Livingstone House

Based on our review of the key questions safe, effective, caring, responsive and well led. The service was not able to demonstrate they were fully meeting the underpinning principles of Right support, right care, right culture.

Right Support: People had plans in place to guide staff on how to support them if they became anxious or upset, however, these plans were not always regularly reviewed or updated. Staff were not always provided with clear guidance on how to support people safely. A failure to effectively monitor incidents meant there were missed opportunities to avoid and reduce reoccurrence. People not always supported to have the maximum possible choice, control and independence in their daily lives. People were not always enabled to access specialist health care support in a timely way.

Right Care: Low staffing levels impacted on people receiving person-centred care. People were not provided with opportunities to try new activities tailored to them that enhanced and enriched their lives. We observed people participated in group activities more often, rather than pursuing their own individual interests or seeking opportunities for volunteering or employment. Poor compliance with training and inconsistent induction processes for staff new to the service meant that people were not always supported by suitably trained, skilled and competent staff. Not all staff could sufficiently demonstrate they knew about the person they were supporting or what was in their care plans.

Right Culture: The provider failed to develop effective governance and quality assurance systems to assess the quality and safety of the support people received. There were a lack of audits and actions taken when things went wrong. Actions were not always documented, and it was unclear if actions were completed. This meant improvements were not always made to improve the care people received. Internal quality assurance systems and processes to audit or review service performance and the safety and quality of care were not effective. Where checks and audits were carried out, they had not always identified or prevented issues

occurring or continuing at the service. Where issues had been identified, the provider had not always ensured actions were taken to maintain or improve the quality and safety of the support being delivered at the service. Some care staff told us they felt unsupported by senior management. Family members told us that until recently, there was insufficient engagement with them. This meant people's families were not sufficiently involved in developing the service. There was limited opportunity for staff to learn from incidents and improve practice.