Lifeways Community Care (Halifax)

Lifeways Community Care (Halifax) is a supported living service providing personal care to people living in West and North Yorkshire. The service provides support to people with mental health needs, people with a learning disability and autistic people. At the time of our inspection there were 127 people using the service across 27 ‘supported living’ settings.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The service could not show how they met some principles of right support, right care, right culture.

Right Support:

People were not always safe and were at risk of avoidable harm.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Accidents and incidents were not always reported. Where they were, outcomes were not always shared with staff and completion of relevant documentation was missed.

People lived in accommodation that was designed to fit into the local residential area.

Right Care:

People’s needs were not always met.

Care delivery was not always person centred and the service did not always focus on people’s quality of life.

Care, activities and goals were not always planned in a way which met peoples individual needs.

Risks to people were not always assessed or managed safely. Some people did not have the required risk assessments in place for staff to follow, and some people’s risk assessments were not being followed by staff.

Medicines were not managed safely.

People told us they were happy with the staff who supported them. We observed kind and caring interactions between staff and people, and staff knew people well.

People’s communication needs were met and well documented in the support records. Information was accessible for people in a range of formats to ensure their understanding.

People were protected from abuse. The provider had implemented new systems for safeguarding people’s finances, and arrangements were in place to continue to improve this system.

Right Culture:

There were widespread and significant shortfalls in service leadership. Leaders did not assure the delivery of high-quality care.

Governance systems were not effective and did not ensure people were kept safe and received high quality care and support in line with their personal needs.

The service did not ensure staff had sufficient time to give people the care they needed.

Training was not well managed and high numbers of staff were not compliant in some of the required and mandatory training, with some required training not being provided to staff by the provider.

People, relatives and staff told us the service was not good at communicating when concerns had been raised or when things had gone wrong.

Recruitment processes were safe and robust. They ensured staff were suitable to work with the people who used the service.

The management team were responsive to the inspection findings. Action had already been taken to improve systems and processes as outlined in the action plan from the last inspection, this was ongoing.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 28 September 2022), and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an announced inspection of this service on 3 and 10 August 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, medicine management, person centred care, governance and staffing.

We undertook this focused inspection in part to check they had followed their action plan and to confirm they now met legal requirements, as well as being prompted due to concerns received about medicines, safeguarding people from abuse, staffing and management arrangements. This report only covers our findings in relation to the key questions safe, responsive and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lifeways Community Care (Halifax) on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to person centred care, safe care and treatment, medicine management, staffing and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

At the last inspection we reported the provider had failed to notify CQC about some significant events and this was being dealt with outside of the inspection process. We reviewed our information and decided no further regulatory action was required. The provider assured us they had improve their systems for notifying CQC and our records supported this.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this time frame and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Lifeways Community Care (Halifax) is a supporting living service providing personal care to people living in West and North Yorkshire. The service provides support to people with mental health needs, people with a learning disability and autistic people. The service provides supported living services across West Yorkshire and North Yorkshire. At the time of our inspection there were 65 people using the service across 25 ‘supported living’ settings.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The service could not show how they met some principles of Right support, right care, right culture.

Right Support:

People were not safe and were at risk of avoidable harm.

The service did not always balance risk management with people’s rights.

The provider had failed to tell us about significant events such as allegations of abuse, which meant they did not fulfil their legal responsibility and we were unable to monitor the service.

Accidents and incidents were not always investigated or dealt with appropriately. The provider did not have an accurate overview of what was happening in the service or an effective analysis of learning to improve the service.

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

People lived in accommodation that was designed to fit into the local residential area.

Right Care:

People’s needs were not always met.

The service did not always focus on people's quality of life and care delivery was not always person-centred.

Care and activities were not always planned in a way that met people's individual needs.

People's communication needs were not met, and information was not shared in a way that people could understand.

Risks to people were not always assessed and managed safely. Two family members told us their relatives were not safe.

The service did not manage medicines safely.

People who used the service told us they were happy with the staff who supported them. One said, “Staff are nice.” Another described staff as “Great”. Staff were observed interacting positively with people and asking people what they wanted to do. We saw staff knew people well.

People were protected from abuse. The provider had improved their arrangements for safeguarding people’s finances.

Right Culture:

There were widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The service did not always make sure staff had time to give people the support they needed.

Staff told us they had received appropriate training, but we did not receive training records to confirm this.

Governance systems were not effective and did not ensure people were kept safe and received high quality of care and support in line with their personal needs.

People’s experience of how concerns were dealt with varied. The service worked with other professionals when they had concerns about people’s health and wellbeing.

Recruitment processes were robust and ensured staff were suitable to work with people who used the service.

The management team were responsive to the inspection findings. The provider also gave assurances they had started taking action to improve systems and processes. They gave examples of recruiting additional managers and introducing more robust governance arrangements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 3 December 2018).

Why we inspected

The inspection was prompted in part due to concerns received about staffing, medicines, safeguarding people from abuse and management arrangements. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lifeways Community Care (Halifax) on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to person-centred care, safe care and treatment, staffing, failure to notify significant events and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

The breach, relating to the provider failing to notify CQC, is being dealt with outside of the inspection process. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will also meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with local authorities to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At the last inspection in May 2016 we found the provider was rated overall as good. At this inspection we found the provider was still overall good with responsive improving to outstanding.

Lifeways Community Care (Halifax) provides support for people with a range of disabilities and complex needs. The service provides supported living services for people living across West and North Yorkshire and East Lancashire. The service aims to enable people to live independent and dignified lives, by the provision of care within their own homes. At the time of inspection there were 59 people receiving a personal care service.

A registered manager was in place. 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.

We found strong evidence the service actively sought the views of people using the service through innovative methods, fully involving them in the interviewing process for new staff, and knowledge sharing. We found an extremely dedicated and knowledgeable management team committed to ensuring people could live as fulfilling lives as possible. Staff showed consistent attention to detail which meant people received a good level of care and support that was completely centred on everyone’s needs. This promoted people's health and wellbeing and enhanced their quality of life.

People said the standard of care was excellent and they were extremely well cared for. People spoke very highly about staff, the support they received and opportunities available to them. People had developed exceptionally strong relationships with staff. Staff including management knew people very well and consistently helped them achieve their dreams and aspirations.

The service had strong links with the local community. This empowered people to be involved in events and activities which took place in the local area. Due to the resources available and dedication of the staff team, people had access to an exceptional range of activities. These helped people achieve their dreams and build self-confidence. The service was exceptional at helping people develop their independence through a series of well thought out goals. People were fully involved in the planning and setting of these goals. People's achievements were celebrated by the service to help build further confidence. People were proud to tell us of their achievements.

Staff had opportunities to update their skills and professional development. Staff demonstrated an understanding of the Mental Capacity Act (MCA) 2005. 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.

Staff were confident in supporting people with medicines and knew people very well.

There was a clear management structure and staff clearly understood their roles and responsibilities. There was an open and transparent culture in which staff felt valued and able to approach the registered manager. Staff told us they felt valued and really enjoyed their role. The management team continued to improve and work as much as possible with people’s relatives if they had any concerns or complaints. We saw accident and incident reviews where lessons learnt had been applied through the review of these.

Further information is in the detailed findings below

At the last inspection in May 2015 we found the provider was compliant with the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, but identified a number of improvements were needed to ensure people received good health and support outcomes. At this inspection, we checked whether these improvements had been made.

Lifeways Community Care (Halifax) provides support for people with a range of disabilities and complex needs. The service provides supported living services for people living across West and North Yorkshire and East Lancashire. The service aims to enable people to live independent and dignified lives, by the provision of care within their own homes.

A registered manager was in place. 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.

Since the last inspection a new registered manager was in post. We found a number of improvements had been made to the service since the previous inspection. Care plan documentation was more comprehensive and person centred. The service had improved the way it engaged with and involved people who used the service.

People all said they felt safe whilst using the service. Staff understood how to identify and act on allegations of abuse. Where safeguarding incidents had occurred appropriate action had been taken to help keep people safe.

Since the previous inspection, risk assessment documentation had been overhauled and was now more comprehensive and person centred. Staff had a good understanding of how to look after people in a safe way.

There were sufficient quantities of staff deployed to help ensure people were kept safe and in order to support them to achieve good health and support outcomes. Staff were recruited safely to help ensure they were of suitable character to work with vulnerable people.

Overall medicines were managed safely. In most cases people received their medicines as prescribed, although we did identify some concerns at one supported living property. Prompt action was taken by the registered manager to investigate these concerns and put measures in place to prevent a re-occurrence.

Overall, care and support was delivered by staff who had the right skills and knowledge to care for people. Staff received a range of training and support tailored to their role. However some relatives told us that changes to the staff team led to inconsistencies in the level of care and support.

People were supported appropriately to maintain a healthy diet. People were involved as much as possible in the sourcing and preparation of food to help develop life skills.

People’s healthcare needs were assessed and detailed plans of care put in place. People had access to a range of health professionals to help support their health.

The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, best interest processes had been followed to ensure people’s rights were protected. The service had worked with local authorities to submit applications to the Court of Protection where they thought people were potentially being deprived of their liberty.

People and relatives told us staff were kind and caring and treated people well. This was confirmed in the observations of care and support that we observed.

People’s likes, dislikes and preferences had been obtained through care planning and staff we spoke with were very familiar with the people they were caring for.

People’s needs were assessed and thorough and detailed plans of care put in place. This provided staff with person centred information on how people liked to be supported. Staff we spoke with had a good understanding about the plans of care we asked them about.

The service supported people to plan and achieve goals over time relating to areas such as independence and activities.

The service took steps to involve people in all aspects of the service. For example people were involved in the recruitment of staff and the completion of quality audits as well as the review of their care and support packages.

People had access to a range of social opportunities and activities. People were encouraged to participate in activities daily and also socialise with other people who used the service.

People and staff spoke positively about the way the service was managed. They said the management were supportive and they felt able to raise issues with them.

A range of systems and checks were in place to ensure the quality of the service was assessed, monitored and improved. People were encouraged to provide feedback about the service which was used to drive further improvement.

During and after our visit we spoke with the quality manager, two care team leaders, two support workers, eight people using the service and two relatives of people using the service. Staff, people using the service and relatives all told us the care provided by the service was good and staff received appropriate training to carry out their role.

Comments from people using the service included:-

'I like living here; they take you out shopping, swimming and bowling. We go on the bus; I like buses.'

'I have a busy lifestyle and go to my dad's house once a week to visit. I'm doing an IT qualification at Calderdale College.'

One relative we spoke with said, 'They (relative's name) has been all over in the past and they're really settled now. Staff know how to deal with them and talk with them. They make us very welcome when we visit. They are well looked after.'

The other relative told us, 'I'm absolutely thrilled; I think they staff are fantastic. I think my brother is beautifully looked after and the staff are so patient with them.'

Our visit found that people using the service experienced care, treatment and support that met their needs and protected their rights.

We also found there were effective systems in place to reduce the risk and spread of infection and infection control was well managed.

Evidence we were shown demonstrated there were effective systems in place to regularly assess and monitor the quality of service people using the service received.