Lifeways Community Care (New Barnet)

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

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was previously in breach of the legal regulation in relation to consent. Improvements were found at this assessment, and the service was no longer in breach of this regulation.
 

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Although people’s needs were assessed before they began using the service, we found that some support plans contained conflicting or outdated information and did not always reflect people’s current needs.

Senior staff had transferred support plans and risk assessments onto the provider’s new electronic system. However, there was minimal evidence that senior staff were routinely reviewing the information to ensure it remained accurate, up to date and aligned with people’s changing needs. This meant inaccuracies or inconsistencies were not always identified or corrected promptly.

These gaps in oversight posed a risk that staff could rely on outdated or incorrect guidance when delivering care, potentially leading to inconsistent support. Regular review, meaningful involvement of people and their relatives, and effective clinical oversight were needed to ensure care plans remained a reliable and current source of information for staff.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

While staff we spoke with demonstrated a good understanding of people’s specific dietary needs and how to meet them in practice, the documentation we reviewed did not consistently reflect this. For example, support plans did not always provide clear, up to date or accurate information, and records did not always show that staff were consistently following the guidance set out within them.

Support plans provided staff with guidance on how to support people to eat healthily, and staff we spoke with told us they actively encouraged people to make healthier choices. However, feedback from relatives indicated that this approach was not applied consistently across all services. One relative told us, “Healthy food options are given for [person] to choose.” In contrast, another relative said, “There’s no healthy eating. It’s all frozen food, takeaways and it shows,” highlighting a variation in how dietary guidance was being followed and monitored.

Although the provider had systems and support plans intended to promote healthy eating, these were not always embedded in day-to-day practice, and people did not always receive consistent support to follow a balanced diet. More effective oversight was needed to ensure staff applied the guidance and that people’s nutritional needs and preferences were supported in a way that aligned with their care plans.

Paper records such as hospital passports and health action plans were not always updated in line with electronic records. Care notes and support plans contained gaps and inconsistencies, which made it difficult to confirm that people’s choices, communication needs and daily preferences were being reliably acted upon.

The provider did not always work well across teams and services to support people.

Agency staff continued to be unable to access the electronic care records system and remained reliant on paper based documents which were seen not to always be up to date. This issue had been outstanding since the previous inspection. The provider told us they were in the final stages of trialling agency access, but progress had been slow. As a result, staff were still required to maintain two parallel sets of records, paper and electronic, which increased the risk of inconsistencies, omissions and delays in updating important information. As highlighted in other parts of this report, we continued to identify examples where neither system was fully up to date or aligned.

Staff told us that handovers were in place and generally provided them with the information needed to ensure they were aware of people’s current needs, routines and upcoming appointments. A staff member told us, “Everyone has a support plan, all staff have to read this. We make sure staff are aware of any professional appointments. We have handover meetings and supervisions. Agency staff have to be inducted; we will give a detailed handover of what they need to do. They read the paper records.” Another staff member said, “There is less agency use now as they have recruited to fill staffing gaps, feels more stable and provides more continuity for the people we support.”

The provider did not always consistently support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

People were mostly supported to access healthcare services, and staff generally worked well with external professionals to attend routine medical appointments. However, feedback from relatives was mixed. While some confirmed that appointments were attended, we noted for one person concerns about previous missed appointments, had been raised as a safeguard to the local authority. Local authority safeguard teams are responsible for looking into these cases and share the outcome with CQC when complete.

We also noted a consultant letter which contained guidance for staff had not been followed up or recorded in their support plan. This was reported to the provider to follow up.

The provider did not always consistently and routinely monitor people’s care and treatment to continuously support better quality and experience of care.

The provider did not always demonstrate the care provided met intended outcomes for people and were positive and consistent. This included reviewing the impacts of changes to the approach to supporting people with complex care needs, clinical outcomes and the expectations and experiences of people themselves.

The provider identified support planning process through specific goals and outcomes support plan; however, this was inconsistent and not frequently followed up or reviewed with rationales and evidence based decision making clearly documented.

Systems designed to review and evaluate the quality of care were not being used consistently or effectively, which meant opportunities to recognise and escalate concerns early, or drive meaningful improvements were sometimes missed. For example, fluid monitoring.

As stated in other areas of this report we found examples where care plans contained conflicting or outdated information, and staff documentation did not always reliably reflect the support being delivered.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

While staff demonstrated a general understanding of the importance of gaining consent and supporting people in the least restrictive way possible, they also confirmed they had training in this area. However, the provider’s documentation and oversight systems did not always uphold the principles of the Mental Capacity Act 2005 (MCA) in practice, and this had not been identified by internal audits.

The provider had made some improvements to mental capacity assessments and best interest documentation since the previous inspection; however, these remained inconsistent across services. We reviewed mental capacity assessments and found examples where the documentation did not accurately reflect the person’s abilities or the legal requirements of the MCA. In some assessments, staff had recorded a person had capacity but had nonetheless completed a best interest decision for the same area of care, something which is only appropriate when a person lacks capacity to make that specific decision. This demonstrated a misunderstanding of the two-stage test of capacity and the purpose of best interest processes.

In other assessments, multiple unrelated decisions had been combined into a single capacity assessment. The MCA requires that capacity is decision specific, as a person may lack capacity for some decisions but retain capacity for others. Combining multiple decisions into one assessment increases the risk of making inaccurate assumptions about a person’s abilities and can lead to overly restrictive or inappropriate care.

Whilst more work was needed in records related to consent and capacity, we did see evidence of staff working together to reduce restrictions on people’s care and support. In 1 example the provider’s positive behaviour support team was working with staff to find alternatives to the restrictions they had in place. As a result, a restriction that had been in place for a significant period of time had slowly been, reduced and eventually removed.