Lifeways Paragon Limited

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• 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. This key question has been rated inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes. The service was in breach of legal regulation in relation to safe care and treatment and the need for consent.

This service was previously assessed in 2018 under a different registered address. The overall rating awarded at the provider’s previous address in 2018 was overall good. The service changed address in 2022. This is the first assessment and rating of the provider at their new address.

This service scored 29 (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 make sure people’s care and treatment was effective as they did not ensure people’s needs, risks, care and wellbeing were properly assessed and reviewed with them.

Records showed the assessment of people’s needs and risks did not take account of the whole person. Not all of people's needs and risks were assessed with appropriate care or risk management plans in place to guide staff in the safe delivery of care. Information on people's needs was sometimes contradictory or out of date and when people's needs had changed, care plans were not always updated appropriately.

We saw some evidence people’s care records were reviewed by staff, but this appeared to be a records-based exercise as opposed to an actual review of people’s care.

Daily records in relation to some people’s care and well-being, for example diet and fluid charts, repositioning, and bowel records showed gaps and inconsistencies that suggested people were not in receipt of the care they needed. There was little evidence the delivery of people’s day to day care was reviewed by the provider to ensure people were in receipt of safe and effective care.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

We found serious shortfalls in the assessment, monitoring and management of people’s needs, risks and care which did not adhere to best practice guidance issued by Public Health England CQC, NHS England, Bladder and Bowel UK and guidance issued by the National Institute of Health and Social Care Excellence (NICE); in respect of falls, nutritional care and the prevention and management of pressure sores. Risks in relation to falls, nutrition and pressure sores were not always properly assessed. Staff lacked guidance on how to mitigate risks and people’s daily records showed gaps in the care they received in relation to these needs.

The management and delivery of medicines did not adhere to best practice guidance published by CQC and the Royal Pharmaceutical Society in respect of medicines as people did not always receive the medicines they needed as prescribed or when needed.

The Mental Capacity Act 2005 (MCA), legislation designed to protect people’s legal right to consent was not always properly followed, which meant legal consent to some specific decisions had not been obtained appropriately.

As a result of the above failings, we could not be assured the provider was complying with CQC’s Right Care, Right Support or Right Culture guidance in respect of the model of care being used to support autistic people or people living with a learning disability.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Records relating to people’s needs and the support they required, were not accurate, up to date or clear which impacted on the provider’s ability to share critical information with other services and teams to support people.

Staff teams in people’s individual homes were positive about working for the provider and told us they worked well as a team to ensure people’s needs were met. One staff member told us, “The teamwork is great”. Records however did not always reflect this. For example, one person was immobile and was unable to change their own position to relieve pressure on their skin and prevent pressure sores. This meant the person required support from staff to reposition at regular intervals. Records in relation to this support were ad hoc and consistent and did not show staff were working well as a team to meet the person’s skin integrity needs.

People we spoke with told us staff were kind and ready to help. In the homes we visited, we saw people looked happy with the staff team supporting them, choosing to sit with and spend time with them. This indicated staff worked well as a team to create a warm and homely living environment where people felt relaxed and able to ‘be themselves’.

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

People’s nutritional and hydration needs were not properly assessed. Best practice guidance issued by NICE guidelines ‘Nutrition Support in Adults’ outlines the importance of screening and assessing the risk of malnutrition and obesity to mitigate the risk of preventable health conditions such as malnutrition, dehydration or obesity. This guidance had not been followed by the provider to ensure people’s nutritional and hydration needs were properly identified and managed.

Records of dietary and fluid intake were either not properly maintained or showed intake was inadequate to mitigate risks to people’s health and wellbeing. There was also little evidence people’s weights and dietary intake were monitored appropriately to ensure they received a balanced diet and sufficient hydration. For example, one person’s records showed they had experienced weight loss, but there was no context to this information or guidance for staff to follow to promote their nutritional intake.

Staff told us weekly meal planning took place with the people they supported to enable them to choose what meals or snacks they would like for the week. Records however did not reflect people were always given a choice at mealtimes with some meals recorded by staff as being made in the ‘person’s best interests’ which suggested their meal choices were made for them.

Safeguarding concerns in relation to the adequacy of one person’s diet had been reported to the Local Authority by their family. This matter was still under review at the time of our assessment.

We saw staff supported people to take regular gentle exercise where they were able and supported them to attend health and medical appointments in support of their wellbeing. Records showed however where guidance from other health professionals had been given, this guidance was not always followed. For example, one person required a thickening agent to be added to their drinks to prevent them from choking. The amount of thickening agent being added to this person’s drinks was incorrect which meant the person’s drink was not thickened to the right consistency to prevent a potential choking incident.

Guidance given to staff supporting people who received their food, drink and medicines via a PEG tube was not always followed to ensure people received the right amount of fluids and food.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

People’s risks were not properly assessed, and staff did not have sufficient information to monitor and mitigate risks to ensure people’s outcomes were positive and consistent. There was limited evidence people’s care was adequately monitored by the provider to ensure their support was safe and effective in promoting positive outcomes.

For example, constipation is a known risk factor for people living with a learning disability, yet despite this, staff had no information on the usual bowel habits of each person to enable them to identify change or and monitor for the early warning signs of constipation. There was no guidance on how to support good bowel health, or the action to take if constipation was suspected. Records in relation to people’s bowel movements were poorly maintained and there was no evidence the provider had any oversight of bowel monitoring to ensure constipation risks were managed.

Some people required regular repositioning to prevent the development of pressure sores or needed help with their continence care. Records reviewed were inconsistently and poorly maintained so it was impossible to tell if people were in receipt of the support they needed to promote positive outcomes and dignity.

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

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to make specific decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We found the service was not always following the requirements of the MCA to ensure people’s rights were respected at all times.

Where capacity assessments had been completed, it was not always possible to tell if people had been involved in their own assessment or supported to participate in the assessment process in accordance with their communication preferences and needs. Some decisions had also been made in the person’s best interest before their capacity was assessed which is not in line with the legal framework.

People’s daily records did show some evidence people had a choice in how they lived their everyday life, for example, what time they liked to get up, go to bed or how they wanted to spend their time.