Lifeways Community Care (Sunderland)

Lifeways Community Care (Sunderland) provides personal care to people living in their homes in Newcastle and South Tyneside. At the time of our inspection there were 22 people living with a learning disability and/or a mental health related condition receiving a regulated activity from the service.

Not everyone using Lifeways Sunderland receives a regulated activity; CQC only inspects the service being received by people provided with 'personal care' which includes help with washing, dressing and eating.

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.

Right Support:

Staff no longer used some people's homes as an office base; staff related records were now accessed electronically on a laptop.

Staff supported people to access the community. People told us about recent outings they had and others that were planned.

People were 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 supported this practice.

Right Care:

People made daily living choices and supported people to achieve these. There were good relationships between people and staff and staff treated people with dignity and respect.

Staff had reviewed people’s goals and plans were developed to achieve these.

Right Culture:

The registered manager had improved the effectiveness of the quality assurance processes so that areas for improvements were identified and acted on.

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 requires improvement (published 30 September 2021) 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 improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that staffing levels were reviewed and that people were supported to review their goals. At this inspection we found the provider had acted on these and had improved.

Why we inspected

We carried out an announced inspection of this service between 26 July 2021 and 12 August 2021. 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 the need for consent; safe care and treatment; good governance and staffing.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective 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 changed from requires improvement to good. 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 (Sunderland) on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Lifeways Sunderland provides personal care to people living in their homes in Northumberland, Newcastle, North Tyneside, South Tyneside and Sunderland. At the time of our inspection there were 73 people living with a learning disability and/or a mental health related condition receiving a regulated activity from the service. Not everyone using Lifeways Sunderland receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’ which includes help with washing, dressing and eating.

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

People were not always supported to have maximum choice and control of their lives. Staff did not always support people in the least restrictive way possible and in their best interests. The provider had policies and systems in place to support good practice but these had not always been implemented.

People were safeguarded from the risks of abuse by staff who were trained in safeguarding and were able to raise concerns. People’s personal risks were well managed. Medicines were managed in a safe manner. Fire safety actions had been addressed. Staff supported people to keep their homes clean.

There were mixed comments about their being sufficient staff on duty to meet people's needs. We made a recommendation about this.

Staff were supported through an induction period and received training suitable for their role. They did not always receive supervision in line with the provider’s policy.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not always able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture in some of the individual supported living services.

Right support:

• Staff were using some people’s homes as an office base.

• Relatives and staff reported some people were not able to access the community in line with their care plans due to staffing levels.

Right Care

• People were given choices by staff and were supported to pursue their individual likes and interests. People were treated with dignity and respect.

• People’s goals included tasks staff were expected to carry out rather than personal goals.

Right culture:

• The registered managers of the services demonstrated they had the right values and ethos to lead a supported living service. However, audits failed to identify where services could be improved to further develop and enhance people’s experience of living in their own homes.

Based on our review of the key questions of safe, effective and well-led, the service was not always able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

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 good (published 17 February 2021). At this inspection we found improvements were required.

Why we inspected

The inspection was prompted in part due to concerns received about suspected abuse of people in a supported living service and the service having a closed culture. A decision was made for us to inspect and examine those risks. The registered manager and other professionals reported the concerns to us. Staff in the relevant service had received supervision to address any practice concerns.

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

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective 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.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authorities to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

The service had a registered manager who was working their notice at the start of inspection. 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.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, 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 providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Systems were being introduced or strengthened across the organisation to ensure the right culture was being promoted.

A governance system was in place to monitor the quality of the service through audits and feedback received from people, their relatives, staff and external agencies. However, some improvements were needed. External audits were not carried out to check the effectiveness of the audits carried out and to observe staff practice.

We have made a recommendation about continuing to strengthen systems, including quality assurance systems, to ensure an open culture across the organisation.

The vision of the service ensured people with learning disabilities had opportunities to be part of the community. They were supported to make choices and achieve their aspirations. Staff adopted the ethos to provide person-centred care that enabled individuals to develop skills and behaviours to live more independent lives.

Information was accessible to involve people in decision making about their lives. People were 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 supported this practice.

Staff knew the people they were supporting well. People’s care records were well-personalised and up-to-date. There was clear evidence of joint working and strong communication with other professionals to help meet people's needs.

Systems were in place to protect people from abuse. One person told us, “I feel safe because I have privacy and the protection of very good staff.” There were enough staff available to provide individual care and support to each person. Due to the pandemic there had been some changes to the usual staff team supporting people but this did not poorly impact people's care.

Arrangements for managing people's medicines were safe.

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 10 July 2017).

Why we inspected

We had received concerns in relation to management and culture at another of the provider’s services where we found improvements were required. As a result, we undertook a focused inspection at this service to review the key questions of safe and well-led and parts of the caring key question to check the culture of the domiciliary and supported living services.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. However, the quality assurance system needed to be strengthened as described above. Please see the safe, caring and well-led sections of this full report.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Lifeways Community Care (Sunderland) provides a supported living service to people within their own homes or shared houses. The service provides personal care and support to 88 people across several local authorities in the North East. People who use the service have learning disabilities, autism spectrum disorders and/or physical disabilities. People who use the service are supported with personal care, medicines, cooking, shopping, activities and other day to day tasks.

The service had a 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.

We have made a recommendation about medicines. This was because the procedures for the administration of 'when required' medicines and topical creams were not always robust as there was no clear guidance for staff to refer to.

People and their relatives told us the service was safe as people were well looked after. Staff told us they were confident any concerns they raised would be listened to and investigated thoroughly to ensure people were protected. Staff had completed up to date training on safeguarding adults, and could describe different types of abuse and signs to look out for.

A thorough recruitment and selection process was in place which ensured staff had the right skills and experience to support people who used the service. Identity and background checks had been completed which included references from previous employers and a Disclosure and Barring Service (DBS) check.

Contingency arrangements were in place in case of accidents or staff emergencies and on-call management arrangements were in place. Each person had a Personal Emergency Evacuation Plan (PEEP), which provided staff with information about how to support them to evacuate the building in an emergency situation such as a fire or flood.

Staff training in key areas was up to date. Staff told us they felt confident to care for the people who used the service.

People were supported to maintain a balanced diet and to have enough to eat and drink. People were supported to maintain their physical and mental health needs.

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

People and their relatives made many positive comments about staff being caring, respectful and kind. The locations we visited had a homely atmosphere and there were positive interactions between staff, people who lived there and their relatives.

People had access to important information about the service, including how to complain and how to access independent advice and assistance such as an advocate.

Staff supported people to do the things they enjoyed and also encouraged independence with daily living. Support plans contained clear information about the person's level of independence as well as details of areas where staff support was required. Support plans detailed people's needs and preferences.

People, relatives and staff told us the service was well led and the registered manager was approachable. All areas of the service were quality assessed regularly and overall identified shortfalls and areas for improvement.

There were systems in place to gather regular feedback from people who used the service and their relatives. Feedback was acted upon.

The registered manager and senior service manager supported us at the inspection visit.

One person using the service said 'I like my carers.' Another person told us 'Everything is okay, I'm happy.'

One relative said 'X is making good progress with Lifeways.'

Another relative said 'Staff are good.'

We found people's needs were assessed and care was planned in line with their needs. The records were person centred, this means written in a way that describes how a person would want their needs to be met and focused on them as individuals.

Relatives told us they felt included in the care arrangements and decisions.

People who used the service were protected from the risk of abuse.

Family members felt able to report any concerns to the agency.

We found that there were systems in place to monitor the quality of the service, and make improvements where required.

Relatives told us they were 'happy' with the support plans and felt that staff kept them informed about people's care. One relative told us 'I have seen the care plan. The manager came and discussed this with me and we agreed on it'.

We looked at the files of eight people who used the service. All the files contained detailed assessments of the needs of the individuals which were reviewed at regular intervals to reflect people current support needs. One person told us 'I have a care plan and staff accompany me for my hospital appointments'. Another person told us 'I see my doctor all the time. The staff take me to see him'.