Archived: Lifeways Community Care (Exeter)

Lifeways Community Care (Exeter) is a supported living service people with learning difficulties and mental illness who live in their own homes in the community. Most people who use the service live in shared houses with other service users. This service provides care and support to people living in ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

At the time of this inspection there were 34 people with disabilities who received a range of support from the service, including personal care. Our inspection focussed on the support given to these 34 people. The service also provided support to people who did not require personal care. This part of the service is not covered by CQC legislation and therefore was not included in the inspection.

We checked the service was working in line with ‘Registering the right support’, which makes sure services for people with a learning disability and/or autism receive services are developed in line with national policy - including the national plan, Building the right support - and best practice. For example, how the service ensured care was personalised, discharge if needed, people’s independence and links with their community.

Rating at last inspection

At our last inspection we rated the service as Requires Improvement overall. We found some aspects of the leadership and responsiveness of the service required improvement, although the service was otherwise safe, effective and caring. At this inspection we found the service had improved and is now Good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

Why the service is rated Good.

People told us they felt safe. Comments included, “I like it here” and “Yes, I feel safe”. The provider and registered manager had effective safeguarding systems in place. All staff we spoke with had a good understanding of what to do to make sure people were protected from harm or abuse.

There were enough staff employed so that people received support when they needed it. Since the last inspection the turnover rate for staff had decreased. There were more permanent staff employed and less reliance on agency staff to fill vacant shifts. This meant people received a consistent service from staff they knew and trusted.

There were good systems in place to assess risk and to ensure people received safe care and support. Care plans contained evidence of risk assessments covering all anticipated risks and explained the actions staff must take to support the person to remain safe and well. People were supported to manage their medicines safely and people had been supported to make decisions about where they wanted their medicines to be stored.

People told us staff supported them effectively. People’s needs were assessed before they began receiving support from Lifeways and a plan of their support needs was drawn up. The plans contained detailed information about all aspects of each person’s support needs. Staff worked closely with health and social care professionals from other organisations to deliver effective care, support and treatment. Comments included “It’s nice” and, “We like the staff.”

Staff had the skills, knowledge and experience to deliver effective care and support. Staff received a comprehensive induction at the start of their employment and regular ongoing training and updates on topics relevant to people’s needs. Staff told us the training was good. The level of supervision to staff had improved over the last year, although the level of supervision was unlikely to reach the provider’s expectation of four supervisions per year. Staff meetings were held monthly for teams of staff who worked with people living in the shared houses. Most staff told us they were happy with the level of supervision and support they received.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to eat and drink a healthy diet. Staff understood each person’s dietary needs and preferences. People were supported to attend health checks regularly. Staff had liaised with health and social care professionals to ensure people received the care and treatment they needed.

People told us they continued to receive a service that was caring. People told us they liked the staff. A person told us, “It’s nice. They are kind.” The service ensured that people were treated with kindness, respect and compassion. Staff we met were passionate about their jobs and making people’s lives as happy and fulfilling as possible. Comments from staff included, “As long as their life is enriched, that’s all I care about” and, “I like to go home and think I have brightened up their day”.

People now received a service that is responsive to their changing needs. People had been consulted and involved in drawing up and reviewing their support plans. Letters and information given to people used symbols as well as simple text to help people understand the content. Where people wanted support, staff read letters and information to them and checked they understood the content. Some people had information in symbol format in their rooms to help them find their belongings easily.

The provider plans to implement a new computerised care planning system in the next year. We have recommended that the provider ensures people are given a copy of their care plan in an accessible format suited to their individual needs.

Care plans were reviewed regularly and any changes to the care plans were updated on the agency records promptly. Changes to the management structure and recruitment of new team leaders meant there was more time for management tasks, such as updating care plans, to be completed. People were supported to talk about their wishes for care at the end of their lives and care plans setting out their last wishes were drawn up in a format people could understand.

People knew how to make a complaint and were confident any concerns or complaints would be listened to, investigated and addressed.

The management of the service had improved and was now well-led. Progress had been made to promote people’s independence and reduce the institutional aspects of the service. There was greater consultation with them about their belongings and where these should be kept. The management team had taken action to challenge staff where they found outdated practices and supported staff to consider new ways of working.

Staff turnover had reduced, and staff morale had improved. There was a clear management structure in place with sufficient management time allowed to carry out management tasks such as staff supervision and support. Staff told us the level of the support they received had improved significantly in the last year. Comments from staff included, “It’s good. I feel like I am supported. There is always someone there for advice on the phone” and, “The bosses are hands-on. They really care. We are very well looked after”

There were efficient systems in place to monitor the service and ensure all areas were running smoothly and safely. There were monthly audits carried out by team leaders, service managers and the registered manager covering all aspects of the service. Annual surveys were sent out to people using the service, community professionals, relatives and staff. The provider’s quality monitoring systems showed that improvements had been made in most areas in the last year.

Further information is in the detailed findings below

Lifeways Community Care (Exeter) provides personal care and support to people living in their own homes in Exeter, Mid Devon, East Devon, North Devon, Plymouth and Newton Abbot areas. At the time of this inspection there were 32 people who received personal care. In addition they provided support to a further 109 people who required support without personal care. This part of the service is not covered by CQC legislation and therefore was not included in this inspection.

There was a registered manager in post who was appointed at the end of 2016. In the last year there have been three changes of registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. Staff told us the new registered manager had introduced many positive changes and improvements. Comments on the registered manager included “Absolutely fantastic! Things filter down now. Praise for staff is passed on.”

The provider had systems in place to monitor the quality of the service. However, they did not always take prompt or effective action to address any areas where improvements were needed. We also found that where the provider had made improvements in the past, these had not always been sustained.

Staff morale had been very low in the last year, and staff turnover had been high. There were signs this was improving following a recent recruitment campaign that had resulted in most vacant posts being filled. Actions by the new registered manager had helped to build staff morale, for example by visiting most of the shared houses and meeting people who used the service and many of the staff team. However, some concerns raised by staff related to the provider’s management of the service. Team leaders had insufficient management hours to enable them to carry out their managerial tasks such as regular supervision for support workers. We also found some staff had not received supervision at the frequency laid down by the provider. In previous inspections we had also found there had been problems due to low staff morale and high staff turnover. Where improvements had been made, these had not been sustained.

Progress towards supporting people to achieve independence and control over their lives had been slow. Some positive steps had been taken, for example, forums had been set up in some areas to enable people to have greater involvement in the service. People had been involved in drawing up and agreeing their support plan before the service began. However, some people were unsure if they had been involved in regular reviews of their support plan. Progress toward supporting people to hold a copy of their support plan, or hold their own medications, had also been slow. Support plans provided staff with detailed and up-to-date information on all aspects of people's support needs but were not always provided in a format that enabled people to understand or be fully involved in planning their support needs.

New staff received induction training that provided them with a good basic level of knowledge and competence before they began working with people. There was an on-going training plan offering staff regular updates on health and safety related topics, including some topics relevant to the individual health and personal care needs of the people they supported. However, some target dates for staff to complete these training topics had been missed. The registered manager told us they were aware of the need for staff to complete the training and they were making progress towards meeting the targets.

Each person had a plan in place giving instructions to staff on how to support the person. Support plans had been reviewed and updated in the last year, and provided clear and detailed information on all areas of the person’s health and personal care needs, including any risks. However, where changes had been made to the copy of the support plan in the person’s home, the copy held in the agency office had not always been amended at the same time. This meant that if problems or queries were raised with senior members of the management team, they did not have access to up to date or accurate information about each person’s needs to enable them to make informed decisions or take appropriate action to ensure people received a safe and responsive service.

Arrangements were in place to receive and investigate people's concerns and complaints. People told us they knew how to make a complaint, and most people said they were confident these would be listened to and acted upon promptly. A person told us “I have been given information about how to make a complaint in my file, and it’s by the telephone.” The provider invited people to complete a survey in 2016 which included questions about the complaints process. People were asked "If you ever make a complaint do things change for the better?" The results of the survey showed that 58% of people agreed that this had changed for the better after they had made a complaint. However, 29% of people were not sure and 13% disagreed. At the time of this inspection we found the level of confidence in the complaints procedure was beginning to improve.

People were protected from abuse and harm by staff who had received training to enable recognise potential abuse and knew how to report it. Towards the end of 2016 we received a number of concerns and complaints about the service, including concerns raised by whistle blowers. These were passed to the local authority safeguarding team who investigated the concerns and met with the senior management to draw up and agree an action plan to address the concerns. At the time of this inspection we found improvements had been made in a number of areas, including staff recruitment and management of medications. A member of staff told us “I am one hundred per cent certain I could contact the appropriate person if I had any concerns (about potential abuse)”. Safe recruitment procedures were followed which ensured new staff were trustworthy, honest and had the skills and aptitude to meet the needs of the people they supported.

People received support from staff who were caring. A person told us “Staff are very kind to me. If I am upset they will talk to me and comfort me.” A relative said “Staff are very kind and compassionate. When my (relative) was in hospital recently the carers came into the hospital to visit her and be with her. The Consultant and ward staff commented on how kind and compassionate the staff were."

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Lifeways Community Care (Exeter) provides support with personal care to people with learning disabilities and/or mental illness. The support was provided to people living in a variety of settings, such as shared houses, flats and bungalows, and to people living on their own or with their families. The service covered many parts of Devon. People living in shared accommodation had an individual tenancy agreement. At the time of the inspection the service provided support with personal care to 38 people. In addition they also supported a further 105 people who did not require personal care. This part of the service is not covered by CQC legislation and therefore was not included in the inspection.

There was a new manager in post who had not yet been registered. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. Staff were supported by a management structure that provided accountability at all levels.

The service was last inspected in April 2015 when we found some aspects of the service were not entirely safe, effective, caring, responsive or well-led. The overall rating was ‘requires improvement.’ At this inspection we found improvements had been made in many areas, although further actions were needed to ensure people have control over their own lives, and to ensure people are fully involved and consulted.

People did not have a support plan drawn up in a format they could understand. The support plans were detailed and covered all areas of support needs, but the lack of ‘easy read’ support plans meant people had not been supported to take control of, or be fully engaged in planning a service that met their needs. The support plans were regularly reviewed with people, which meant they had an awareness of the plans, and had been consulted about any changes where necessary. Staff told us the support plans provided them with good information about all aspects of each person’s support needs.

Most people received regular support from a small and consistent staff team. However, they did not always know the names of staff or the times staff would be supporting them because they were not given a timetable in a format each person could understand. People told us they were happy with the support they received, and told us the service was usually reliable. There were systems in place to plan staff rotas. This meant staff knew in advance the days and times they were expected to work each week and the people they would be supporting.

At the last inspection we found medicines were not always administered and recorded safely. At this inspection we found improvements had been made. Monitoring systems were in place to ensure medicines had been safely administered. Where errors were found, actions had been taken to reduce risks in future. Where people lived on their own in single accommodation storage of medicines had been risk assessed and people had control of their own medicines according to their individual needs and circumstances. However, medicines for people who lived in shared accommodation were usually stored centrally which meant people did not always have control of their own medicines.

The provider had a quality monitoring system that ensured checks were regularly carried out on many areas of the service. However, the quality monitoring system failed to show that they had identified areas for improvement such as promoting people’s independence and control by providing support plans and information in a format people could understand.

There was a complaints policy in place and the service kept a record of all complaints, including the investigations carried out and responses given to complainants. Most people we spoke with knew who to speak with if they had any concerns. However, questionnaires sent to people by the provider showed that almost half the respondents were unhappy with, or lacked confidence in the complaints procedure. The questionnaires had been collated and people were given a summary of the outcome with assurances that their comments would be actioned. However, we were unable to see evidence to show how this was being put into practice.

Where people were unable to manage their own money and had no relatives or representatives willing or able to take on this task, the provider held responsibility for this task. There were robust systems in place to manage people’s savings, income and cash safely. The provider was in the process of handing this responsibility to an organisation specialising in this task. Where people did not have capacity to make important decisions for themselves, for example how to manage their finances, their capacity had been assessed and ‘best interest’ procedures had been followed.

At the last inspection we found some risks to people’s health and safety had not been assessed, reviewed or acted upon to prevent possible harm or injury. At this inspection we found risks such as choking and falls had been identified and actions had been taken to involve relevant health and social care professionals, carry out assessments and put in place actions where possible to reduce the risks. Staff supported people to attend medical appointments. Support plans provided detailed information on all aspects of each person’s health needs.

People were supported by a consistent, reliable and happy team of staff. Staff shortages meant support sessions had sometimes been covered by other agencies, and people therefore received support from a member of staff who did not know them well. This was being addressed because new staff had been recruited. Risks to people’s safety were reduced because robust recruitment procedures had been followed. New staff received induction training that provided them with a good basic level of knowledge and competence before they began working with people. There was an on-going training plan in place that provided staff with regular training and updates on health and safety related topics, including some topics relevant to the individual health and personal care needs of the people they supported.

Staff told us they were well supported. They received regular supervision from their team leaders, and team meetings were held regularly where they could raise issues and discuss where changes or improvements could be made. However, some staff also said that communication with the provider and senior managers could be improved. The new manager told us they were aware of this and had begun to take actions to improve communication, for example by sending out regular newsletters to all staff.

People told us the staff were always caring. Comments included said “All the staff are kind – never bossy” and “They are really helpful. We have a laugh and a giggle. If I am struggling they help me cope.”

We have made three recommendations relating to the quality monitoring and improvement systems, responding to complaints, and about involving people in the service by providing information and support plans in a suitable format.

People told us they were happy with the care and support they received. We heard examples of how Lifeways Community Care (Exeter) staff had supported people to help them gain independence and control over their lives.

Medicines were well managed. People received support with their medicines that was tailored to suit their individual needs and as prescribed by their GP.

Safe procedures were followed when new staff were recruited. All required checks were carried out before new staff began working with vulnerable people. They made sure applicants were suitable and had the knowledge and skills necessary to meet people's needs.

People knew how to raise any concerns or complaints. They told us they were confident they would receive support if necessary to make sure their concerns were listened to, investigated and actions taken where necessary to address the matters they raised.

People experienced care, treatment and support that met their needs and protected their rights. Comments included 'Lifeways gives me the support I need,' and 'Lifeways is a good organisation. We get the help we need.' Care and support needs were well planned and staff had the right information to ensure they understood people's needs.

People who used the service were protected from the risk of abuse. People told us they felt safe. We saw evidence to show that effective procedures were in place to ensure all incidents or concerns about potential abuse had been addressed thoroughly following good practice procedures.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. People told us they liked all of the staff who supported them. Comments included 'The staff are nice.' We saw evidence to show the staff had received training and support and had the right skills to meet people's needs.

The provider had an effective system to regularly assess and monitor the quality of service that people receive. We saw evidence of a variety of auditing tools and methods to seek people's views to ensure the service remained fully compliant with all essential standards.