Lifeways Community Care Limited (Bolton)

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

People had care and support plans that reflected their physical and mental health needs. Care plans reflected a good understanding of people’s needs but needed more frequent review to ensure care and support preferences were still valid.

People had health actions plans and health passports which were used by health and social care professionals to support them in the way they needed.

Relatives told us people had access to healthcare professionals who provided guidance and support. Whilst we found evidence that people were supported to attend health appointments, where these were not always available action had not been taken.



Staff knew about people’s capacity to make decisions through verbal or non-verbal means, but these were not always detailed in support plans. Staff were consulting relatives to make health and welfare decisions on behalf of people without the legal authority in place. Best practices within the Mental Capacity Act (2005) were not always adhered to and not all staff recognised potential restrictive practices in place.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us people's needs were assessed and relatives were involved in the care planning. Comments included, "I was involved in the care planning, and I am involved in reviews that take place every 12 months" and "I am involved in the care, a member of staff rings me every week to keep me updated.”

We discussed assessed needs with 11 support workers. They told us care plans reflected people’s needs, although we identified information within support plans that did not always accurately reflect people’s current needs. Care plans were not always reviewed or updated in a timely way.

We received mixed feedback from local authority professionals. One told us some of the care packages were complex and a consistent staff team helped ensure these were met. Another indicated that fluctuating staffing levels meant that some people’s needs were not always met; person-centred care was not always possible.

We reviewed three care plans in detail. Staff were aware of people’s preferred communication methods and responded to these. However, support plans did not contain detail for staff on how to maximise people’s ability to make choices and decisions for themselves, where possible.

Relatives told us staff have a good understanding of people's care needs. Comments included, "Staff know [relative] well, they [staff] follow good practice [when supporting relative] and look after [relative] well" and "Staff know [relative's[ likes and dislikes well.”

Relatives told us people nutrition and hydration needs were met. Comments included, "[Relative's] dietary needs are met. [Relative] is on a modified diet and staff blend foods for [relative] appropriately."

Staff demonstrated they knew the people they supported well. Staff were aware of people in receipt of modified diets, including thickened fluids. Specialist training had been delivered by the Speech and Language Therapy (SaLT) team to help guide staff and to ensure people received safe care.

There was evidence of people being involved in the support planning process where they were able to communicate with staff. Different ways of involving people who couldn’t communicate their needs verbally need to be explored so that care plans accurately reflect what is important and matters to them. We saw no use of any communication tools or aids to help with this process.

Relatives told us people received a good transition into the service and staff worked in collaboration with relatives and other agencies to meet people's needs. For example, staff worked with the local authority and care professionals involved in people's care, sharing information as needed.

Staff spoke positively about their own teams and how they worked together for the benefit of people. Staff were also complimentary about the training, input and support they received from external professionals, for example occupational therapists, SaLT team and epilepsy specialists.

A social care professional was complimentary about how staff continued to support people to the best of their ability, despite facing many challenges. Partners were aware of the limited leadership and oversight individual teams had faced in the months prior to this inspection. A new manager was working on improving this.

Processes were in place to guide staff to work together effectively. Service managers could approach other members of staff in the service to cover shifts if this was necessary, to avoid using agency staff. Daily handovers helped inform staff of events happening within services and staff considered supervisions to be useful. Two people were moving from one house to another; teams of staff were working together to ensure a smooth transition for people.

Relatives told us people had access to healthcare professionals who provided guidance and support. Comments included, "Staff work with the GP and us. If there are any concern, staff will call a GP or an ambulance” and "Staff support [relative] to access healthcare.”

Staff told us people were supported to attend regular health appointments and any scheduled hospital appointments. We saw evidence of appointments and any agreed actions following these. One care plan we reviewed indicated 3 monthly dental appointments for specific treatment were necessary, but none had been attended. Staff had not raised any concerns with regards to the lack of availability of dental appointments or the lack of treatment.

We received mixed feedback from 2 commissioners and a health professional. Improvements had been identified during quality check visits and audits and the provider was working on these at the time of this inspection.

We reviewed a selection of care and support plans for people receiving a regulated activity. We saw 1 person required regular trips to the dentist for specific treatment. This was noted in their care plan. There was no record of any dental appointments or treatments in the 9 months they had lived in the service. Processes in place to ensure the delivery of good person-centred care needed to be improved.

Relatives told us staff monitored people's health and well-being. Comments included, "Staff do monitor [relative's] health and contact their GP if they are unwell", and "Staff are good at monitoring [relative’s] well-being.”

Leaders we spoke with described how the new electronic care planning system would better evidence good outcomes for people. Most of the services we visited were still using paper-based systems, which did not contain enough relevant details.

Staff told us ways they tried to support and promote good lifestyle choices with people able to make their own decisions.

Support plans were basic and needed improving to better evidence how outcomes were monitored and improved for people. It was too early to gauge the success of the electronic care planning system as this was not yet in use across the service.

There was a compliments and a complaints process available for people and other stakeholders to complete.

Relatives told us they had consented to the care for people received as people were unable to consent for themselves. However, records and care plans did not reflect any legal authorisations in place to do this.

We observed staff in one property settling a person into a recliner chair, elevating their feet and placing a tray table in front of them to do a jigsaw. We were told this was what the person liked to do, but staff did not recognise that this was a potentially restrictive practice. There was nothing documented within the person’s support plan to indicate this was in their best interests. We brought this to the manager’s attention.

We spoke to 7 support workers on site and over the telephone about their understanding of consent. There was some confusion with regards to gaining consent where people lacked capacity to make specific decisions regarding their health and welfare. Staff told us relatives had been approached and made decisions for people regarding receiving flu and Covid jabs.

We reviewed the company MCA policy and consent and decision-making processes within care plans. Records and support plans did not reflect when relatives had the legal right to make health and welfare and or financial decisions, however staff gave examples of health decisions that had been made for people who lacked capacity.

There were examples of best interest decisions being made for people. For example, it was deemed to be in a person’s best interest to undergo a medical procedure and an operation was scheduled. The service was not compliant with the MCA and we judged that this was a breach in regulation.