Lifeways Community Care (Taunton)

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

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.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant people’s outcomes were not consistently good.

The provider was previously in breach of the legal regulation in relation to consent. Improvements were not found at this assessment, and the provider remained in breach of this regulation.

This service scored 50 (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 make sure people’s care and treatment was effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

The service had a process in place to ensure people had their needs assessed before moving into the service. The assessments were completed with people and their relatives. Areas covered included, communication, capacity, mobility, nutrition, and safety at home. The assessment formed the basis of people’s care plans.

However, people’s changing needs had not always been assessed appropriately. For example, 1 person with a deteriorating health need had not been supported well with their changing needs. One relative told us, they had raised concerns regarding their loved ones deteriorating health, which were not acted upon. The relative told us they supported their loved one to the appointment themselves.

The service did not always plan and deliver people’s care and treatment in line with current evidence-based good practice and standards. For example, we observed 1 person being told by staff they were not able to have a drink when they requested one.

Staff spoken with were aware of people’s dietary needs and requirements and explained how they supported people in line with their speech and language therapy eating and drinking plans.

Staff supported people to maintain links with those important to them. One relative told us, “[Name of relative] rings me a couple of times a week. He seems quite happy.”

The provider had not always worked well across teams and services to support people. People living in different services had different experiences relating to the support they received.

We received mixed feedback from professionals regarding their involvement with the services. One visiting health professional told us they had concerns relating to inconsistencies in staff, care plans not being followed, leading to people experiencing incidents and concerns about the staff culture. The professional told us, following their recent visit there was a more consistent and robust team in place, care plans were predominantly being followed and there had been no major incidents involving the person for 3 months. Another professional raised concerns about the absence of structured activity plans, appropriate routines for people and staff not following up actions. They did comment however staff had gone “Over and above” in some instances.

Staff and the management team provided us with examples of how they worked with health and social care professionals to support people’s needs. Staff gave an example of how they supported a person with their anxieties around appointments such as the GP and dentist. They worked with the practice to visit, used role play, pictures and stories. This had a positive outcome, and the person had experienced positive visits to see health professionals.

The service did not always support people to live healthier lives and reduce their future needs for care and support.

The provider had a system for recording people’s health appointments and any follow up actions or appointments required. These had not always been completed by staff which meant it was difficult to ascertain if appropriate actions had been taken. This had been identified by provider audits.

We received mixed feedback from relatives relating to staff supporting their loved ones with health appointments. One relative told us how appointment letters had been sent to their family member and staff had not supported the person to open them, therefore they missed vital appointments. The relative told us they supported their loved one to the appointments and a significant health concern was identified.This had occurred prior to our assessment and now the person was attending appointments with the support of staff.

Other comments from relatives were positive. Comments included, “They [staff] take [name of person] regularly to see the GP” and “I am sure if he was unwell the staff would know and deal with it appropriately. He goes to see a dentist regularly.”

Staff told us they encouraged people to exercise and eat healthily. One person told us they had set themselves a goal to exercise and lose weight which staff were supporting them with.

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

Although the provider had systems in place to monitor people’s care and treatment, these were not fully effective in ensuring outcomes were consistently positive. People had review sections in their care records to identify achievements, outcomes and future goals. These were not consistently completed. The provider had identified shortfalls in their governance audits.

Review meetings had not been consistently carried out, which was an opportunity for people to give feedback on their support and identify any goals. However, 1 person told us about their care plan and how staff sit with them to review it. This person also told us about a recent review they had and the goals they had set. Records showed they had been involved in preparing for their review and also completed their daily diary record.

Some evidence of positive outcomes achieved were provided during the assessment. For example, a health professional had commented on the positive outcome for 1 person. The professional stated, “I really wanted to take a moment to acknowledge all the hard work [name of staff member] has been putting in to improving [name of person’s] quality of life and how much [name of person] appears to be thriving at the moment. [Name of staff members] hard work, and the support they have received from the, current, management structure has been instrumental in this huge improvement in [name of person].” One relative told us, “The best thing is that [name of person] is extremely settled there. It took a bit of finding. I think the last 9 months has seen an upward trajectory, with good staff.”

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), which provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves, was not always being followed. Appropriate procedures were not always followed where people had restrictions in place. Whilst mental capacity assessments and best interest decisions were in place for most restrictions, we found some examples of where they were not. For example, 2 people had a shield in their car between the driver and the person to prevent incidents, a mental capacity assessment and best interest decision had not been completed for this in both cases. Mental capacity assessments that were in place were of a mixed quality.

Not all staff were fully aware of and following appropriate procedures regarding supporting people with consent. For example, we found 1 instance where a staff member had signed a consent form for a person.

Communication plans and decision-making profiles provided guidance for staff on how to support people to make decisions.