Lifeways Paragon Limited (North West)

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.

This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

Medicines were not being managed and stored safely and risks to people had not always been taken into consideration. Infection prevention and control practices were not always robust and we found concerns with the environment people lived in; however, some of these concerns were outside of the provider’s control. Lessons were not consistently being learnt and we found gaps in staff training.

Staff recruitment processes were overall robust and accidents and incidents appeared to be managed well. People were protected from the risk of abuse.

The service was in breach of legal regulation in relation to safe care and treatment.

This service scored 47 (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 had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. However, lessons were not always learnt to continually identify and embed good practice. Where people were at risk of choking, risk assessments were not always in place. This was despite a significant incident occurring of this nature. This meant lessons had not been learnt from previous incidents. Some relatives told us they would not always be informed by the staff should a person have a fall. Following our assessment, the registered manager ensured choking risk assessments were in place as required.

There appeared to be an open culture of reporting and staff were knowledgeable on what to do should someone have a fall. Staff told us they completed incident forms and that higher management would contact the service to ensure the person was OK. Most relatives felt risks were managed well. One relative said, “There’s no choking hazards or falls. The staff understand them (person). No medication errors either. (Person) is in a bungalow, no step hazards. (Staff) look after them (person) really well. It’s nice and clean when I go to visit. The staff seem to cope.” Processes were in place to manage accidents and incidents which looked for trends and themes to help reduce future risks. Lessons learnt following falls were shared amongst staff teams.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care; including, when people moved between different services. Relatives told us the transition process for people joining this service was made easy. One relative said, “It was an easy transition, smooth. Handled the right way.” Staff told us the process for when new people joined this service. One staff member said, “When we get an enquiry for new admissions to the service, the service manager goes with the assessor to meet with the person. We pass on as much information as possible to staff through team meetings and discussions.” Another staff member told us how people moved between services. They said, “Sometimes people transition between services. The person will visit a few times to make sure they like it and meet other people and staff.”

Processes were in place should a person need to attend a hospital. People had hospital passports in place and ‘me at a glance’ paperwork which detailed a person’s medical needs and how they liked to be cared for. This ensured people received the appropriate level of care.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately. Relatives told us people were safe using this service. One relative said, “They (person) is absolutely safe. No concerns, no safeguarding, no errors.” People also told us they felt safe. One person said, “I am looked after well. If worried, I will talk to care staff.”

Staff told us what steps they would take should they suspect abuse or neglect and they confirmed they had completed training in this area. One staff member said, “I have absolutely no concerns, people are very safe here and looked after. If I had any concerns, I would report them to the local authority.” The registered manager told us there was an open-door policy across all services to support staff in voicing concerns. Staff were observed to be supporting people with patience and in a supportive way. Systems were in place for investigating safeguarding concerns and we saw evidence of this being shared across services.

The service did not work well with people to understand and manage risks. They did not always provide care to meet people’s needs, that was safe. Risks to people were not always managed well. People who were at risk of choking did not have risk assessments in place and guidance for people who were on specialised diets was not always up to date. One professional felt staff did not always fully understand the risks associated with people’s dietary requirements and the input from the Speech and Language Therapy Team (SALT). For people who required the use of a feeding tube, we could not be assured this was checked and changed at regular intervals. We could not be assured people’s hoist slings, which were used to aid mobilisation, had been serviced within the appropriate time frames. This is important to ensure people’s safety. Some people had specific health conditions which would require guidance in place for staff to follow should their condition deteriorate. However, not everyone had a specific risk assessment in place for this, and for one person who had suffered from seizures in the past, staff were not aware of this risk. Following our assessment, the registered manager ensured risk assessments were in place and tailored to people’s needs.

Relatives told us risks were managed well. One relative said, “There is no risk of choking, but their (persons) food is cut up into small pieces.” Other relatives told us how staff managed medical episodes such as seizures and that equipment was put in place, including seizure mats to alert staff. Staff told us how distressed behaviours were managed. They said, “We sit and talk to people and try and distract them to another activity. Support plans tell us how to manage people’s behaviours.”

The service 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. The environment had been adapted to meet people’s needs which included handrails in corridors and grab rails in bathrooms, however, in some bathrooms, grab rails were not in place and toilet roll holders were broken. One window had a broken window restrictor, and some handrails were chipped and rusty. Some of these concerns were outside of the providers control, however, it was not always clear from records what actions had been identified or reported to the relevant housing company.

Checks of water temperatures and fridge temperatures were in place. However, we found several entries where the fridge temperature was out of range and no action had been taken. Fire risk assessments had not always been updated when people moved bedrooms and Personal Emergency Evacuation Plans (PEEPS) were not always accurate and up to date. First aid boxes were in place; however, some of the products in these were expired and there was no audit or checks in place to ensure they were fully stocked and in date.

People and their relatives told us the environment was safe. One relative said, “Their (persons) home is safe, a lovely flat. All decorated and has a nice garden.” Staff also felt the environment was safe. They said, “It’s very safe here. We have fire drills every few months.”

The service made sure there was enough staff who received effective supervision. However, we could not be assured all staff had the appropriate skills and knowledge for their role. Training records were difficult to understand, and it was not clear which staff had carried out the training appropriate for their role. Not all training courses had been completed recently. For example, training courses relating to communication and caring for people with a learning disability were completed during a staff members induction with no evidence refresher courses had been undertaken. This meant some staff had not completed these courses for some time and may not be up to date with best practice guidance. One professional told us they felt staff were lacking in knowledge when it came to caring for people with a learning disability. Recruitment processes were overall robust; however, we did find some concerns relating to risk assessments not being carried out where appropriate for new staff.

Feedback on staffing levels was mixed. Whilst most people felt there was enough staff, some concerns were raised about the staffing levels at weekends. We did however receive positive feedback about staffing levels. One relative said, “There are enough staff day and night. Staff are consistent.” Staff told us there was enough staff and that arrangements were in place to cover sickness. The registered manager told us there was a robust recruitment process where they looked for candidates who demonstrated a commitment to the service’s core values of compassion, respect and excellence.

People were actively involved in the recruitment of new staff and some people had plans in place outlining what they wanted from their care staff and how they would like to be cared for. This was incorporated into the interview process. We observed there to be a staff presence throughout the services we visited and for those people who required 1-1 support, there was always a staff member present. Staff were receiving regular supervisions.

The service did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading. Not all areas of the services were well maintained. Some slings and shower chairs appeared to be damaged and discoloured, tiles had what appeared to be mould in the grout and sponges people used to wash themselves with were stained black. Some handrails were chipped and rusty and some skirting boards required cleaning and painting. As mentioned above, some of these concerns were outside of the providers control, however, it was not always clear from records what actions had been identified or reported to the relevant housing company. The registered manager took action during this assessment and ensured infection prevention and control concerns were rectified.

People and their relatives felt the services were clean and tidy. One relative said, “The home is always clean and tidy. No outbreaks of any infections, apart from Covid times. Staff wear PPE (Personal Protective Equipment) when I visit.” Staff told us services were kept clean. They said, “We have plenty supplies of PPE including masks, gloves and aprons.” Staff had received training in this area and there was a supporting policy.

The service did not always make sure that medicines and treatments were managed safely and met people’s needs, capacities and preferences. Some people received medication covertly. This meant the medication may be hidden in food, there was no supporting plans or risk assessments for this. For people who had their medicines administered through a feeding tube, it was not clear which staff had received training or undertaken competency checks to ensure they were doing this in line with guidance. Some people received medicines ‘as and when required’ which included medication for distressed behaviours or pain. There were no protocols in place to guide staff on when this medicine was needed and what symptoms to look out for. Creams and liquids were not always dated when opened and the temperature of the medicines room was at times too high. This meant medicines could be ineffective. Some medicine records held details of medicines the person no longer took and the recording of thickening powder in fluids was inconsistent. Following our assessment, the registered manager ensured protocols were in place for as required medicines.

Relatives told us medicines managed well. One relative said, “They support with medication. [Person] comes home to mine with blister packs. Staff inform me of any changes in meds when they drop them off.” Staff told us they were confident in medicines management. They said, “The service manager checks our competency once a year. They watch what we are doing and make sure we are doing it right.”