Lifeways Community Care Limited (Bolton)

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

People were protected from the risks of abuse and staff were trusted to keep them safe. The provider had policies and procedures in place for safeguarding to protect people from the risk of abuse.

Some people were involved in their support planning, however, there was a lack of meaningful strategies to encourage involvement from other people. Staff understood about risk and how to keep people safe. Risks were assessed however these needed more frequent review to ensure they remained valid. People received their medicines as required.

Staff were recruited safely and had the necessary pre-employment checks in place before starting work. Staff received an induction when they first started working at the service and training relevant to their roles.

Suitable staffing arrangements were not always in place. Staffing levels were at times minimal. People who needed support from staff, for example with moving and handling or going out into the community, were affected at times as to what they could do and when.

Infection prevention and control was not always suitably maintained in all properties.

This service scored 59 (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 staff learnt from incidents and the service endeavoured to make improvements. One relative told us, "After [relative's] last fall, more staff were brought in to support [relative]. They are very well looked after now." Another relative added, "The service has responded to concerns [I have raised]."

During the onsite visits we engaged with 11 support workers and spoke with 3 service managers and a senior service manager, both face to face and on the phone. There was mixed feedback regarding the culture within the service. Many staff felt supported at a local level and considered their own team to operate well. There was less of a connection with the wider organisation. Staff were grateful for the appointment of a new manager, although not all had met them.

Commissioners had raised concerns prior to our inspection. We received mixed feedback from partners we contacted for feedback. The provider had a service improvement plan in place and was working with the local authority to evidence improvements made.

The provider had recently introduced new processes to have improved oversight of services, including a new electronic care planning system ‘Nourish’. Only 1 service we visited had gone live with this and was parallel running paper-based systems. It was too early to gauge the success of ‘Nourish’ as staff were becoming familiar with the new ways of recording support at the time of this inspection.

People and relatives told us people were safe living in the service. Comments included, "[Relative] is safe", "[Relative] is very much safe. They are very happy and safe and comfortable" and "[Relative] is safe and happy as anything.”

People and relatives told us the transition into the service was good. One person commented, "it was a slow and smooth transition." Relatives added, "Lifeways transition was fine" and "Staff supported [relative] well and supported them to get settled."

Staff provided examples of how people were supported when moving into the service. Two people were being supported to move from one Lifeways property to another. They had met with people living at the new property and had gone for a meal. Their consistent staff team was also transferring with them, helping to reduce any negative impact the move might have.

We received mixed feedback from partners we contacted as part of this inspection. Commissioners we contacted had identified safeguarding concerns and deemed that people were not always kept safe within services. Improvements were noted but these had taken a considerable amount of time.

There were mechanisms in place to ensure people received a smooth transition into services. Assessments were carried out and people visited prior to moving in permanently, to meet others living there and to meet members of the staff team.

People were protected from the risks of abuse and staff were trusted to keep them safe. Comments from relatives included, "[Relative] is well looked after. We have a fantastic team, couldn’t wish for anything more", "[Relative] is unable to express themself, staff would use their body language to know if they are feeling scared or unsafe" and "[Relative] is very well looked after."

Staff were supported through their induction and mandatory training to understand their safeguarding responsibilities. All staff had received training, understood the different types of abuse and when to report to service managers. Staff were confident local managers would respond appropriately.

We observed positive interactions between people and staff during onsite visits to 3 supported living projects. Staff were busy but managed people’s needs; both people and staff were relaxed in their environments. We observed no concerns about poor care or any dignity issues.

The safeguarding and whistleblowing policy included how to raise concerns with local councils and the Care Quality Commission and also how to contact local independent advocacy services. The training matrix provided a record of staff attendance at safeguarding training.

Relatives told us they had been involved with their care planning and ongoing risk management. Comments included, "Staff work with [relative] to manage their risks and “staff manage [relatives'] needs well."

We discussed care plans and associated risks with 11 support workers. They told us care plans reflected people’s needs and there was guidance on how to manage risk. We were not assured that all risks had been identified. Managers were confident that the new electronic care planning system would cover all known risks.

We engaged with 3 service users during our onsite visits. We observed no concerns during our visits, other than the potential risks posed by a makeshift repair in 1 of the properties we visited.

The service had processes in place to manage risks posed to people, although we judged these could be improved. Some of the paper-based support plans we reviewed were basic, but staff were provided with actions to take to mitigate risks. We saw risks aligned with people’s health conditions such as epilepsy and choking.

Staffing levels in the home at night was 1 sleeping member of staff. We did not see that a risk assessment had been completed; it was unclear how a lone staff member would mitigate any risks presented in the event of an emergency.

Relatives told us people's homes were suitable and maintained. Comments included, "The home is lovely" and "Staff maintain [relative's] bedroom."

Staff recognized that the properties were not the direct responsibility of the provider. They told us that some landlords were more responsive than others when it came to carrying out emergency and routine repairs.

During our 3 on site visits we observed potential risks in the care environment. Whilst these had been detected they had not been addressed in a timely manner or to a satisfactory standard. Bathroom facilities in 1 of the supported living houses we visited did not support the delivery of safe care due to makeshift repairs.

Whilst processes were in place to detect, report and act on making environments safe and fit for purpose we judged that these needed to improve.

Relatives told us the staffing levels varied and there were not always enough staff. Comments included, "Lifeways have a big turnover of staff", "There is not enough staff who drive", "There were not enough staff and [relative] kept having falls because of it."

We discussed safe and effective staffing with 11 support workers, 2 service managers and a senior service manager. Not all service managers had support from a team leader. This meant that there was reduced support in dealing with rotas and other staff related processes. In properties where people were less independent staffing levels impacted on what people could and could not do. Staff told us there were occasions when more staff were needed.

We observed care and support in 3 supported living projects during our onsite visits. Staffing levels did not always meet people’s needs as there were times when people were limited in what they could do due to the number of staff on duty.

There was a staffing structure in place and staff had defined roles. There had been limited use of agency staff, however we were made aware there were times when staff had worked long hours to help cover shifts, for example in the event of staff absence or an emergency.

We reviewed safe recruitment by looking at documents for three staff members. There was a dedicated team at a central office to help with recruitment. Whilst we judged recruitment processes to be safe, recruiters had not always considered the need for staff to have wider skills. Training records evidenced that autism and learning disability training was completed by staff during induction. The provider was compliant with the legal requirement of the Health and Care Act 2022.

Relatives told us the service was clean and their properties were maintained. Comments included, "The home is always clean” and “The carers do the cleaning."

Relatives told us staff wore Personal Protective Equipment (PPE). Comments included, "I have seen staff wearing aprons and gloves when they are doing certain jobs" and, "Staff wear aprons and gloves when dealing with residents."

Whilst staff and leaders did not raise any infection control concerns, we were not assured that appropriate steps were taken to adhere to company policy. We questioned the lack of access to soap and a towel on both days we visited a bathroom used by both people and staff. This did not promote good hand hygiene and there was potential for cross-infection.

We flagged 2 infection control concerns during our inspection visits. Both were communicated to managers. Whilst there were reasons for the lack of soap and a towel, any alternatives had not been explored.

Policies and processes in place were not always reflected in practice. A repair to the main bathroom in one home was temporary, and did not promote good infection control. A permanent repair had not been followed up by staff.

Relatives told us people received their medicines as required. Comments included, "Staff administer [relative's] medication. I have no concerns" and "Staff give [relative] their medication, always given on time. Staff are spot on with everything. When [relative] has [prescribed] creams, carers put them on and there are no issues."

Staff told us people were encouraged to self-administer medication when it was safe to do so; assessments reflected this. Staff received training in medication administration and had their competency assessed at regular intervals.

We reviewed medication records in 2 homes for people receiving a regulated activity. These were confusing as some discontinued items were still included on pre-printed medication administration records (MARs) in 1 home. This was a pharmacy error which staff were aware of; they were following up to have these removed. Medicines were securely stored, and protocols were in place.

A medication administration policy was in place and accessible by staff. There was an effective system in place for storing medicines. Regular audits were undertaken by staff on site and checked by service managers. Staff we spoke with were aware of the processes to follow in the event of any medicine errors or incidents.