AFG Community Liverpool City South

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• 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 good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

People’s health needs were monitored and guidance from professionals was followed. However, some aspects of ‘Right support, right care, right culture’ were not always being considered or followed. For example, the model of care did not always maximise people’s choice and control and restrictions were observed within some services without the appropriate legal frameworks in place.

The systematic implementation of the Mental Capacity Act 2005 (MCA) was not fully embedded into practice. In some settings we found capacity assessments and best interest decisions were only completed by external professionals. Not all staff were aware of the principles of the MCA 2005 and processes were not always followed. We identified a legal breach with regard to the need for consent.

People’s needs and preferences in relation to their nutrition and hydration had been recorded within their support plan. This included how people liked to be served their meals and drinks.

Records confirmed people were offered a variety of healthy meals in line with their choices and preferences.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were involved in the assessment of their needs, and the support was provided maximised their involvement. People’s communication needs were assessed with detailed support plans in place.

Staff had access to the assessment information completed by the Local Authority Adult Social Care team on people’s needs and risks which was good practice. Care reviews and pen pictures about people’s day to day lives and preferences were in place and a yearly review of people’s needs was undertaken to ensure people’s support plans remained up to date.

Most review records observed were detailed, person centred and involved the person, however, some lacked detail regarding future goal setting and ‘what is important for the future’.

People and their relatives told us they were involved in reviewing their care needs, one person stated, “I am involved in my reviews of care plans and the diary is filled in every day and staff write care notes daily.” A relative confirmed, “I feel I am involved in [Name of person’s] care plan and when I spot things they are acted upon.”

The provider did not always plan and deliver people’s care and treatment in line with legislation and current evidence-based good practice and standards. Not all staff we spoke with were aware of best practice guidance such Right Support, Right Care Right Culture or how this impacted on their work. Not all staff were aware of who was subject to Community Deprivation of Liberty Safeguards (c-DoLS) or Court of Protection arrangements (COP). This meant there was a risk care was not being provided in the person’s best interests as specified in the legal authorisation.

Relatives told us staff have a good understanding of people's care needs. One relative stated, “Staff know her well and understand her needs. I would know if she was unhappy.”

People were supported with their nutrition and hydration, where required, and people’s care plans detailed the support they required with their nutrition and hydration needs.

A relative stated, “[Person] has feeding and swallowing difficulties and they support him well with this. Staff are well trained, and they know him well and are aware of his condition.”

National recognised assessment tools were in place to establish risk levels. Staff spoken with knew people’s needs well and acted on any concerns identified. Staff worked in partnership with other professionals such as speech and language therapists and Learning Disability teams to ensure risk assessments and guidelines were in place to support safe eating and drinking.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff advised when people moved into the service they were involved in the planning and assessment to ensure continuity of care. The provider worked in conjunction with health and social care professionals to ensure people received safe and effective care. We observed staff communicating effectively with other organisations when there were issues or concerns about people’s health and wellbeing. Relatives spoke positively about communication and feedback from staff within the service. One relative stated, “They give me good feedback and they communicate well.”

Staff supported people with transitions to new services. Within one of the services visited the staff team had celebrated the admission of a person and displayed a ‘welcome to your new home banner’ and balloons.

Each person had a hospital passport which ensured key information about people was shared with hospital staff if they needed to go into hospital.

Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People were supported to follow a healthy balanced diet. One person stated, “I am currently being supported with healthy eating and staff support me with shopping to make healthy meals.” Another person stated, “I am on a weight loss and healthy eating programme.” Staff were supporting the person to attend a weekly weight loss class in the community.

Care plans contained detailed information on how to support people to manage their healthcare and recorded people’s preferences and level of independence. Health action plans were in place evidencing how people were to be supported to access health services including frequency of visits.

People and their relatives told us they were confident staff would recognise any deterioration in a person’s health as they were supported by staff who knew them well.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured outcomes were positive and consistent, and they met both clinical expectations and the expectations of people themselves.

Support plans were detailed, personalised and reflected the outcomes people wanted to achieve. People’s care was reviewed yearly. Some people’s reviews were detailed and reflected people’s goals and aspirations, whereas others did not. We spoke with the registered manager about this who had identified training needs for staff and actions were in place to support learning.

Staff described the internal schemes/initiatives in place for staff. One staff member stated, “I won the ‘Amazing person of the year 2024’ for going above and beyond and not giving up. I want the best for people and will always try and support them the best I can. For example, I have asked for a review of [person’s] wheelchair as I noticed it was not meeting their needs.”

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

Not all staff spoken with had a good understanding of MCA/DoLS and some staff were not sure who was subject to DoLS. Some aspects of ‘Right Support, Right Care, Right Culture’ were not always being considered or followed. The use of keys within some services was not appropriate for a supported living model of care, the location of the keys to some rooms was not appropriate.

Mental capacity and best interest assessments were not completed in line with The Mental Capacity Act 2005. For example, where a person lacks capacity and restrictive practices were in place, the restriction(s) were to be specifically recorded within an MCA and Best Interest Decision making process. We observed this process had not been followed for people with restrictions in place. There was a lack of consent for restrictions observed during the assessment, this included locked bedroom, restricted beds, restricted wardrobes, wheelchair belts, and bedrails. Records failed to evidence the care and treatment of people was provided with the consent of the relevant person. Consent to care and treatment was not always sought in line with legislation and guidance. The provider was not compliant with the MCA and we judged this was a breach in regulation ‘Need for Consent’.