Independent Supported Living and Disabilities Ltd Also known as ISLAD

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We identified 2 breaches of the regulations. The provider did not always ensure initial assessments were carried out to identify the support people required and to ensure the service was able to meet people’s diverse needs. The care plans did not consistently contain information specific to peoples’ complex needs and how to manage any conditions they had. Peoples’ families and other people that mattered felt they were not involved in the planning of their care, and they were not always informed about people’s health and welfare. The provider did not ensure the principles of Mental Capacity Act 2005 (MCA) were fully understood and promoted so that peoples’ rights were recognised, protected, and upheld when giving consent and making decisions about their care. The service did not carry out any mental capacity assessment and best interest decisions to determine the level of support people required when making various decisions about their health and care support.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We spoke with people about their care and support plans. One person told us they were not sure if they had a care plan. They said, “I have not seen care plan. Yes, I would like to see it. No, I did not have an assessment, not yet and I have not had a review yet. I did have one with the doctors”. We raised this with the manager and the nominated individual. They said they would print out the documents and go through it with the person. The manager also noted people had their reviews coming up so they would be involved in those, as well. Relatives told us they had not seen their loved one’s care plans and had not been involved in the care planning process. This meant people who were unable to communicate their needs, did not have adequate representation during the care planning process.

We spoke with the manager and the nominated individual about assessments and reviews of people’s needs and how they worked with people, their families and professionals to ensure care plans were person-centred. During our site visit, we were informed the service accepted one person without having appropriate assessments of needs in place. This meant that the provider could not demonstrate they followed the process to determine if the placement was suitable for the person, which could result in the person being at risk of receiving inappropriate care. The manager and the nominated individual told us there were still processes ongoing for this person to arrange appropriate plans of care, even though the person started using this service in February 2024. We also discussed with the manager regarding people’s communication needs and if visual aids were readily available. This was not in place, and the manager acknowledged this needed rectifying. We asked how the information about people was disseminated across staff and senior staff supporting people directly. The manager said this was printed out or put on an online platform for staff to read and sign. Staff told us they assessed people’s needs and communicated with them in ways they could understand.

We requested feedback from different professionals. We received some feedback that indicated the provider did not always follow the plans of care for one person that put the person at risk of harm. One professional noted provider was not always open and transparent with professionals and relatives such as informing them of incidents or accidents such as falls or changes to person's care.

People’s care needs were not always assessed initially to identify the support they required and to ensure the service could meet their individual needs. For example, one person started using the service without having appropriate support in place to ensure their needs were met consistently and according to dedicated hours of support. The provider did not ensure there were suitable staff to meet the person’s needs which affected people’s care and support. The provider could not provide evidence the initial assessment was carried out to ensure they were able to provide safe care and support to this person, without putting them at risk of harm or being unable to receive care they needed. Support plans contained information covering people’s routines and aspects of support. It also described people’s likes and preferences, their social interests, as well as physical and emotional needs. However, some parts of the support plans were basic and did not provide any further guidance in more detail to ensure staff were able to meet peoples’ diverse needs. For example, one person had a health condition and staff had to monitor it. Recent visit to health professional noted the advice how to support this person more effectively but the support plan nor the daily notes reflected this was being actioned. Support plans noted aims for people but information on steps to achieve were basic and did not offer clear guidance for staff to follow. For example, people needed visual and pictorial aids to understand the information they were presented and discuss various topics during key worker meetings. It was not recorded that it was regularly reviewed with people. This meant the provider could not demonstrate the staff team followed support plans and recorded their support consistently to ensure people were involved and could live life to their full potential according to their choice.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

People's rights to make their own decisions, where possible, were not always protected and respected. Relatives gave us mixed responses when asked if people were asked for their consent prior to delivering care. One relative could not answer the question. Another relative told us, “I am of the opinion that [Person] refuses a lot of the time because [Person] knows the staff will refuse to help most of the time.” This was confirmed by an ongoing safeguarding enquiry and staff meeting minutes regarding staff refusing to support this person. We also observed, while we were talking to one person, staff came into their room without knocking. During our visit, we also observed staff were polite, kind and respectful towards people and respected their decisions. One person told us, “Yes staff do seek consent [before delivering care and support]. Yes, staff respect my decisions and I make my choices. Staff are respectful to me.”

We asked the manager how they ensured people understood their rights around consent to the care and treatment, and the right to refuse it. The manager was not able to describe the process clearly or how it was communicated to people, and records kept for those conversations. The manager also did not demonstrate clear understanding and knowledge of Mental Capacity Act 2005 (MCA) and how this would be used in their role as a manager, to ensure people’s rights were recognised, protected, and upheld when giving consent and making decisions about their care. With some prompting, the manager was able to describe how they supported people to make decisions and making sure it was the right choice; recognise the risks and challenges and what it meant for people to ensure the MCA was followed accordingly. The manager told us how they supported people with day-to-day decisions and choices. They also told us about people refusing care and support, “If we see a pattern, we will seek further help as it becomes a risk to themselves.” Staff told us they sought peoples’ consent prior to delivering care, and respected peoples’ right to privacy.

The provider did not ensure they had a clear process to ensure if decisions had to be made on people’s behalf, there were clear assessments and reviews completed to demonstrate the decisions were the safest and least restrictive option. The provider did not ensure they worked with people, staff, and others to ensure people’s rights around decisions and consent were respected when delivering person-centered care and treatment. The provider did not ensure all people had appropriate capacity assessments or reviews completed when required so the staff had clear guidance on how to support them appropriately including making decisions about their life and upholding their rights to make choices. For example, 2 people had consent agreements noted in their care plan for various aspects of their care. However, these had not been reviewed for more than a year. This meant provider did not ensure people’s decision-making and right to refuse care or support was reviewed and respected. Another person was not able to sign certain legal documents nor had capacity to do so. However, a tenancy agreement was signed by a relative who did not have a legal right to sign on their behalf. People did not have clear separate support agreements in place to demonstrate they agreed for this provider to support and care for them, which also was not regularly reviewed. Within people’s support plans, the information was basic about peoples’ capacity and support they required with making decisions, what process to follow and ensure people’s rights to make decisions and choices were always promoted and respected. For example, one person’s plan noted steps such as to ask the person “of what it was asked so they could understand the impact it could have on the person”. It was not clear what the sentence meant and how this conversation should be managed to ensure the person received information according to their needs and was able to make decisions.