the lack of information could result in staff failing to respond to a person’s needs or deterioration in heath.

People and relatives told us they had not been offered their support plans in an alternative format. For example, for a person receiving support who was unable to read English, their relatives continued to tell us alternative formats had not been offered or provided leading to them having to deal with the paperwork.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

We found the provider had implemented an up-to-date complaints policy and an improved system to receive and respond to complaints since our last assessment. However, complaints received did not always drive changes and improvements to prevent occurrences of the same things. For example, a person told us they had requested a change of care staff they had, but the manager told them they could not make this change for them. This is not a responsive approach and does not take into consideration people’s voice when making requests about who supports them. Another person told us how the response they received from the provider when complaining did not action the concern and it was not resolved. This approach does not foster an open and transparent culture where people using the service feel empowered to voice their concerns.

Whilst feedback forms were being regularly sent to people these were not available in appropriate formats to meet all people’s preferred communication methods or their abilities. This meant not all people were encouraged to provide feedback.

People and their relatives told us they knew how to make complaints telling us they would call the office. Most people and relatives told us they had no complaints about the service at this time. However, 1 person told us that out of hours it could be difficult to speak to someone.

The provider had maintained a record of the complaints they received about the service, and they told us they shared this information with staff members.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

People were supported to access healthcare professionals and appointments or receive emergency healthcare as needed. This included GP’s, opticians and other supporting professionals. However, some people were reliant on care staff escalating a deterioration in their health and recognising the need to access health services, on their behalf. We found there had been some improvements but there continued to be a shortfall in staff recognising the need to report such things to the management team.

Where young people lacked capacity, the provider had failed to use the appropriate competencies and tools to assess if they were able to make decisions about their own health needs. When we raised this with the provider, the registered manager was unable to clearly describe the approach taken to assessing the ability of young people to make decisions about their care. This meant opportunities had been missed to support young people, enabling them to have a say in their care and treatment.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

The provider failed to recognise the inequalities people they supported may face. These inequalities and people’s needs were not always considered. Although some people were supported to participate in the community and to go out on trips to places of interest, for some access was limited due to risks which had not been reviewed to help improve access to the community. For example, for some people who had previously been at risk of absconding when outside or people living with dementia or physical disabilities they were not supported to address and remove barriers ensuring they had equal opportunities to live a full and varied life. Reasonable adjustments for some people had not been fully considered or timely action taken to resolve known accessibility issues. This included a lack of steps taken to make everyday enjoyment of going outside more accessible and safer for people to enjoy outside spaces. Instead, at least 1 person was confined to their home for the majority of the time due to the provider not implementing positive risk management and accessing support in partnership with other health professionals to achieve a positive outcome.

Relatives of those who were supported to access the community and participate in hobbies and interests were very positive about the staff. One relative told us, “They [care staff] keep [name] entertained and they take her out.” Whilst another relative spoke about how the staff supported their loved one to go out for walks in the park, which they enjoyed.

People were not supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

At the time of the assessment the provider told us they were not supporting anyone on the end-of-life pathway, although there were many people who were at different stages of this journey. One relative we spoke with told us, “[Name] is at the end-of-life stage. They [care staff] are gentle with her. There is an end-of-life plan in place.” We were not provided with an end-of-life plan for this person so we could not be assured this was in place. Furthermore, the registered manager was not aware of anyone receiving end of life care which indicated an end-of-life support plan had not been implemented and their care was not being overseen by them.

For many people using the service whose support plans we looked at there was little evidence of advanced care planning for when they approached the end of life. Some people using the service were supported by loved ones and others by advocates. There were no records to demonstrate people, or their relatives/advocates had indicated they did not wish to discuss their end-of-life journey. There was no record of when this lack of information should be revisited with the person or their loved ones. This meant if end of life support was needed unexpectedly, something which was important to that person may not be actioned. This was of particular concern for those people who had specific cultural beliefs and wishes which staff would need to be aware at end of life.

Where people had made the decision not to receive active treatment in the event their heart should stop, this was not recorded in people’s support plans, but the provider told us this was accessible by staff on the electronic care management system and a copy was in people’s homes.