Legacy Supported Living improved from Requires Improvement to Good overall, with both Safe and Well-led rated Good following remediation of previously identified concerns around medicines competency assessment and recruitment robustness. The service demonstrated strong person-centred practice, effective safeguarding processes, and a well-functioning governance and audit framework.
Strengths
· Staff competency in medicines management had been assessed and documented, addressing the previous recommendation from the last inspection.
· People were supported to manage their own medicines where chosen, including ordering and collecting prescriptions.
· Risk assessments had improved in scope, promoting positive risk-taking and people's independence.
· People were involved in staff recruitment, including participating in interview panels.
· Safeguarding training was in place; the registered manager received positive feedback from the local safeguarding team.
Quality-Statement breakdown (11)
safe: Using medicines safely
Good
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving careGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staff, fully considering their equality characteristicsGood
Legacy Supported Living received an overall rating of Requires Improvement at its first inspection in July–August 2019, with Safe and Well-led both requiring improvement due to gaps in recruitment records, risk assessments, infection control policy, medicines competency checks and quality assurance systems. Effective, Caring and Responsive were all rated Good, reflecting strong person-centred practice, positive staff relationships and effective multi-agency working.
Concerns (7)
moderateGovernance: “limited quality assurance systems in place to review staff files and recruitment, risk assessments, health and safety checks, staff training and policies and procedures.”
moderateRecord keeping: “For most staff there was no record of interview and explanations for gaps in employment were not recorded.”
moderateStaff competency: “systems to assess staff competency in medicines administration required improvement...this competency assessment was not recorded and there was no schedule for competency to be assessed regularly.”
moderateInfection control: “The provider did not have an infection control policy in place and staff had not received sufficient training in infection control.”
minorCare planning: “the provider did not keep a record of their assessment meeting with the person. This meant they did not have an accurate record to enable reflection on the discussions that had taken place.”
minorEnd-of-life care: “The provider's policies required further development to detail the support staff would provide to people in preparing for the end of their life.”
minorStaff training: “the induction package was not based on current guidance and did not follow the principles of the Care Certificate. Care staff had not received training in MCA.”
Strengths
· People felt safe with staff and reported kind, caring support: 'It's fun, the staff are lovely, we all get on here.'
· People's independence was actively promoted and staff worked creatively with them to achieve goals.
· Person-centred care plans were detailed, regularly reviewed and tailored to individual cultural, communication and social needs.
· Staff received bespoke training for specific needs such as learning disabilities and autism, and were supported to pursue vocational qualifications.
· Staff received regular supervision every six weeks and described the provider as accessible and supportive.
Quality-Statement breakdown (25)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Preventing and controlling infectionRequires improvement
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and controlGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships and take part in activitiesGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving careRequires improvement