AFG Community Liverpool City South

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.

The provider was unable to demonstrate legislation such the Community Deprivation of Liberty Safeguards (c-DoLS)had been followed appropriately when imposing restrictions on people’s day to day. For example, one person’s bedroom door was locked of an evening. There was no evidence to show this restriction had been assessed as proportionate, necessary or in the person’s best interests.

Overall, the management of medicines was safe. Improvements were required to the management of, ‘when required’ medicines (PRN). Some PRN medications were required to have specific time gaps in between each dose of medicine, however records did not evidence this. This meant there was a risk people were being given too much medicine at any one time. There was a lack of reviews for PRN protocols to determine if these medicines were still required and to assess whether they were effective.

Within some of the services there were inconsistencies with PEEPS (Personal Emergency Evacuation Plans). Improvements were required to ensure some records were reflective of fire evacuation times and people’s fire escape plans.

There were sufficient staff deployed; however, some staff reflected the current levels impacted on people’s access to the community. Records for daily living did not always reflect people were accessing the community as indicated in their support plan. This meant people’s social needs were not always being met and interests such as community activities not being fulfilled.

Staff were recruited safely and had the necessary pre-employment checks in place before starting work. Staff received an induction when they first started working at the service and training relevant to their roles.

People were protected from the risks of abuse and staff were trusted to keep them safe. The provider had policies and procedures in place for safeguarding to protect people from the risk of abuse.

Risks associated with people’s health conditions had been assessed and measures were in place to reduce potential risks to people. Detailed risk support plans were in place and reviewed regularly.

The provider had an active learning culture. People’s relatives and staff felt able to raise any concerns they had about the service. They told us they were confident their concerns would be acted upon.

There were systems in place to ensure people moved safely between services. There were processes in place to share important information with others, such as ambulance and hospital staff to support people to receive consistent care in an emergency situation.

This service scored 62 (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 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.

Relatives told us they were informed of any concerns, and action was taken to support their relatives safely. One relative told us, “Staff chat with me and tell me any concerns when I go. I have never made a complaint but would do if needed. Overall, I am happy with the service.”

Staff were able to describe the process to follow to report accidents and incidents. One staff member told us, “There are regular team meetings, we debrief if there has been an incident.”

Professionals we spoke with told gave positive feedback on the service and raised no concerns.

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. Processes were in place to share important information with others, such as ambulance and hospital staff to support people to receive consistent care.

Feedback from relatives reflected a positive interaction with the provider and good communication. One relative stated, “They give me good feedback and they communicate well.” Another relative commented, “They keep me well informed and sort out most problems. We talk regularly with them.”

Staff had good knowledge of the health and social care professionals supporting people. We observed a staff member responding to health concerns about a person, action was taken, and the GP was contacted for support. The same staff member advised they had referred a person to the wheelchair service following signs the person appeared uncomfortable in their wheelchair. Staff showed a good understanding of the risks to people’s health and wellbeing and how to mitigate these.

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.

We did identify a safeguarding concern for a person living within one of the supported living services relating to a restriction being imposed without the appropriate legal framework being followed. The provider had not followed the Mental Capacity Act 2005 and the Community Deprivation of Liberty Safeguards (c-DoLS) when decisions were made about people’s care and support. There was a lack of a robust understanding of the Mental Capacity Act 2005. The provider acted without delay to review our concerns and made a safeguarding referral to the Local Authority safeguarding team.

People told us they felt safe and were well cared for by staff. One person stated, “Yes I feel safe here, been here a long time.” This was supported by people's relatives. Comments included, “As far as I am concerned, he is safe and if he wasn't I would have him moved” and “He trusts them and he feels safe there.”

Staff were able to demonstrate their knowledge of safeguarding and the actions they would take to ensure people were kept safe. Staff confirmed they received training in safeguarding and would report any concerns where necessary. One staff member stated, “Safeguarding is an open topic, and the organisation are transparent.”

The Provider held records of any safeguarding concerns raised with them and liaised appropriately with the Local Authority to ensure concerns were acted upon. Where there was good evidence of learning from recent incidents and staff meeting minutes reflected learning was shared with the staff team to help develop and improve practice. A safeguarding policy and procedure was in place including an easy read version to make it easier for people with learning disabilities to understand.

People were supported safely, and staff were quick to respond to people’s needs. A relative stated, “They are very good with him as he is quite frail. I can't praise them enough. He 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.” One person shared, “I am involved in reviewing my care and the staff fill in the diary every day and complete the care notes daily.”

The provider had assessed risks to people's safety and wellbeing. The assessments included plans about how they could support people and reduce risks.

Risk assessments relating to people’s health conditions included the guidance staff needed to understand and respond to these.

The provider had a business contingency plan. This covered all supported living properties to ensure in the event of any emergency backup procedures were in place.

Bedrooms were person centred and reflected people’s personality and interests. It was clear people had been involved in decorating their own bedrooms. One relative told us,“[Name of person’s] flat is lovely. It's been decorated and he choose the colours.”

Systems were in place to check the safety of the environment and equipment. The management team completed audits of the environment to ensure the properties in which people lived remained in good condition. However, where concerns with the environment were identified to the housing provider for repair, action to complete maintenance requests took some time. The provider did not complete a risk assessment in those instances of delays to assess the risk to people using the service. For example, one person had waited several months for their bedroom door lock to be fixed. This posed a potential risks to the person following a previous incident whereby the person was locked in their bedroom and emergency services had to be contacted. Another person had an unsafe radiator within their bedroom that had been reported to the housing provider some time ago, this remained a potential hazard and placed the person at risk.

Fire evacuation plans and PEEPS were in place within people’s homes. The use of locked doors was not reflected within PEEPs for a person whose bedroom was being locked of a night by staff. Improvements were required for some of the records as evacuation times within fire evacuation drills did not match fire evacuation times within PEEPs in place. One fire evacuation plan observed was out of date (2021) and reflected a temporary plan whilst awaiting the appropriate equipment. This had not been updated or reflected if the equipment was now in place. Fire risk assessments reflected a number of actions within the property and another reflected recommendations for nighttime fire drills to be completed to assess the evacuation times when staffing levels reduced. There was a lack of evidence within services of what actions had been met and evidence of night/evening fire drills.

Relatives provided positive feedback about the staff team. Comments included, “The staff are good, very helpful and friendly. They ring me and keep me updated” and “The staff are good. I couldn't ask for more.”

Staff provided mixed feedback on staffing levels. Some staff reflected staffing levels were good and spoke positively about the support from team leaders. Other staff stated, “The level of staff is not always good” and “Staff, it’s a hard balance. Easier for staff to go out together when supporting people in community. If three go it leaves one behind and the person needs 2-1 support, it can be difficult.” Records within a service for a person did not evidence the proposed support for planned community stimulation was being met, comments made by staff evidenced the difficulties in managing risks and supporting people to access the community.

A training matrix was in place for staff training. The record evidenced some gaps with mandatory training. A clear induction process was completed by new staff, this included staff shadowing and completing mandatory training before they completed any care and support with people. Staff completed competency assessments, this identified confidence in staff completing tasks and areas to improve skills.

Safe recruitment processes were followed. For example, previous employers were contacted to give references on the staff member. Staff had regular Disclosure and Barring Service (DBS) checks to ensure they were safe and suitable to work with vulnerable people.

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.

Relatives told us the properties were always kept clean. One relative stated, “The house is clean. I would recommend the home, and it is much improved.”

There were good supplies of PPE in services and staff knew what personal protective equipment they should wear and when.

Infection prevention and control policies were in place. Staff had completed infection prevention and control training.

There were processes in place to support the safe and effective management of medicines including policies and procedures, however, we identified some areas in need of improvement.

‘When required’ medicines protocols (PRN) were not in place for all medications required. Some PRN medications required specific time gaps between each dose of medicine, this was not recorded on protocols and timings were not recorded. This meant there was a risk people were being given to much of their medicine at any one time. PRN protocols were not subject to regular review to ensure they remained necessary and effective. Liquid medications and creams did not always reference the date of opening in accordance with the manufacturer’s recommendations. This meant it was impossible to tell when it had been opened and whether it would still be effective.

Records showed staff completed training for managing medicines with their competency to administer medicine checked annually.

The provider was aware of national initiatives such as STOMP (stopping over medication of people with a learning disability and autistic people) which was aimed at stopping the over prescription of psychotropic medicines which were sometimes used to control people’s behaviour.