Archived: Living Glory Social Care

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• 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 changed to inadequate.

This meant services were not planned or delivered in ways that met people’s needs.

The service was in breach of legal regulations in relation to receiving and acting on complaints.

This service scored 36 (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 make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

We found records did not always provide staff with detailed guidance about people’s individual needs, or how to support them. We found continuing problems with care and support plans not being person- centred or fully reflective of people and their relatives’ involvement in care planning. Some people and relatives had concerns in relation to the service which had been raised with the provider, but no actions had been taken. One person, and a relative told us they had not had a reassessment completed since their care from the provider started, years earlier. The provider’s systems showed both individuals having had assessments carried out recently, but they were unable to provide the completed paperwork to evidence this.

The staff, who carried out assessments and wrote support plans and risk assessments, had not received appropriate training and support to be able to complete person- centred support plans.

We were told no people using the service were subject to any forms of restrictions or restraint; however, 1 relative told us a staff member had used restraint with their loved one. This was not documented in the care and support plan.

There were significant shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not 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 attended people in their own homes.

We saw that care records maintained for people required improvements, to ensure they were more robust and reflective of what support took place. For example, 1 person required de-escalation techniques to be used for certain behaviours. However, this was not recorded in their care plans, and instances where de-escalation had been used were not recorded.

Some people and relatives told us they felt the service did not work with them when they were required to do so. One relative told us they had requested a regular worker for their loved one due to them refusing care because they did not know the staff attending, but this had not happened.

Records demonstrated that people mostly received the same staff which provided a continuity of care and meant that people and staff built good, supportive relationships where trust was developed.

The provider did not always 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 staff, 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 did not always meet the Accessible Information Standard. People's communication needs were not always assessed. This did not enable effective communication between staff and people using the service.

The provider failed to ensure staff had clear information about people's communication needs. Records relating to people’s communication needs and preferences lacked detail. For example, 1 person was unable to effectively verbally communicate with us due to cognitive impairment. We found they did not have a communication care plan which informed staff how to clearly and effectively communicate with them. Most relatives told us that staff knew people well and understood what they wanted.

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

The provider had a complaints policy; however, we found that complaints were not reliably recorded. Where complaints about the service had been recorded, the provider was unable to evidence investigations had taken place, and follow up actions had not been completed. Where complaints had been received, the provider was unable to evidence they had given updates, or outcomes, to the complainant.

Whilst feedback forms were sent to people, feedback received on the service was not analysed or reviewed. This meant we could not be assured people’s feedback, and views were listened to or acted upon.

People and their relatives told us they knew how to make complaints telling us they would call the provider but reported were unable to speak to the manager. People and relatives told us they had made complaints about the service, but the provider had not communicated with them with updates or outcomes. One relative told us, “I’ve stopped complaining to the office because they don’t listen or care.”

Another relative told us they had been trying to reduce the number of different staff attending their relative as it was having an impact on their confidence and they were now refusing personal care. The person was reluctant to accept personal care and, their relative explained, it took time to build trust in staff and feel comfortable with allowing them to help.

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

People were not regularly supported to access healthcare professionals, attend appointments and request emergency healthcare as needed.

Where people may lack capacity, the registered manager was unable to clearly describe the approach they would take to assessing the ability of people to make decisions about their care. This meant opportunities could be missed to support people, enabling them to have a say in their care and treatment.

One person told us they had missed medical appointments due to staff turning up over 1 hour late for a morning call. A relative told us, that due to regular late care calls, they sometimes cancel the visits and provide the care themselves, when the person has an appointment to attend.

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.

We found continuing problems with the provider failing to recognise the inequalities the people they supported may face. 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, where people were at risk of absconding when outside or 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.

Relatives of those who were supported to access the community and participate in hobbies and interests were not positive about the staff. One relative told us, “They [care staff] ignore [name] when they’re here and when they take [name] out.”

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 people who were at different stages of this journey. One relative we spoke with told us, “[Name] is nearly at the end-of-life stage. They [care staff] are careful and gentle with her. There is an end-of-life plan in place.” The relative informed us there had been no reassessment of the person’s care needs completed by the provider. However, the provider told us they were not currently providing end-of-life care to anyone. This means the provider had not implemented the end-of-life care and support plan the staff were following.

For people using the service, whose support plans we looked at, there was no 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 to not receive active treatment in the event their heart should stop, this was not recorded in people’s support plans, and the provider was unable to evidence how they, or the staff, could access a copy of this document, or where in people’s homes the document was kept.