Livability Somerset improved from requires improvement to good overall, with previous breaches of regulations 9, 11, 12, 13, 17 and 18 now resolved. Well-led remained requires improvement as governance and oversight systems were not yet fully embedded, with staffing challenges and a leadership vacancy at one location continuing to impact people.
Concerns (6)
moderateGovernance — “Whilst the provider was immediately responsive to issues identified during the inspection such as the locked fruit bowl and potential safeguarding, the internal systems had not identified these.”
moderateSafeguarding
— “We identified one potential safeguarding issue that had not been raised using the internal system and as a result was at risk of being missed.”
moderateStaffing levels — “Relatives, and staff, observed an improvement but we heard there was still an impact on people due to high agency use.”
moderateLeadership — “Staff at one location felt less supported. They attributed this to the vacancy in the leadership of this location and gave examples of the impact.”
minorInfection control — “When we first visited one home staff were not wearing masks when in close proximity to the people they supported. This was addressed immediately.”
minorOther — “We noted that a fruit bowl had been locked away in one house and this was not covered by the oversight of restrictions.”
Strengths
· People received personalised care and support built around their needs and preferences.
· Staff knew people well and understood how to protect them from abuse.
· Medicines were administered safely by trained staff with competency assessed.
· Care plans were written in respectful language and focussed on people's strengths and skills.
· Improved communication with relatives including regular updates and meetings.
Quality-Statement breakdown (14)
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongNot rated
safe: Staffing and recruitmentNot rated
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
effective: Supporting people to live healthier lives, access healthcare services and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsNot rated
well-led: Engaging and involving people using the service, the public and staffNot rated
well-led: Duty of candourNot rated
well-led: Working in partnership with othersNot rated
Livability Somerset, a supported living service for people with learning disabilities and autism, deteriorated from Good to Requires improvement following a focused inspection that identified breaches in risk management, safeguarding, staffing, MCA, person-centred care and governance. Chronic staff shortages, leadership restructuring and weak oversight resulted in restrictive practices, missed safeguarding referrals and inconsistent training, prompting a warning notice for governance.
Concerns (13)
criticalStaffing levels — “The service had been experiencing a chronic shortage of staff... There were not sufficient staff to meet people's assessed needs.”
criticalSafeguarding — “we identified two situations that had occurred in the six months prior to our visit that should have been considered as safeguarding concerns.”
criticalGovernance — “Systems to monitor the quality and safety of people's support were not effective. There was a breach of regulation 17 (Good Governance)”
criticalConsent / capacity — “The MCA was not used as a framework to ensure people's best interests were always reflected or that they had consented to their care.”
criticalPerson-centred care — “People's support was not provided within a framework that ensured consistency in person centred support.”
criticalStaff training — “People were supported by staff who had not always undertaken appropriate training. The training around autism had not been mandatory and most staff had not completed it.”
moderateSupervision / appraisal — “Staff had not been receiving regular supervision sessions due to the issues with ensuring staff numbers.”
moderateCare planning — “Care plans and people's written records were not the main source of agreed information for staff and there were risks associated with this.”
moderateIncident learning — “Incidents had not been appropriately monitored and analysed to ensure lessons were learned.”
moderateLeadership — “a lack of leadership and oversight meant that people's support was not always effective and consistent.”
moderateCommunication with families — “Relatives commented on not being sure who they should speak with and difficulties with communicating.”
moderateRecord keeping — “There were gaps in these records and staff and professionals described the impact of these gaps in ensuring people received the right support.”
moderateOther — “Statutory notifications had not always been made to the CQC... Notifications regarding the outcome of a deprivation of liberty and allegations of abuse had not been made.”
Strengths
· People received their medicines as prescribed; staff trained and competency assessed; medicines stored safely
· Staff used PPE effectively and infection prevention measures were in place
· Long-standing staff knew people well and were committed to providing consistent, kind support
· People felt safe with staff and reported positive relationships ('Staff make sure you're safe. I am safe.')
· People were supported with menu planning, eating together and shopping for food
Quality-Statement breakdown (14)
safe: Assessing risk, safety monitoring and management; Learning lessons when things went wrongInadequate
safe: Staffing and recruitmentInadequate
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Preventing and controlling infectionGood
safe: Using medicines safelyGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experience
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Requires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies; supporting people to access healthcare servicesRequires improvement
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirements; Continuous learning and improving careRequires improvement
well-led: Engaging and involving people using the service, the public and staff; promoting a positive person-centred cultureRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
well-led: Working in partnership with othersRequires improvement