Independent Supported Living and Disabilities Ltd Also known as ISLAD

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We identified 4 breaches of the regulation. The provider did not always ensure their safeguarding systems were operated effectively to investigate and follow the provider's procedure after becoming aware of an allegation of abuse. When incidents or accidents happened, we were not assured the provider fully investigated those, and there was little evidence of any lessons learned from these events. The provider did not always ensure people were not deprived of their liberty unlawfully. The provider did not always ensure effective recruitment processes were in place to ensure, as far as possible, that people were protected from staff being employed who were not suitable. The provider did not ensure clear plans were in place for staff to minimise the risks to people’s health and well being and take timely action to support people. Not all staff were up to date with, or had received, their mandatory training and competency checks to ensure they had the right skills and knowledge to provide effective care to people. The provider did not ensure appropriate process were followed when people needed additional medication. Staff were not fully trained and assessed as competent to support people with medication. Staff deployment was not always managed effectively to ensure people were able to receive care according to their needs and have access to local community. We observed friendly interactions between staff and people when we visited people in their own homes. However, relatives and professionals were not always happy with the way the provider and staff communicated with them, and the care and support they provided to people.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People were not always protected from harm, neglect and discrimination. One person’s relative told us they did not feel the person was safe at the service because they felt their needs were not being met. They felt the attitude and behaviour of staff was disrespectful to the person. They told us they witnessed a staff member shouting at the person. Another relative we spoke with felt people were safe because the door was locked most of the time. Some people who use the service were not able to tell us of their experiences verbally, so we observed their interactions with staff. Staff responded well to people and supported them with their requests. People indicated they felt safe and could raise concerns with staff. One person told us, “Yes and they have night staff because if anybody is sick at night, they come help. Yes, I can raise [concerns] with staff, my key worker”. Another person indicated staff were friendly and listened well.

The manager was able to explain about making sure people who use the service were kept safe from improper treatment. However, they were not able to explain the process they would follow in accordance with the local safeguarding adults’ policy and procedure. We discussed the process with the manager, to ensure they worked with the local authority and police where necessary regarding people’s safety. The manager told us they supported and encouraged staff to share any concerns with them, so it was addressed without delay. The manager told us how they worked with staff to ensure people were supported to raise concerns when they did not feel safe and regularly monitored, or any changes in the safety of people. The manager told us the staff completed the training and read the policies, in addition to discussions around the safeguarding process during meetings and supervisions. The nominated individual added they had weekly meetings to review incidents, accidents, and safeguarding so they would have oversight, and provide support to the managers to deal with incidents and accidents. The management team told us they were working together with the local authority safeguarding team to investigate safeguarding incidents as and when they occurred. Staff we spoke with told us they were aware of their responsibilities in relation to keeping safe and had received safeguarding training. Staff demonstrated knowledge of how to escalate concerns. However, evidence obtained during the assessment process showed that staff and leaders did not always meet their safeguarding responsibilities.

We have visited people in their own homes and observed interactions between people and staff. People could seek support from staff and the manager at any time. We observed staff responded to people in a caring and kind manner and supported them with their activities or any requests they had on that day.

The provider had a safeguarding policy that noted processes and practices to follow that would make sure people were protected from abuse and neglect. However, the provider, the manager and staff did not always demonstrate there was a commitment to taking action to keep people safe from abuse and neglect. We received evidence from the provider and professionals, which indicated the provider, and the manager did not ensure any concerns related to people or the service were shared openly, quickly, and appropriately. The provider did not ensure incidents and/or accidents were recorded and reported consistently to ensure appropriate actions were taken and people protected from risk of harm, neglect or abuse. For example, there was an incident where staff refused to provide essential care to one of the people using the service. The relative raised this with the service at that time but it was not investigated until 18 days later. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). When people receive care and treatment in their own homes an application must be made to the Court of Protection for them to authorise people to be deprived of their liberty. The provider and the manager were not able to describe clearly to us when such authorisation would be needed to be applied and the process for it. At the time of the site visit, 3 people did not have any authorisations in place however they were restricted by not being able to leave the premises as they wished, and they had to have staff with them. We requested further evidence from the provider to demonstrate how these decisions were made but no clear records were provided of discussions and decisions made to ensure people were not being deprived of liberty unlawfully.

People were not sure if they were involved in planning their care, including managing risks which may affect their health and wellbeing. We informed the manager and nominated individual about this, and they said they would ensure people were involved in the process. One person said, “I only see the staff in the morning, or when they do the tablets and sometimes in the evenings. No, I do not have review meetings”. The person added when they felt worried or stressed, staff helped them and that the staff were “very good.” Relatives did not always feel people were supported to manage risks. For example, one relative told us, “[Person] doesn’t go where they want to go because the staff make the rules, and [Person] doesn’t get to do what [Person] wants to do…. I think [staff] do what they want to do to make their life easy.”

The manager was able to explain how they supported people on day-to-day basis. However, they needed prompting when we asked about how they worked and communicated with people to ensure people were aware of their rights, risk taking and protecting them from discrimination. The manager said staff received training around equality and diversity, and it was discussed in supervisions. The manager also said people had key worker meetings. However the records did not include clear information that people were supported to understand their rights and risks. The manager explained how they completed and reviewed people’s care including risk assessments and care plans. The manager said they involved people, their families and staff to gather information about people that would inform person-centred plans of care. The manager said they reviewed the care records 6 monthly or if anything had changed regarding people’s needs and support. The manager said they communicated with staff about people, their care, any changes and what action to take to address it. When people communicate their needs, emotions or distress, the manager said the staff were present on daily basis and would support people as and when needed, for example, speak to people and reassure them regarding their worries or stress. The manager confirmed they did not use any type of restraint. Most staff we spoke with demonstrated an understanding of their responsibilities and peoples’ rights when involving people to manage risks. However, feedback from peoples’ representatives indicated staff did not always apply their knowledge while supporting people.

We observed when people communicated their needs, staff were able to manage this in a positive way that protected their rights and dignity. While we were spending time with one of the people, the staff member demonstrated how well they knew the person and their individual needs, likes and dislikes, and communication preferences. They also praised the person’s independence and character that helped the person lead the life they preferred. The person responded well and with a smile every time the staff member communicated with them. We observed people were able to move freely around the service and staff did not place any restrictions on people. We saw people approached staff freely to discuss any queries or concerns they had.

The provider did not ensure clear and effective risk assessments and mitigations were in place. The support plans and supporting documents provided some information people needed for different aspects of care and support. For example, people had to follow a routine to look after their oral care, but the staff did not record the support was provided regularly to ensure people were not at risk of deterioration of their oral health. One person could get upset, distressed or anxious but there was no clear guidance for staff to follow if and when they had to support this person. The risk assessment noted that the person was not able to communicate any complaints if they were abused or neglected. However, it did not offer any further clear guidance on how to support this person to ensure they were able to express their feelings with any communication aids and remain safe. Various topics from support plans and risk assessment had to be discussed with the person during key worker meetings, however the notes were basic and did not cover those topics. The information had generic statements such as ‘staff to communicate with me at all times to a level of understanding’. This meant the provider did not demonstrate they consistently reviewed, assessed, and monitored risks to people’s safety so they could take sufficient and timely actions to mitigate and identify risks. The provider did not follow their own policy to ensure all incidents were consistently reported and thoroughly investigated to mitigate the risk of recurrence. For example, we found 2 incidents for the same person where the person was put at risk. The provider was unable to demonstrate they had investigated each incident and identified lessons learned to mitigate the risk of recurrence. The provider also failed to demonstrate they had completed the appropriate risk assessment for one of the incidents. This meant people continued to be at risk of harm or neglect.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Feedback regarding staffing was mixed. One relative told us they were satisfied with staff at the service. However, another relative told us they did not feel staff kept the person safe because staff refused to meet the person’s essential personal care needs. They said, “I don’t think staff are trained or qualified enough to meet [Person’s] needs, which means [Person] is being neglected, and suffering abuse.” People told us staff helped them with their support. However, people told us they were not always able to go out. One person said, “When staff are not here or off sick, we do not go out. They need more staff so we can go out, so we can go out to cinema, shopping. We need morning, afternoon and evening staff support.” We raised this with the manager and the nominated individual during site visit. They explained how the hours of support were set up for the service and the individual people. We noted to review this with people, so they understood this type of set up well.

The manager told us the recruitment and selection process were completed by provider’s HR team and passed onto the manager. Then the manager would review the files for any gaps and if any found, return to HR team to address those. The nominated individual explained their system to ensure good numbers and mixture of staff and to meet people’s diverse needs effectively. They said the service was directly led by people’s hours, core and shared hours, and then one-to-one hours. If needs changed, requiring staff adjustment, then the provider would work with the local authority to review the funding and adjust the staffing. The manager said this was reviewed according to people’s reviews and any changes noted. The manager and the nominated individual told us about staff training to ensure there were enough qualified, skilled and experienced staff, who received support, supervision and development. The manager said they checked staff competencies for various topics in the staff meetings by asking questions for staff to answer. The manager said staff had online policy access to read and review different policies. They said staff completed 2 weeks of induction including shadowing. Most staff we spoke with told us there were enough suitably trained staff to meet peoples’ needs. The staff felt they could seek support or advice from the management team. Although feedback from leaders and staff was positive, evidence found during this assessment identified a number of concerns relating to safe and effective staffing.

During our visit, we observed people were involved in some activities and staff engaged well with people to ensure a level of stimulation. We observed staff were patient with people and were able to support people with their requests.

The provider failed to establish and follow robust recruitment processes. We found discrepancies in 6 staff files such as evidence for right to work, full employment history and unexplained gaps, an application form, interview records, health checks, verification of reasons for leaving previous employments working with vulnerable adults/children. When the service commenced a care package to a person under 18, they failed to request children’s DBS for staff prior to commencement of care. Staff training records showed staff were not up to date with mandatory training for example, 5 staff were not up to date with safeguarding adults, 6 with fire training and 7 with first aid.  The provider failed to follow their own policy in relation to supervision and appraisal of staff. The staff did not receive regular supervisions and appraisals to review their performance and enable them to continue carrying out duties they were employed to perform. When new staff started at the service, they had an induction and a period of shadowing experienced staff. The provider used Care Certificate which is an agreed set of standards that define the knowledge, skills and behaviours expected of specific job roles in the health and social care sectors. The provider’s policy did not have a clear and defined process for completion of the care certificate including observations and assessing staff’s knowledge for each standard. The manager and the nominated individual were unable to clearly describe the format of this process to us. The provider failed to deploy sufficient numbers of suitable staff to make sure people’s needs were met. For example, one person who use the service was repeatedly refused essential care by staff. The provider failed to identify this as a concern which led to the person suffering from neglect. People were unable to have regular access to the local community because the provider did not organise staff effectively to be able to meet those needs.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People were supported to have their medicines to support their health. One person told us, “Staff help me with medication. Yes, I have medication reviews; the other day we had a review at the surgery. Yes, they do [record] it on medication administration record (MAR) sheets”. Relatives told us they did not have concerns regarding the management of people’s medication because they were not aware of any problems. However, they further advised us that they had not received communications from the service to keep them informed of any issues regarding medication.

The manager told us people were appropriately involved in decisions about their medicines. People were supported to attend appointments with their GP’s for medication reviews. The manager said at this time, no one expressed their wish to self-medicate. The manager said they completed reviews every 3 to 6 months or sooner if people’s emotional well-being changed or their health deteriorated. The manager said they communicated with GP’s and other health professionals to ensure the approach to medicines reflected current and relevant best practice and professional guidance. The manager said they also completed medication audits, as well as, review policies, complete training, and seek advice from senior staff or professionals. The manager said they did not use any controlled drugs, any covert administration or ‘as required’ (PRN) medication. If any PRN medication was needed, the manager said this would be discussed and prescribed by people’s GP. Staff were able to explain how they ensured safe administration of medicines to people using the service and demonstrated a basic understanding of the principles of medicine safety. However, we found concerns relating to management of medicine that did not reflect the feedback we gathered from leaders and staff.

Staff ensured people’s behaviour was not controlled by excessive and inappropriate use of medicines. The medication was stored securely in a lockable office and the temperatures were checked regularly. One person’s medication was kept in their flat according to their choice. We did not observe anyone receiving medications during our onsite visit.

The provider did not ensure that all staff administering medicines were trained and had their competency checked. The manager informed us they had recently been trained to assess staff’s medicines competencies. The nominated individual said the staff would have to be re-assessed once the manager was certified. People's care records stated staff must be trained before administering medicines. This meant staff were supporting people without appropriate training, and not according to provider’s policy that would ensure safe and proper management of medicine. We received further evidence from professionals that the provider did not follow their policy to ensure safe management of medicine. Staff purchased medication for one person without any discussion with their GP how this should be used safely. The person did not have any protocols or guidance of how and when it should be administered. Relatives and social worker were not involved or informed about this arrangement. We reviewed medication administration records (MAR) sheets and did not find any gaps; the records were double signed for each dose. However, we found a discrepancy in one of the MAR sheets where staff crossed out their signatures on two days, and there was no explanation for it. When we asked the manager how this error was logged, they responded this was not an error. Provider’s policy noted a process to follow if errors were made including completion of a medication error report form and a record should be made on the back of the MAR sheet. The provider did not follow the process to ensure it was established that people did not miss their medication.