Lifeways Paragon Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence people were protected from abuse and avoidable harm.

At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk people could be harmed.

The provider was in breach of a legal regulation in relation to safe care and treatment.

This service scored 56 (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 ensure records demonstrated a positive culture of safety. While we were generally assured the necessary action was taken immediately following incidents to ensure people’s safety, we found not all incident records showed effective analysis had taken place. For example, not all records included details of incident analysis or the lessons that had been learnt to minimise the risk of harm.In addition, for 1 person who had experienced recurrent falls, risk assessment records did not demonstrate a review had been undertaken following all falls to ensure the control measures remained appropriate.

However, the provider had made some improvements to a learning culture following our last assessment. We saw examples of how the provider had listened to regulatory feedback and took action to improve several areas of care provision such as person-centred care planning.

The provider did not always work effectively with people and external stakeholders to establish and maintain safe systems of care. Effective handover processes were not consistently in place where care was shared, increasing the risk of important information not being communicated and people's needs not being met. For a person who accessed education services and regularly went on social leave, we found handover arrangements relating to their medicines and fluid intake were not robust. This meant there was an increased risk medicines may not be administered safely, and the monitoring of the person's hydration needs may not be maintained. We shared our concerns with the provider, who committed to reviewing and strengthening these processes.

At our previous assessment, we identified shortfalls in the information available to support effective hospital admissions. At this assessment, we found improvements had been made. Records were in place to provide external health professionals with clear information about people's care needs, preferences and individual risks, which helped promote continuity of care.

Safeguarding processes were not always effective. A process was in place to record and monitor safeguarding referrals the provider had reported to the local authority safeguarding team. However, we found these records were not always well maintained. For example, we found not all incident records showed safeguarding considerations, actions taken, or outcomes relating to two people's unexplained skin injuries. Further improvements to record keeping was required to ensure leaders had effective oversight of safeguarding referrals and investigations.

However, staff understood their safeguarding responsibilities and described the action they would take if they felt someone was at risk of abuse or harm. People told us they felt safe in the care of staff. Comments included, “I have no safety concerns whatsoever” and "Yes, [Person] feels happy and safe with the care she gets."

The provider did not always ensure staff were provided with detailed guidance to mitigate risks. While the provider had made some improvements to individual risk assessments since the last assessment, we found further improvement was needed to ensure all records were sufficiently detailed to effectively guide staff in reducing the risk of harm. For example, where people had risks associated with their skin and eating and drinking, we found some risk assessments were not always sufficiently detailed. Information about all factors that could increase the risk were not always recorded. Although we identified shortfalls in relation to the detail in some risk assessments, staff knew people well and they could confidently describe the action they took to reduce the risk of harm when delivering care.

The provider was responsive to the feedback and took action to improve some records during the assessment process to reduce the risk.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Staff understood the need to escalate any environmental concerns to the provider for action. The provider had an appropriate system in place to escalate any issues to external stakeholders for action.

Environmental risks were generally assessed and mitigated, including risks relating to fire safety. However, we identified an issue with the emergency call bell system in people’s shared accommodation. The provider had completed a risk assessment and had implemented control measures to reduce the risk. While we found no evidence of harm, we discussed with the provider the need for a long-term fix to ensure people could summon emergency help when required. We were assured the provider was working with external stakeholders to try to resolve the issue.

Theprovidermade sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff were recruited safely and deployed in sufficient numbers to safely care for people. People were generally supported by a consistent staff team who know their needs well. Staff completed a range of training courses the provider deemed mandatory. Improvements were noted at this assessment in terms of staff training completion which included specific training to meet people’s individual needs. We were assured staff received appropriate training to ensure they had the skills to care for people with a learning disability and autistic people. People and relatives spoke positively about staff skills, comments included "[Staff] seem to be well trained and they seem to know what they are doing". However, we did identify some shortfalls regarding medicines related training which we have referred to further under the medicine’s optimisation quality statement.

The provider did not always ensure staff had access to sufficient guidance to safely manage infection prevention and control risks. While care plans contained some information about how to manage people's individual infection risks, not all records contained the detail necessary to support consistent and safe practice. For example, people who received food, fluids and medicines via a Percutaneous Endoscopic Gastrostomy (PEG) tube were at increased risk of infection if appropriate infection prevention and control measures were not followed. We found care plans did not always provide sufficiently detailed guidance regarding when and how personal protective equipment (PPE) should be used during PEG-related procedures, or how contaminated PPE should be safely disposed of to minimise infection risks. In addition, records relating to the PEG care did not consistently demonstrate hygiene practices had been followed prior to the delivery of PEG care. Further improvement was needed to ensure infection prevention and control risks were effectively assessed, managed and mitigated.

However, our observations of people’s homes found their environment was generally clean and well maintained and we observed plentiful supplies of PPE were available for staff use. People and their relatives provided positive feedback about the general cleanliness of their homes.

The provider did not always make sure medicines and treatments were safe and met people’s needs, capacities and preferences. They did not always involve people in planning. Following the last assessment, the provider had put an action plan in place to address the medicines management concerns found. At this assessment, we found some improvements had been made, however, some further concerns were identified.

Medicine administration records (MAR) did not always contain accurate information relating to people’s medicines. We saw for some people medicines had been stopped however, they continued to be listed on the MAR and routes of administration were not always documented. Although staff had received medicines training and had their competency assessed. We were not assured all staff supporting people with some specialised tasks had completed training or had their competency checked.

For people prescribed medicines to be administered when required, there were person centred protocols in place. However, when this included an option to give a variable dose, there was not always enough information to guide staff on which dose to give. We saw evidence people had their capacity assessed for decisions related to medicines and best interest conversations had been completed however, it was not always clear when people’s families or advocates had been involved.

However, the application of topical medicines such as creams were recorded on a topical medicines administration chart and body maps were in place to guide staff on where to apply the creams.