Lifeways Community Care (Taunton)

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 that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant people were not always safe and protected from avoidable harm.

At our last inspection the provider was in breach of the legal regulations in relation to staffing, safeguarding, medicines, and the safe assessment and management of risk to people. Some improvements were found at this assessment and the provider was no longer in breach of regulations in relation to staffing, safeguarding and medicines. The provider remained in breach of the regulation in relation to the safe assessment and management of risk to people.

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 ensure there was a positive and proactive learning culture. There were processes in place for reporting and learning from incidents, these were effective in some of the supported living services. For example, people had experienced a reduction in incidents. However, in other services there was a lack of analysis and oversight of incidents. Staff did not always receive debriefs following incidents, which meant potential opportunities to learn lessons when things went wrong, were missed.

The registered manager had oversight of incidents on the providers electronic system, and they were in the process of completing some ‘deep dive’ incident analysis to identify themes and trends. The registered manager told us, the provider’s positive behaviour support practitioners were involved in reviewing and analysing incidents for specific people using the service.

Some staff told us learning was shared amongst their team. We received mixed feedback from staff regarding debriefs. One staff member told us, “It’s all reported, we have a debrief, I put things in the communication book straight away. In team meetings we discuss better ways of making sure things don’t happen again and, how we can prevent it.” Another staff member when asked if they were spoken to individually following incidents told us, “Not really no.”

The service had not always effectively worked with people and healthcare partners to establish and maintain safe systems of care. For example, for 2 people it was difficult to establish if health related appointments had been followed up by staff due to lack of recording or information being recorded in different places. During the assessment, staff contacted health professionals to confirm if the required follow up actions had been carried out.

Care plans were in place to support people to have a good day, and strategies were in place to prevent distress. Some people were not always supported in a consistent way when they were distressed. We discussed this with the registered manager who told us they had reviewed people’s records and identified some inconsistencies in how people were supported. The registered manager was taking action to address this.

Two professionals told us people’s care plans had not always consistently been followed, which had caused 1 person anxiety. One of the professionals told us this had recently improved.

One relative told us about how their loved one had not been supported in hospital. They told us although their loved one received 1-1 commissioned support, they were made aware by the hospital staff they were not receiving this in hospital. The family member told us, “Communication from the house was non-existent. There doesn’t seem to be any contingency plans in place for if [name of person] needed to go into hospital.” The registered manager confirmed people’s care plans included information relating to arrangements for people to be taken to hospital. They also confirmed relevant people and next of kin would be informed as required.

Records of people’s care needs were kept so they could be shared with other professionals if needed. This included hospital passports which ensured relevant information was passed over if people were admitted to hospital.

The provider did not always work well with people to understand what being safe meant and they did not always concentrate on improving people’s lives or protecting their right to live in safety.

Staff knew how to recognise and report abuse. However, safeguarding incidents had not always been acted upon appropriately when staff reported them. During the assessment we were made aware of safeguarding incidents that had not been escalated in line with the providers procedure, we discussed this with the registered manager who took appropriate action.

Since our last inspection safeguarding incidents had been raised by a range of sources. The registered manager provided assurances they were working with the local authority safeguarding team regarding the concerns.

Since our last inspection improvements had been made to the way care was provided to ensure people were not unlawfully deprived of their liberty. The registered manager provided assurances that appropriate applications had been completed to authorise a person being deprived of their liberty.

One person told us when asked if they felt safe, “Yes I do, they [staff] are alright to me.” We received some mixed feedback from people’s relatives relating to how safe they felt their loved ones were. Most relatives said they were safe. Comments included, “In general I think [name of person] is safe”, “Yes, [name of person] is safe” and “My relative is safe.” However, 1 relative raised a concern about their loved one’s safety. This related to incidents between people. We discussed these with the registered manager who was aware of the concerns and taking action to address them.

The service demonstrated where restrictions had been reduced. For example, the use of restrictive physical intervention had reduced significantly for 1 person and another person had access to their kitchen where this had previously been restricted.

The provider did not always work well with people to understand and manage risks. Where people were at risk of harm, appropriate risk assessments and control measures were not always in place. One person’s care plan stated they were, ‘at risk of urine burns and skin breakdown’. It also stated a skin integrity body map should be maintained. This was not being completed. Another person’s care plan stated, ‘When in the car can become unsettled’. The service manager told us there was no risk assessment in place relating to traveling in the car. When anxious this person was able to access the communal garden where other people could be present. The service manager told us no risk assessment was in place to consider the risk to other people.

In other services risk assessments were in place and people were involved in these. The registered manager provided examples of where people were supported with positive risk taking. One staff member told us, “I am all for taking positive risks. We risk assess and try and minimise, but we all take a risk in life it's something we should do.”

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

People's homes had a mixed standard of safety. The provider did not always ensure potential risks were detected and controlled. For example, 1 person was at risk of falls, the person had uncovered radiators in their flat. The risks relating to the uncovered radiators, such as risk of burns and potential to fall against the hard edges of the radiators and injure themselves had not been assessed.

A fire risk assessment had been carried out at 1 of the services in October 2024. The fire risk assessment had an outstanding action point that stated a fire drill for night staff should be completed before 22 December 2024. At the time of the assessment this had not been completed.

People had personal emergency evacuation plans (PEEPs) in place and support plans contained a section on maintaining a safe environment. However, for 1 person their PEEP had not been updated to include relevant information following a fire drill where they did not evacuate.

One relative raised concerns regarding the safety of equipment used to support their loved one. They told us this had been raised with the service several times, but nothing had happened about it. We raised this with the registered manager who provided evidence the wheelchair had been assessed and was safe.

People personalised their rooms and were included in decisions relating to the interior decoration and design of their home.

The provider did not always make sure staff were qualified and skilled to provide safe care that met people’s individual needs. Although there were improvements since the last inspection, not all staff had training in relation to people’s specific needs. The provider had identified this during a recent audit and during the assessment the registered manager explained the plans in place to address this.

We received mixed feedback regarding the induction for new staff. One staff member told us the induction was the “worst training” they had ever had, however another staff member told us it was “Good.” Some of the management team raised concerns regarding the induction they received when starting within their management role. However, the provider had recently provided face to face leadership training which the management team told us had been beneficial. The provider had ongoing plans to ensure the management team had appropriate training.

Most relatives were positive about the skills of the staff supporting their loved ones. Comments included, “All the carers bring something to the table. They all have different strengths. Everyone forms their own relationship with [name of person]. It seems to work although I’m not sure everyone’s knowledge is passed on, or if [name of person] has consistent support”, “The current staff have known [name of person] for about 6-9 months. They have the cognitive ability to recognise [name of person’s] needs and are consistent. They have the knowledge to support [name of person]” and “Each of the staff have a different skill set. By and large the staff are stable, a good mix of people.”

We observed that people were supported by enough staff. We received mixed feedback from relatives. Comments included, “At the moment there seems to be enough staff”, “It depends on the staffing as to how often [name of person] goes out” and “[Name of person] loves to go out, chatting to people. There is always an excuse though, not enough staff, no driver.”

Staff were recruited safely. One person had recently been involved in the recruitment of staff by attending a recruitment day. One person told us they chose who supported them and 1 staff member told us people usually picked who they want to support them at the beginning of the day.

The provider did not always assess or manage the risk of infection. They did not always have measures in place to detect and control the risk of it spreading. People were not always supported by staff to live in a clean home, and we were not fully assured the provider was promoting safety through the layout and hygiene practices of the premises. Cleaning schedules were not always in place, and some of the schedules that were in place had gaps. Two of the services were not clean. One relative told us, “The cleanliness of the whole house is an issue.” There was personal protective equipment (PPE) available for staff to use.

There were improvements to medicines management since the last inspection, and people generally received their medicines as prescribed for them. However, there were some improvements needed to people’s medicines records. There were gaps on people’s medicines record charts. On some occasions these had been identified and reported, but not for all. From dose counts and checks it appeared the doses had been given but not signed for. On 1 occasion a medicine was documented as being given in the morning, but was in fact being given in the evening, as confirmed by a staff member.

When medicines record charts were produced in the service, they were not all signed and checked by 2 members of staff to ensure they were accurately transcribed, which would reduce the risks of errors. People’s allergy status was not present on all of the medicines records.

There were suitable arrangements for ordering, storage and returns of unwanted medicines and weekly checks were recorded. There were some improvements needed to the recording of medicines prescribed ‘when required’. Some doses were ticked by staff rather than signed by the staff member who gave them, and the times of administration were not always recorded. For most of the ‘when required’ medicines there were person-centred protocols and guidance for staff when they might be needed. However, 1 person’s support plan lacked clear guidance for 1 medicine about when the GP would need to be contacted for advice.

Staff we spoke with confirmed they had policies available to guide them, and regular training and competency checks took place. Medication audits were carried out, covering administration, stock and ordering.