Living Ambitions Limited - Essex

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 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 service 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.

Staff were aware of the process for reporting concerns and uploading them to an electronic system. This enabled senior managers to oversee what was reported and manage the actions taken effectively. Accidents and incidents were shared in team meetings for future learning with staff.

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.

The registered manager told us how they worked jointly with external services such as the mental health team, the local authority and the occupational therapy service to ensure peoples identified care needs were referred to health professionals promptly.

Staff gave us examples of supporting people to transition into the service and understood how important it was to provide appropriate support.

Hospital passports were in place to ensure important information was shared when people were using hospital r community health services.

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.

People and relatives told us they felt safe with staff about the care delivered. A person told us, “I do feel safe here. I can buzz staff and they come quickly.” A relative said, “It’s a safe and suitable environment for [person]. There are good grounds, and they have a nice room.”

Staff had completed safeguarding training and understood how to monitor people for signs of abuse and how to escalate any concerns. A staff member told us, “We can raise a concern internally or straight to the local authority.” Another staff member said, “I would report to team leader or higher. There is a whistle blowing hotline we can use.”

The registered manager followed the correct processes and informed relevant parties of any concerns and the outcomes of these. They understood their legal responsibilities in relation to the submission of statutory notifications to the Care Quality Commission (CQC). The registered manager worked effectively and openly within the local authority safeguarding process.

The provider worked well with people to understand and manage risks. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. However, improvement was needed to support plans to ensure information was accurate and updated.

The provider had introduced an electronic care planning system to support care delivery. Some paper records, such as hospital passports, had been uploaded to the system but required review. These were updated immediately following feedback. Personal Emergency Evacuation Plans (PEEPs) were available both electronically and in paper form. Staff participated in fire and evacuation drills; however, in one service, we fed back more detailed follow-up was needed to address concerns identified during drills.

Risk assessments were completed to identify potential risks associated with people’s care and support, including eating and drinking, falls, accessing the community, epilepsy, and mobility. Support plans provided guidance for staff on how to support people safely. However, monitoring of these risks was not always robust. For example, in one service, seizure monitoring forms lacked sufficient detail about what the person was doing before the seizure, how they presented during the seizure, and their condition afterward. Detailed recording of seizures is essential to help healthcare professionals identify triggers and patterns for ongoing treatment and prevention.

We also noted inconsistencies in recording prescribed IDDSI diets within support plans. In one care plan, a person was recorded as requiring a Level 6 diet, while another section stated they were receiving a Level 7 normal diet. IDDSI (International Dysphagia Diet Standardisation Initiative) is a global framework that standardises terminology and definitions for food and drink textures for individuals with swallowing difficulties. Accurate recording is critical to ensure safety and consistency. However, it was noted staff were aware of current risks and knew people well.

One of the locations was looking into using a supplier of ready meals pre-prepared for people with prescribed diets to reduce risks to people. A tasting session which involved people using the service had been arranged.

We observed safe moving and handling practices in one location. A relative told us: “The staff are on top of the risks of [person] falling… there’s always someone in the (communal) room with [person] and they need that.”

The provider made sure equipment, facilities and technology supported the delivery of safe care.

Systems were in place to make sure checks on the environment were completed as required. Whilst we observed some issues with the environment senior staff were able to demonstrate these issues were actively being reported and followed up with the landlord.

People had access to equipment they needed to support their mobility and safety. People’s bedrooms were personalised, where we found a difference in 1 location the registered manager followed this up.

The registered manager told us more work was underway to clarify fire risk assessments in place by the Landlords.

The provider did not always make sure there were enough qualified, skilled and experienced staff.

Most relatives, people and staff told us there were enough staff to meet people’s needs. However, we did observe 1 service where due to a last-minute absence there was not enough staff for people to access the community if they chose this. For example, 1 person was asking for an up-to-date television magazine but as there was only 1 staff member on duty this was not possible so they were told they would get it another day. There did not appear to be any attempt to cover the shortage. When we viewed the providers planned verses delivered hours, we could see overall the hours for this location were being consistently covered. The registered manager told us staff had not followed recognised procedures for staff absences.

Some people who used the service required 1-to-1 support from staff to keep them safe. Staff were able to give us examples of how this was used. In the other services our observations confirmed there were enough staff to support people safely both inside and to access the community. We received mixed views from relatives in relation to staffing levels, however, this related to newly appointed staff not being as confident as regular staff.

Staff received training, which staff told us was mainly delivered online. Some staff reported they had not received practical manual handling training, only online modules. When asked how they learned to use equipment, responses varied: some staff said occupational therapists had demonstrated the equipment, while others said they were shown by colleagues or received practical training in house. The registered manager clarified senior staff had completed training to enable them to undertake competency assessments for staff using equipment.

Staff were recruited safely. There was evidence of references being sought prior to employment, criminal record checks completed, and confirmation of the right to work obtained. Overall, while systems were in place to manage risks and promote safety, improvements were needed in monitoring, documentation, and ensuring staff received practical training to maintain consistent safe practice.

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.

Comprehensive policies and procedures guided staff on the actions required to prevent unnecessary transmission of disease. Regular audits were undertaken, and staff had received appropriate training in infection prevention and control. A relative commented, “The communal lounge is lovely and clean and tidy.”

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. However, some improvements were needed, and action was taken at the time of the assessment.

Medicines were stored in people’s rooms unless risks had been identified that required alternative arrangements. Medicine Administration Records (MAR) were in place and appropriately signed. However, in some services, medicines were not always booked in on the MAR. This meant for some medicines, particularly ‘as required’ (PRN) medicines, a carry-forward figure was missing, which impacted reconciliation. In addition, PRN protocols were not always in place to guide staff on the safest method of administration. These gaps were addressed immediately following the assessment, and protocols were implemented. Staff had received training in medicines management and had their competency assessed to ensure safe practice.

People and relatives expressed confidence in the way medicines were managed. One relative told us: “Staff support administering medication as [person] can’t do it now. I’ve seen them take great care of the doses and reordering. There is a checklist and regular stock checking and a tick list.” Overall, while some improvements were required, the provider demonstrated a proactive approach to managing medicines safely and acted promptly to reduce risks.