AFG Community Liverpool City South

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.

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

People’s health needs were monitored and guidance from professionals was followed. However, some aspects of ‘Right support, right care, right culture’ were not always being considered or followed. For example, the model of care did not always maximise people’s choice and control and restrictions were observed within some services without the appropriate legal frameworks in place.

The systematic implementation of the Mental Capacity Act 2005 (MCA) was not fully embedded into practice. In some settings we found capacity assessments and best interest decisions were only completed by external professionals. Not all staff were aware of the principles of the MCA 2005 and processes were not always followed. We identified a legal breach with regard to the need for consent.

People’s needs and preferences in relation to their nutrition and hydration had been recorded within their support plan. This included how people liked to be served their meals and drinks.

Records confirmed people were offered a variety of healthy meals in line with their choices and preferences.

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

The provider was in breach of legal regulations in relation to good governance. Concerns relating to the implementation of the Mental Capacity Act and due regard for people’s rights under the Deprivation of Liberty Safeguards legislation had not been identified or addressed by the quality assurance systems in place.

‘Right support, right care, right culture’ guidance was not always followed to ensure people with a learning disability and/or autism were supported appropriately in a way that maximised their independence.

The governance systems in place had not identified people’s daily records indicated they did not always receive the amount of personalised support considered necessary by the Local Authority in order to meet social and recreational needs.