LIBERTAS received a focused inspection of Safe and Well-Led, both rated Requires Improvement, downgrading the overall rating from Good to Requires Improvement. Key breaches of Regulations 9 and 17 were identified relating to persistently late and cut-short care visits, ineffective governance systems, and failure to deliver person-centred care including respecting gender preferences.
Concerns (8)
critical
Missed or late visits
: “Staff told us they did not receive travel time planned into their rota which had an impact on the times of care visits, often making them late by an hour or more.”
criticalPerson-centred care: “Care visit times were inconsistent and preferences for gender specific support or care visit times stated at reviews of care not always adhered to. This was a breach of regulation 9(1)”
criticalGovernance: “Systems were not effective in assessing, monitoring and mitigating the risks relating to inconsistent care visit times. This was a breach of regulation 17(1)”
moderateMedication management: “Inconsistent care visit times sometimes meant people who required their medicines at specific times or with meals were not always able to do so. People had not come to harm, but this placed them at risk.”
moderateComplaints handling: “People and relatives felt they were not listened to and were not told outcomes as a result of their feedback. One relative told us, 'The interpersonal skills of office staff and the [registered manager] need to be improved'”
moderateSupervision / appraisal: “Staff told us they received supervisions and staff meetings but they felt unsupported and not listened to by the registered manager and office staff.”
moderateIncident learning: “There was a disconnect between the analysis of concerns understood by the registered manager and what people told us they were experiencing.”
moderateStaffing levels: “Staff felt pressured to cover more care visits than they had capacity to complete which impacted on care visit times or 'cutting corners.'”
Strengths
· Staff received training in safeguarding and understood how to recognise and report concerns; most people felt safe with staff who treated them with kindness.
· Safe recruitment processes were in place, including DBS checks for both permanent and temporary staff.
· Staff were trained in safe medicines administration with competency checks conducted by senior staff.
· Care plans and risk assessments contained detailed guidance for staff, including guidance for high-risk conditions such as diabetes.
· Staff followed effective infection prevention and control practices including hand washing and use of PPE.
Quality-Statement breakdown (10)
safe: Staffing and recruitment; Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Learning lessons when things go wrongRequires improvement
safe: Assessing risk, safety monitoring and managementGood
safe: Preventing and controlling infectionGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Continuous learning and improving careRequires improvement
well-led: How the provider understands and acts on the duty of candourGood