Lifeways Paragon Limited (North West)

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.

This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

Consent forms were not always signed, and restrictive practices were not always carried out lawfully and safely. Support plans were not always up to date and people’s goals and ambitions for the future were not always documented. Oral care plans were not always in place and we found staff training to be lacking in this area.

Some relatives told us they were involved in the support planning process and they felt people were encouraged to live an active, healthy lifestyle where people’s independence was encouraged.

The service was in breach of legal regulation in relation to consent.

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.

The service did not always make sure people’s care and treatment was discussed and documented. Support plans were not always up to date or accurate. While some people had their goals and ambitions for the future documented, other people didn’t which meant the support plan was not person-centred. It was not always clear who had been involved in the implementation of the support plan or had been involved in reviews and some people and relatives told us they had not seen or been involved in their support planning. The provider was in the process of transitioning over to an electronic care system and the electronic support plans we reviewed were more person-centred and tailored to people’s needs.

Other relatives told us they had been involved in the support planning process. One relative said, “We were part of the initial assessment of them (person) moving there and took part in the planning.” Staff told us they had read people’s support plans and felt they knew people well. They said, “The service manager reviews and updates care plans alongside the social worker, person and families. This is passed onto all staff.”

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. People spoke positively of the service and felt involved in the planning of meals. One person said, “They (staff) cook nice meals. Homemade cheese and onion pie.” A relative commented that there was always plenty of snacks and drinks available throughout the day. Staff told us people were given a choice of what they would like to eat and encouraged people to be involved in this process. They said, “There is plenty of staff. We can sit with people at mealtimes, and it isn’t rushed. People can choose what they like to eat. Not everyone will have the same thing, it’s their choice.”

Nutritional plans were in place which highlighted people’s likes and any special requirements. We did however find SALT plans were not always up to date and work was needed to ensure this process was more robust.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. Relatives told us staff worked well as a team. One relative said, “A member of staff who [person using the service] gets on well with will come in on her day off if they have a (medical appointment.) This takes a lot of pressure off (family).” This empowered people to feel safe around staff who were familiar to them.

Staff told us they worked well together as a team. Handover information detailed any changes to a person’s health needs and separate documentation was in place to record any medical appointments people had attended. This document was available for all staff to read.

We saw evidence of referrals being made to various healthcare professionals as required and partners felt there was a good staff team. However, some professionals felt communication could improve to ensure important information was passed on and embedded.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives, however, oral care plans were not always in place to guide staff on people’s oral care needs. Where they were in place, the information lacked detail. We also found staff training in this area was either not completed or had not been completed for many years. This meant best practice guidance may not have been followed.

Relatives told us people were supported to live healthier lives. One relative said, “They (person) help to prepare meals which are all home cooked and help with jobs around the house.” Other relatives spoke of how staff encouraged people to be active. They said, “They (person) swim at the hydro pool. Staff have the best possible outcomes for them.” Staff spoke positively of the care people received. They said, “Care isn’t rushed, it’s very relaxed here. The staff team are really good and make sure people’s needs are met. We encourage people to go out for walks and to get fresh air, we encourage healthy eating.”

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves. Relatives told us people were encouraged to remain independent. One relative told us how a person was on a specialised diet and staff encouraged and ensured the person stuck to this diet to improve their overall health. Staff spoke of how they encouraged people to take up activities to keep active. One staff member said, “We encourage people to get out. We do activities like cycling and hydrotherapy. People tell us what they like to do, or their families do, and we make sure where possible that this is done.”

We observed staff assisting people with fluids to ensure they did not become dehydrated. Tools for monitoring outcomes were in place and any incidents of distressed behaviours were logged. This was then analysed to look for trends and themes to help reduce future risks.

Although not everyone had their desired goals and ambitions formally logged in their support plan, we did see evidence of some people achieving their desired outcomes and how staff supported in making this happen.

The service did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. Consent forms had not always been signed by the person, advocate or relative. Not every restrictive decision was followed with a capacity assessment or best interest decision and not everyone had the relevant Deprivation of Liberty Safeguards (DoLS) or court of protection in place to ensure people were deprived of their liberty lawfully and safely. For restrictive decisions such as bed rails, there was no appropriate documentation in place to support this where people lacked the capacity to consent. Support plans indicated some people had Lasting Power of Attorney’s (LPA’s) in place. However, no documentation was provided to check what was in place and to ensure the relevant people were involved.

Although relatives knew about certain restrictions being in place, they did not know the full details of these restrictions and there was little evidence of their involvement in this process. Staff told us about the importance of consent. They said, “I always ask for consent before doing something. Some people are non-verbal, but we look for signs such as gestures or nods to say it is OK.” The registered manager told us they supported people in decision-making by presenting information to the person in their preferred method of communication.