Lifeways Community Care Limited (Leicestershire County)

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the provider met people’s needs. This is the first assessment for this newly registered service. This key question has been rated Requires Improvement. This meant people’s needs were not always met.

This service scored 39 (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 make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

The provider had not ensured people were at the centre of their care and treatment. Relevant changes in people’s needs had not been assessed and planned for with people, relatives, staff and external partner organisations. Some care records were person-centred to help ensure care was provided in accordance with people’s needs and preferences, however, these had not been reviewed or updated following changes in need or risk mitigation's identified.

Staff told us they had been asking for direction from the management team in terms of managing a new risk identified by the day service a person attends. The staff member said, “I have reported this on numerous occasions as [Name] is at risk of getting in trouble. We have had reports from the day service of incidents. I have emailed the service manager a few times to report the risk. Nothing has been done about it. The care plans haven't changed for years, and we still haven't had any guidance from management of how we should manage this risk or what to do to keep them safe”. This meant staff were not guided or supported by management teams to ensure peoples care is person centred in delivery and new risks to people are managed with care records updated to reflect change in need and staff practice. The registered manager confirmed there was a gap between the services and their ability to ensure effective oversight across the residences they managed, “I am concerned that information is not shared with me timely as there is no formal process to ensure oversight of incidents are reported by the service managers to me directly”

The provider did not have a proactive and positive culture of safety based on openness and honesty. They did not listen to concerns about safety and did not investigate or report safety events. Lessons were not learnt to continually identify and embed good practice. Opportunities to learn lessons to ensure people’s safety and improve their care experience were missed.

People's complex health risks were not robustly managed, which left people at risk of increased significant harm. For example, the management of acute health needs such as diabetes, epilepsy, stoma care and enteral feeding tubes (PEG) was not robust or managed safely. Additionally, oversight of incidents and accidents was poor with no evidence these were acted on to make improvements. For example, incidents where people were distressed and inflicted harm on themselves or others were not supported by an effective oversight process.

Staff told us they were not supported through de-briefing processes. Care plans and records were not reviewed post incident to identify what could be done differently to meet people’s needs and mitigate risks. One staff member told us, “We complete incident forms in the location and send a picture to the management team. We don’t get told if they have received them or if there are any actions to take following an incident. No lessons learnt and paperwork isn’t updated. We have no direction” This meant there was not a thorough process to review incidents, learn from them, improve care and keep people safe.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Some people’s care plans included information around their preferences for communication and how information should be shared with them and some people had completed communication passports for staff to follow.

The registered manager confirmed some written documentation had been completed in Easy Read to support people to understand information if it was beneficial to do so. These included tenancy agreements and medicine policies. The registered manager also told us people have a communication plan in place to ensure peoples preferred communication methods are known by staff.

However, we found some care records for people with complex communication needs, such as people who were nonverbal and required staff to communicate with them using signs, did nothave preferences or details within their care records of how the person uses signs Staff had not received adequate training in communication or the practice of signing. This meant staff did not have up to date guidance or sufficient training to ensure they could meet people’s communication and emotional needs.

The provider did not have effective or robust systems in place to ensure people, relatives and staff felt able to raise concerns and complaints.

The provider had processes for relatives and people to make complaints and raise concerns. However, relatives told us they had not been provided with satisfactory responses or outcomes when following these processes. For example, one relative told us, “Whenever I have raised a concern, the manager is defensive. She emails me back saying we can't do this, or we can’t do that”. The registered manager did not consistently use concerns or complaints to make improvements or share learning with staff. We saw although complaints were recorded in line with the provider’s policy, the records lacked detail, there was limited follow up and the lack of learning culture was evidenced in the repetition of certain complaints.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

In some residences, staff had developed good working relationships with health services such as GP surgeries and pharmacists, however, not all managers and staff had developed good working relationships with local health professionals or knew how to contact the appropriate teams to support people when the need arose. Some people with acute health conditions did not have their needs assessed by relevant health teams and staff could not tell us who they would contact if people’s health needs deteriorated. A person had not had their stoma needs reviewed by a health professional since 2017, despite staff telling us the person had problems with it in 2023. The service manager could not tell us who was responsible to ensure the person had effective clinical oversight. We asked the Registered Manger to ensure the relevant external health professional was contacted to have their stoma needs reviewed.

The provider did not have a proactive and positive culture of safety based on openness and honesty. They did not listen to concerns about safety and did not investigate or report safety events. Lessons were not learnt to continually identify and embed good practice. Opportunities to learn lessons to ensure people’s safety and improve their care experience were missed.

People's complex health risks were not robustly managed, which left people at risk of increased significant harm. For example, the management of acute health needs such as diabetes, epilepsy, stoma care and enteral feeding tubes (PEG) was not robust or managed safely. Additionally, oversight of incidents and accidents was poor with no evidence these were acted on to make improvements. For example, incidents where people were distressed and inflicted harm on themselves or others were not supported by an effective oversight process.

Staff told us they were not supported through de-briefing processes. Care plans and records were not reviewed post incident to identify what could be done differently to meet people’s needs and mitigate risks. One staff member told us, “We complete incident forms in the location and send a picture to the management team. We don’t get told if they have received them or if there are any actions to take following an incident. No lessons learnt and paperwork isn’t updated. We have no direction” This meant there was not a thorough process to review incidents, learn from them, improve care and keep people safe.

People were not supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Peoples care records lacked detail in supporting people at end of life. There was a lack of proactive, and effective planning to ensure people had appropriate pathways in place. One relative told us, “[Name] is not out of bed. [Name] is at end of life. There is a plan, but I’ve had to organise the whole thing, it has been problematic.” Training records showed some staff had read the end-of-life policy; however, staff did not have training in end-of-life care, despite a person living in the service who was being supported with their end-of-life care needs.

People were not supported with their future goals or planned changes to their care and support. For example, a person was looking forward to moving but they didn’t know where they were going or what the plans for their move would be. They told us, "I have lived here for 3 years, it’s okay I am ready to leave but I have nowhere to go at the moment. I want to move nearer to my family and my aunt.” The provider had not developed any transition planning to support this person to achieve their goal. This demonstrated People’s care plans did not reflect planning for their future life development, with short term goals and a progression towards longer term aspirations.