Lifeways Paragon Limited

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs. This key question has been rated requires improvement. This meant services were not always planned or delivered in a way that met people’s needs. The service was in breach of legal regulation in relation to person centred care. 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 43 (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 were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

People’s care plans were not accurate or fully reflective of their needs.They failed to adequately identify people’s up to date needs and risks in order for person centred care to be provided. Records showed gaps and inconsistencies with the support given to people in relation to dietary needs, skin integrity, continence, bowel health and medicines. Robust reviews of people’s needs and care did not take place to ensure care plans were correctly maintained so staff had clear guidance on how to respond to changes in people’s care.

Some decisions had been made on people’s behalf without ensuring the mental capacity had been adhered to and records did not reflect all reasonable action had been taken to support the person to be involved. For example, one person required communication aids to help them communicate with staff, yet there was little evidence these communication aids were promoted to help the person understand or communicate their choices and preferences when decisions about aspects of their care and treatment needed to be made. This did not show the provider made sure people were at the centre of their care and treatment choices.

As a result of the above shortfalls, people did not consistently receive responsive, personalised support that met their needs or promoted their wellbeing at all times.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

Best practice guidance on the diverse needs of the people supported by the service was not always followed to ensured people’s support was safe, effective and joined up. For example, the provider failed to ensure the support provided adhered to best practice guidance issued by CQC, NHS England, Public Health and NICE in respect of falls, mobility, continence care, medicines, the risk of constipation, skin integrity and mental capacity. This highlighted shortfalls in the provider’s understanding of how to appropriately support the diverse heath and care needs of the people using the service.

Continuity of care was not properly supported when people transitioned to and from hospital Hospital passports which provide critical information to hospital staff about people’s needs and care were not always accurate or up to date to ensure continuity of care. When people were admitted to and subsequently discharged from hospital there were no robust systems in place to ensure the person’s transition back to the home was seamless and any changes made by medical professionals adhered to.

Health action plans designed to identify a person’s long term health needs and goals were not always sufficiently detailed or up to date. We did however see some evidence people had an annual health review with their doctor.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Communication care plans were in place. These gave staff information on the signs or gestures people who struggled to communicate verbally, would use to communicate their needs, wants or feelings to staff. Some people also had additional communication aids in place such as iPads or picture systems to help them interact with staff and others. Records in relation to some decisions made on people’s behalf however did not always show these aids were used appropriately to encourage and support people to participate in decision making.

In some of the homes we visited, some people had no access to easy-to-read information about the service or their care. This meant the provider did not comply in full with the Accessible Information Standard (AIS). AIS isa UK law requiring NHS and adult social care providers to ensure people with disabilities, impairments, or sensory loss receive information and communication support in accessible formats like large print, Braille, Easy Read, or via BSL interpreters, so they can understand and use services effectively.

The provider had a complaints policy in place to guide people using the service and their families on how to make a complaint. We saw the provider had produced the complaints policy in an easy ready format but the graphics used to demonstrate points made in the text were not obvious in terms of the point they were attempting to convey to the person. Drawings were used as opposed to Photosymbols recommended by NHS England. Some drawings did not appear to be a good match to the text or were grouped together, instead of being separated out. For example, drawings for writing a letter of complaint, making a telephone complaint or making a complaint by email were all grouped together. It was not clear if there were any other formats advising people how to make a complaint such as an audio recording or video.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

Quarterly forums called ‘Our Voice’ were organised to help people using the service to get together to share their feedback on the service and make any suggestions for improvement. Records showed people gave feedback on ‘what was working’ and what was not working for them’ in terms of the service but it was difficult to know how many people attended and participated in these meetings, as participant numbers were not recorded. We saw group events were a positive outcome of these forums in response to people’s feedback such as a trip to Blackpool, a Sport day in Manchester and an Easter Egg hunt in April 2025.

We saw however that if people raised any concerns in relation to their support, the person had the option of having a ‘call back’ with the registered manager to discuss their concerns. This was good practice. Surveys also took place to elicit people’s feedback.

Staff meetings took place for staff to share their ideas, views and concerns about the running of the service. Staff members told up leaders of the service were open to new ideas and listened to any feedback. The provider also surveyed staff views on the delivery of the service and their working life.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

People’s needs were not properly assessed or monitored which increased the risk of referral opportunities to other health and social care professional in support of people’s needs being missed.

Some referrals had been made to other health and social care professionals for advice in respect of nutrition, skin integrity and general health. Professional guidance given however had not always been followed.

Leaders did not always ensure information about the needs and risks of people’s most likely to experience inequality in experience or outcomes was used appropriately to plan and monitor their care. This impacted on the provider’s ability to ensure equity in experience and outcomes.

Some people’s support was not adequately tailored to their individual needs as staff did not have sufficient information on what these needs and risks were, to ensure equitable support for everyone using the service. There was a lack of provider oversight of people’s day to day care which meant gaps in the delivery of support were not identified or addressed to mitigate the risk of people having unmet needs due to protected equality characteristics. This aspect of service delivery required improvement.

People and their families told us staff supported them to attend medical and health appointments and ensured reasonable adjustments were made where necessary to promote attendance.

Equality, diversity and human rights policies were in place to make sure people were treated fairly, regardless of their age, sex, race, disability or religious belief. Equality and diversity training was available and completed by most staff. Staf spoken with understood people had a right to be treated fairly and equally.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Hospital passports and health action plans lacked critical information about people’s long term health needs, goals, aspirations and plans. Although care records contained an advanced care plan, the majority of advance care plans focused on people’s current needs as opposed to documenting what decisions had been made about people’s longer term needs should their health decline.

No one at the time of our assessment was on end of life care. However, some people had DNARs (do not resuscitate orders) in place and some people lived with degenerative health conditions likely to worsen over time. Despite this, there was little evidence discussions around people’s end of life wishes and preferences had taken place. It is important these discussions take place whilst people are well enough to be involved where possible in making decisions about their future care. One person had a DNAR put into place during a period of serious ill-health. This decision however had not been reviewed following the person’s recovery to determine if the decision was still valid and in the person’s best interests.