London Care (Bristol Court)

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

The service was not always safe. People were not always encouraged to raise concerns. They felt that these were not always acted on and learnt from to improve the service. People also felt allegations of abuse were not always reported or investigated. Medicines were not always managed well because records relating to these needed to be more detailed. Staff received training and guidance, but some people felt staff lacked the skills to care for them safely and well. They gave examples of this, which included failing to understand how to support autistic people and practices which were potentially risky. We have identified breaches in relation to good governance and safeguarding people from abuse and improper treatment.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People did not always feel encouraged to raise concerns. They did not feel confident they would be treated with compassion or understanding. Some people living at the service and their relatives told us about negative experiences they had when speaking up. Their comments included, ''Managers say they are too busy to talk and complaints go unheard'', ''I have fed back my concerns about communication to management, but they have not taken any action'', and ''The management do not consider the needs of how different people communicate. They are not always listening or solving problems.'' One person told us that when they raised a complaint about a member of staff, they were not believed at first and the complaint was only taken seriously when another staff member witnessed the same issue and spoke up. A relative told us, ''They see me as a troublemaker.'' A recent assessment by the service by the local authority commissioning team found that people sometimes lacked the confidence to voice complaints due to past experiences with negative outcomes. Failure to effectively implement systems to monitor and improve the quality of people's experience was a breach of Regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There were procedures for responding to and investigating complaints. However, these had not always been operated effectively because people living at the service and their relatives told us they did not always feel confident raising concerns and/or these had not been acted on. There were records staff needed to complete following incidents. These had not always been completed in enough detail to show what had happened and why. There was limited analysis of the incidents or information about triggers. This meant these records could not be effectively used to monitor and plan for people's care and to learn what had gone wrong. We discussed this with the registered manager. They told us they had been working with staff to try and improve these records. There were regular handover meetings and ways for staff to share information about things that had gone wrong. This helped them to discuss ways to make improvements and learn together. The provider was introducing new ways to help gather feedback from people using the service and their relatives. In response to concerns identified during the local authority assessment, the provider was revising how complaints were logged and responded to.

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.

Two people using the service told us about allegations of abuse they had raised with staff and leaders. They explained they did not think any action had been taken at the time to investigate these concerns or alert the safeguarding authority. We shared the information with the local authority safeguarding team so these allegations could be investigated. People told us they were unhappy that the provider had not taken enough action to help protect them. People using the service and their relatives did not always feel safe. They told us the provider had not always responded when they had raised issues about their safety. One person told us, ''Some carers don’t have any empathy, I don’t trust them, and I don’t want them in my flat.'' Failure to protect people from abuse and improper treatment was a breach of Regulation 13 (safeguarding people from abuse and improper treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, other people and their relatives explained they felt safe. Their comments included, ''It is safer than where [person] was living before'', ''It feels safe'', ''The carers come quickly in an emergency'' and ''It is safe enough.''

There were procedures for responding to allegations of abuse. The staff had received training in these. However, feedback we received from people using the service and their relatives included incidents when they had spoken up about potential abuse and this had not been acted on by the staff and leaders they informed.

People and their relatives told us they did not always feel safe or feel that risks were well managed. Some people raised specific concerns about their individual care and we discussed these with the management team so they could look into these and help to make sure risks were being well managed.

There were procedures for assessing risks to people's safety and wellbeing. The staff liaised with people and created plans to help manage the risks. Risk assessments and management plans included information relating to people's health conditions, mobility, and independence. They were regularly reviewed and updated when people's needs changed. The staff did not use any form of physical restraint. Some people expressed themselves in ways which challenged staff. For example, shouting, saying unkind things or being physically aggressive. The staff liaised with other professionals to help develop plans to support people so they, other people, and the staff were safe at these times. However, records of these incidents did not include enough detail to help monitor and review whether plans were working effectively.

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

People using the service and their relatives gave mixed feedback about whether there was safe and effective staffing. Some people felt there were not enough staff deployed and that they did not always have the same regular workers. Some of their comments included, ''This is a big place, and some people need more help than others, they could do with a few more carers., '' Some of carers rush. They do not do all they are supposed to do'', and ''They keep sending me different carers and I don’t like them.'' Some relatives and external professionals told us staff needed better training and understanding of people with a learning disability and autistic people. One relative explained, ''The staff do not know how to deal with autistic meltdowns, they do not recognise the signs of anxiety or know how to respond to this.'' Whilst the provider had recently organised training for staff, the provider needed to make sure this training was embedded and included ways to recognise and support people with anxiety and during meltdowns. (A meltdown is an intense response to an overwhelming situation. It happens when someone becomes completely overwhelmed by their current situation and temporarily loses control.) Some people told us they thought newer staff needed more training to improve their understanding of how people communicated with them. However, people liked the regular staff and felt they were well trained. Comments from people included, ''They do not always understand what is being asked of them'', ''There is a language problem at times'', ''I think the carers are well trained and they do a good job'' and ''Some are fantastic and know exactly what they are doing.''

The staff told us they thought there was enough of them to meet people's needs. They described how they worked well as a team and supported one another. Staff explained they undertook training which helped equip them for their work. Some staff told us they would like more face-to-face training rather than computerised training (e-learning).

The provider told us they had started to address the issues with staff consistency and had developed rotas to help make sure people were usually cared for by the same group of familiar staff. The provider did not use agency staff and was able to meet their assessed staffing needs with their own employees . Although feedback from some people and relatives was that staff did not always stay the agreed length of time and people sometimes felt rushed. The provider offered a range of training for staff. Staff had recently undertaken training about people with a learning disability and autism. The provider arranged for staff to undertake specialist training from external professionals when a person had a specific need, for example using a new piece of equipment or a health condition. There were safe systems for recruiting and selecting staff. These included checks on their eligibility to work in the United Kingdom, suitability, and experience. New staff completed inductions, which including shadowing experienced workers and a range of training.

Some people had care packages which included staff helping to keep their flats clean and hygienic. Whilst some people told us they were happy with this, others told us they did not think the standard of cleanliness was good enough. Comments from relatives included, ''When I last visited, my relative's toilet wasn’t very clean, and [their] room hadn’t been vacuumed. It wasn’t dreadful but is should have been done'', ''I am sure the staff do not have time but my relative could do with more housework'' and ''My only gripe is about the cleaning. It is done very poorly, and we have to do it again ourselves.''

There were suitable procedures for infection prevention and control. These included training staff to understand the importance of this and providing adequate personal protective equipment (PPE).

People using the service and their relatives told us they were happy with medicines support. However, care plans did not always have the necessary information to help staff support people with their health needs or prescribed medicines. This meant people were at risk of receiving unsafe care and treatment. Staff did not record the outcomes when they administered 'as required' medicines. Therefore, they had not always assessed the effectiveness of these. People were supported to administer their own medicines if they were able to and wanted to do this. There were regular reviews of people's medicines with their GP or prescribing doctor.

Staff and managers explained they understood the principles of how to handle medicines safely. The staff told us they received training about this, had training updates and their competencies had been assessed. Records confirmed this.

Protocols were in place which explained how and when 'as required' medicines should be administered. However, these did not always have enough detailed information for each person. This meant there was an increased risk the medicines would not be administered effectively. Although medicines were given as prescribed, they were not always recorded according to legislation, national guidance and /or local policy. People’s medicines were securely stored. The staff recorded the date of opening for medicines. The staff carried out regular medicine audits and we found improvements as a result of these. Medicines incidents were recorded, analysed, and learnt from.