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Lifeways Community Care (Swindon)

Overall: Requires improvement read more about inspection ratings

Delta 608, Delta Business Park, Swindon, Wiltshire, SN5 7XP (01793) 539875

Provided and run by:
Lifeways Community Care Limited

All Inspections

12 July 2022

During an inspection looking at part of the service

About the service

Lifeways Community Care (Swindon) is part of a national organisation which provides care to people with learning disabilities living in different communities. The Swindon office manages supported living services for people living in the area of Swindon and Gloucestershire. At the time of the inspection the service was supporting 45 people in 17 different locations. People supported by Lifeways Community Care (Swindon) have physical and learning disabilities, profound difficulties in communicating and can, at times, express emotional distress.

People’s experience of using this service and what we found

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Based on our review of key questions Safe, Responsive and Well-led

Right support: Although the care plans and risk assessments were reviewed, they did not always effectively identify all shortfalls noted during this inspection. Not all risks had been considered in relation to people's specific health needs. The service did not always follow best practice with regard to controlled medicines patches. The manager took immediate action to put things right and make improvements. The service supported people to have as much choice, control and independence as possible. The service supported people to have the maximum possible choice, control and independence be independent and they had control over their own lives. Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs. Staff supported people to play an active role in maintaining their own health and wellbeing.

Right care: The service did not always ensure that care plans were up-to-date and that risks faced by people had been identified, assessed and planned for. Staff promoted equality and diversity in their support for people. They understood people's cultural needs and provided culturally appropriate care. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had received training on how to recognise and report abuse and they knew how to apply it. People using their individual ways of communicating could interact comfortably with staff and others involved in their care and support because staff had the necessary skills to understand them.

Right culture: People received good quality care, support and treatment because suitably trained staff were able to meet their needs and wishes. People's support plans were not always up to date, reflect their needs or demonstrate that the person's care had been reviewed. Checks to ensure that records were up-to-date were not always effective. The provider demonstrated a commitment to create a culture of improvement that provided good quality care to people. However, the success of this approach had been affected by changes in leadership at the service and the high use of agency staff. Staff placed people's wishes, needs and rights at the heart of everything they did. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity. People and those important to them, including advocates, were involved in planning their care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 23 November 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breach in relation to safe care and treatment at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

27 January 2021

During an inspection looking at part of the service

About the service

Lifeways Community Care (Swindon) is part of a national organisation which provides care to people with special needs living in different communities.Lifeways Community Care (Swindon) manages supported living services for people living in the area of Swindon. At the time of the inspection the service was supporting 51 people. People supported by Lifeways Swindon have physical and learning disabilities, profound difficulties in communicating and can, at times, display behaviours that may challenge.

People’s experience of using this service and what we found

Risks to people's health, safety and well-being were assessed and care plans were in place to ensure risks were mitigated as much as possible. People’s relatives told us their family members were safe. Staff knew how to recognise and report abuse. Medicines were managed safely. Incidents and accidents were managed effectively; lessons were learned to prevent future risks.

All staff had been trained in infection prevention and control (IPC) and the use of personal protective equipment (PPE). We observed staff followed current IPC guidance and practice throughout our visit. The service had plans in place to respond immediately and appropriately to an outbreak of infection to ensure the safety of people and staff.

Quality assurance systems were in place to assess, monitor and improve the quality and safety of the service provided. Some people’s relatives told us that communication could be improved between the service management and relatives. Following our feedback the provider was going to introduce appropriate measures to improve communication between the management and relatives of people using the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance the CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People lived in a service that supported them with their independence. Care was person-centred and promoted people's dignity, privacy and human rights. The culture of the service focused on the best outcomes for people. Most of people's relatives and staff praised the management team and the leadership of the service. The manager and the staff team had a good set of values focused on promoting the wellbeing of the people they supported. The ethos of the service was aimed to enable people using services to lead empowered lives.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 23 November 2018).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about staff not wearing appropriate PPE, poor care planning and alleged neglect. The overall rating for the service has not changed following this targeted inspection and remains good.

The CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm resulting from these concerns.

We looked at infection prevention and control measures under the Safe and the Well Led key questions. We look at this in all supported living inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

23 October 2018

During a routine inspection

This announced inspection took place on 23 October 2018.

Lifeways Community Care (Swindon) is part of a national organisation which provides care to people with special needs living in different communities. The Swindon office manages supported living services for people living around Swindon. At the time of the inspection the service was supporting 24 people. People supported by Lifeways Swindon have physical and learning disabilities, profound difficulties in communicating and can, at times, display behaviours that may challenge.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection the service had been rated Good. At this inspection we found the service remained good.

The service had improved to ‘outstanding’ in the ‘responsive’ domain. The service was extremely responsive to people’s needs and wishes. People’s relatives told us that staff had gone over and above their duty this had made a difference to people's lives. People received support to set and achieve goals for themselves. The service had gone the extra mile in providing people with a wide range of activities to prevent social isolation.

The service remained safe. People were safeguarded from potential harm and abuse. Staff undertook safeguarding training. Risk assessments helped to enable people to develop their independence while minimising any potential risks. Any issues raised were fully investigated. Care and treatment were planned and delivered to help people retain their health and safety. There were enough staff to meet people’s needs. Recruitment processes remained robust to protect people from being supported by any unsuitable staff members. Medicines were dispensed by staff who had received training to undertake this safely.

The service remained effective. Staff were provided with training to help them care for people. Staff received supervision and appraisals which helped to develop skills of the staff members. People's dietary needs were recognized. If staff had any concerns regarding people’s needs, people were referred to relevant health care professionals to help maintain their well-being.

People's rights were protected in line with the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager understood their responsibilities regarding this.

The service remained caring. Staff supported people with kindness, dignity and respect. Staff respected people's individuality and encouraged them to maintain their independence to live the lives they wanted.

The service remained well-led. The registered manager, staff and the management team carried out checks and audits of the service. Investigations of incidents and accidents took place and any learning from these issues was implemented to help to maintain or improve the service provided.

3 June 2016

During a routine inspection

We inspected Lifeways Community Care (Swindon) on 3 and 6 June 2016. It was a full comprehensive inspection which was also carried out as a follow-up to our previous visit in November 2015.

We had found four breaches of the regulations at our previous inspection in November 2015. At this inspection we aimed to see what measures had been taken to ensure the quality of the service had improved and check if these measures had been effective. The provider had told us that all the corrective actions specified in their action plans would have been implemented by the end of April 2016. During our inspection on 3 and 6 June 2016 we found that all the recommended actions had been completed.

Lifeways Community Care (Swindon) is part of a national organisation which provides care for people with special needs living in different communities. The Swindon office manages supported living services for people living the area of Swindon. At the time of the inspection the service was supporting 24 people. People supported by Lifeways Swindon have physical and learning disabilities, profound difficulties in communicating and can, at times, display behaviours that may challenge.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care being provided.

Medicines administration was in line with recognised good practice, which significantly reduced the risk of people being subject unsafe medicines administration.

We found recruitment procedures were safe with appropriate checks undertaken before new staff members commenced their employment. Staff told us their recruitment had been thorough and professional.

People told us they felt safe when they received care and support from staff employed by the service. Staff were aware of their responsibilities to report any safeguarding concerns they may have.

Staff felt supported by the registered provider. Staff received regular supervision and appraisal to reflect on good practice and areas for improvement.

The registered manager and staff had a clear understanding of the Mental Capacity Act 2005 and implemented its principles in their practice. They were knowledgeable about protecting the legal rights of people who did not have the mental capacity to make decisions for themselves. The service acted in accordance with legal requirements to support people who may lack capacity to make their own decisions.

People were provided with meals and liquid in sufficient quantities. People were offered choices about the food and drinks they received. Staff supported people to maintain good health and access health care professionals when needed.

Care records showed that people's needs had been assessed before they started using the service and care plans were written in a person-centred way. We saw these care plans were reviewed regularly and with the involvement of people who use the service, relatives and healthcare professionals. We saw professional advice was incorporated into care planning and delivery.

The service had a complaints procedure which was made available to people they supported. People told us they knew how to make a complaint if they had any concerns.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included satisfaction surveys, spot check and care reviews. We found people were satisfied with the service they received.

18, 20 and 27 November 2015

During a routine inspection

We inspected Lifeways Community Care (Swindon) on the 18, 20 and 27 November 2015; this was a full comprehensive inspection to also follow up to our previous visit in May 2015. Lifeways Community Care (Swindon) is part of a national organisation which provides care for people with specialist needs living in the community. The Swindon office manages supported living services for people living in a range of housing provision in Swindon. At the time of this inspection the service was supporting 29 people. People supported by Lifeways Swindon may have physical and learning disabilities, profound difficulties in communicating and presenting behaviour that may challenge.

There was not a registered manager in post at the time of our inspection as the person who had been recruited had only been in post eight weeks and had only just started the application process to become registered. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

At our last inspection on 8 and 15 May 2015, we followed up action we required the service to make following breaches identified in a range of areas in December 2014. The December inspection was also an inspection where we followed up breaches in regulation 9 and 21, which now correspond to regulation 12 and 17 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At our inspection in May 2015 we found there had been improvements, but some improvements were still required and we identified continued breaches in four regulations, 9, 12, 18 and 11. This was due to continued concerns relating to a number of areas, such as; the way staff were being deployed was still not always meeting people’s needs or supporting their well-being and staff we spoke with still did not receive appropriate support and professional development to enable them to carry out their roles effectively. We also found people’s capacity was still not being assessed to ensure their right to make their own choices was being respected. In addition to this, people’s care and treatment was still not always planned in a way that considered all risks and their preferences and people were still not always involved in the design or review of their own care.

At this most recent inspection in November 2015, we found action had been taken to increase the standards of service for people further in all areas, but there were still improvements to be made.

People’s needs were assessed and these assessments were used to create support plans. New support plans were designed in a more person centred way, but they were still not evidencing a person centred process in practise. Relative’s we spoke with were still not involved fully. Whilst support plans identified risks associated with people’s needs, some of these plans did not contain accurate guidance on what actions were needed to mitigate these risks.

The service had been working hard to increase their numbers of staff with the right mix of skills and attitudes. There were enough suitably qualified staff to meet people’s needs and an increased effort had been made to ensure that staffing was deployed in a way that maintained people’s well-being. However there were still occasions where staff were not being deployed in this way.

The numbers of staff trained in the MCA had increased and more staff were able to demonstrate a clear understanding of the act and its principles. However, some staff were still not able to fully understand the key principles of the act and we also observed practise that was not adhering to these principles. In addition, documentation regarding the MCA was still not following the correct process in line with the Act. Staff were not always supported and empowered through supervision to carry out their roles effectively.

Relatives we spoke with felt that staff were caring and shared that staff were becoming more consistent. This was supported by our observations in most of the locations we visited. In one location we found some staff were still not respecting the service as peoples own homes. At the inspection in May 2015 we recommended the service ensure people had more access to Advocacy at our previous inspection in May. We found the provider had taken positive action to ensure advocacy was available to people using the service.

There was a system in place to monitor the quality and safety of the service. Each location since our inspection in December 2014 had received an individual audit with action points feeding in to the wider action plan. At our last inspection in May 2015 we found a number of these improvements had been actioned but some were not completed. At this inspection in November 2015, we found the system had continued to be effective in ensuring tasks had been completed in line with the services action plan, however the system was not always assessing the quality of the tasks completed. This system had also not identified the areas of improvement identified at our inspection. We had required the service to make the necessary improvements to bring some of these areas up to the required standard for the past two inspections.

We identified 4 breaches of the Health and Social Care Act 2008 Regulated Activities Regulations 2014. You can see what action we have asked the provider to take in the main body of this report.

8 and 15 June 2015

During a routine inspection

We inspected Lifeways Community Care on 8 and 15 June 2015. Lifeways Community Care (Lifeways) is a national organisation which provides care for people with specialist needs living in the community. The Swindon office manages supported living services for people living in a range of housing provision in Swindon. At the last inspection the service also supported 42 people across West Berkshire, however from June 2015 the service only supported people in the Swindon area. At the time of this inspection the service was supporting 40 people.

People supported by Lifeways Swindon may have physical and learning disabilities, profound difficulties in communicating and present behaviour that may challenge.

There was not a registered manager in post at the time of our inspection as the service was still trying to recruit. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. At the time of our inspection an interim manager was in place being supported by a regional manager and quality team.

At the last inspection in December 2014 we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was due to concerns in relation to care and welfare, respecting and involving people, supporting workers, management and quality assurance of the service and records. We required the provider to take action to improve. The provider sent us an action plan stating they would be meeting the relevant legal requirements by June 2015.

At this inspection in June 2015 we found action had been taken to increase the standards of service for people but there were still improvements to be made and newly implemented systems to embed.

People’s needs were assessed and these assessments were used to create support plans. New support plans were in the process of being implemented, however a number of people’s files were still to be updated. Whilst most support plans identified risks associated with people’s needs some plans did not clearly indicate what actions were needed to mitigate these risks.

There were enough suitably qualified staff but they were not deployed in a way that met people’s needs.

There was a growing awareness within the service of person centred planning. However,

relatives we spoke with still felt they were not fully involved and some staff we spoke with still had limited understanding of personalised care planning.

Documentation in people’s files in relation to consent and assessment of capacity to consent was not always filled in correctly. The numbers of staff trained in the Mental Capacity Act (MCA) had increased; however, many staff we spoke with could not demonstrate a clear understanding of the act and its principles.

Relatives felt that staff were caring and that the staff were becoming more consistent. This was supported by our observations in most of the locations we visited. In one location we found that some staff were still treating people’s homes like a care home. We have recommended that the service access the British Institute for Learning Disability information in relation to advocacy.

There was a system in place to monitor the quality and safety of the service. Each location since our last inspection had received an individual audit and actions had been identified and were in the process of being completed to improve the services.

At this inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

3, 8, and 12 December 2014

During a routine inspection

We inspected Lifeways Community Care (Swindon) on the 8, 13 and 15 December 2014.   Lifeways Community Care (Swindon) provides care for people with specialist needs living in the community. People supported by Lifeways Community Care (Swindon) may have physical and learning disabilities, profound difficulties in communicating and present with behaviours that may challenge. The Swindon office manages supported living and community services for people living in a range of housing, in both Swindon and West Berkshire. This was an unannounced inspection.

The previous inspection of this service was carried out in June 2014. In June the service was found in breach of regulations in relation to Records and Supporting workers. This was because records did not always contain adequate detail or were not always in place to ensure people’s safety. We also found that staff were not receiving supervision, appraisal and adequate training. Staff were not always supported to understand changes to their role in a way that allowed excellence to flourish.

There was not a registered manager in post at the service at the time of our inspection, but the manager was in the process of becoming registered. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

At this inspection in December 2014, we identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010; you can see what action we’ve taken at the back of this report.

People using the West Berkshire services did not receive the same level of care as people being supported in Swindon. The majority of concerns identified were in relation to West Berkshire services and those being supported in the community.

People were not always safe as not all staff understood their responsibilities with regard to safeguarding and identifying abuse. There were not always enough staff to ensure people had their needs met. The service was aware of this issue and working proactively to improve the situation. The changing staff team and staff vacancies were impacting on people developing caring relationships as care staff were often not with people long enough to develop relationships, or people were being supported by people they preferred not to be. We found that whilst some staff were caring there had been occasions where people were not being cared for appropriately.

Whilst some services were effective in understanding and meeting people’s needs, we found some people were at risk of unsafe care and treatment because their care plans did not detail specific guidelines to ensure consistency. Staff did not fully understand the Mental Capacity Act 2005, so the correct process was not being followed to ensure people were being supported to make decisions and provide consent. Not all staff were receiving regular supervision and appraisal and none of the staff we spoke with had a development plan in place. Not all staff benefited from appropriate training to meet the needs of the people they were supporting. Some staff in line management positions, did not all have the necessary skills and knowledge to perform their roles effectively.

People and their relatives were not always involved in care planning and the service was not adhering to the key principles of person centred care. People were not always being supported in a way that respected it was their own home.

The Manager, who was in the process of being registered, demonstrated a personalised approach and a commitment to good quality care. However, the systems in place to monitor the quality of the service were not effective. We also found that the experience and qualifications of key staff was not at the standard the service stated as ‘essential’.

19, 20, 22 November 2013

During an inspection looking at part of the service

At our previous visit to the home in May 2013 we had found shortfalls in certain outcomes and had required that improvements were made. The service had supplied an action plan explaining the changes and improvements that were being made to ensure compliance. At this visit we looked at these specific outcomes and found that improvements had been made.

We found that staff were receiving training in adult protection and were aware for the process for reporting concerns. The service had appropriately reported safeguarding issues and where required had correctly investigated concerns.

We found that staff were receiving regular supervision and that systems were in place to monitor this process. Supervisions were recorded. Staff we spoke with said they were well supported by their colleagues and the majority of people said they were well supported by their line manager. Some staff told us they thought the service managers could provide more support by visiting the tenancies they supervised more often. Staff were undertaking regular training and there were processes in place for this to be monitored and future updates planned.

The service had systems and checks in place to monitor and audit the quality of service. Where shortfalls were identified action plans were completed with appropriate timescales. The provider had completed a recent questionnaire survey of people who used the service, their relatives and care managers.

22, 23, 24, 25, 29 July and 1 August 2013

During an inspection looking at part of the service

The registered manager told us that the service had been working through its action plan to improve the service it provided. We were told that the registered manager and service managers had been providing regular supervision and support to the various staff teams.

We found that improvements had been made to the support planning process. Improvements had been made to the involving of people in the planning and reviewing of their care and support.

People who used the service told us they were well treated by the staff and we observed positive and respectful interaction between tenants and support staff.

Relatives we spoke with were positive about the care staff but some people felt that improvements could be made to the liaison between the staff and themselves. Two relatives told us they thought they could be kept better informed by Lifeways about issues or concerns regarding their relatives care and support.

Staff were receiving regular supervision meetings and there were regular staff team meetings taking place.

People we visited had the right equipment in place to support their personal care needs and the staff had undertaken the appropriate training to use this equipment.

We observed staff and managers interacting with people who used the service in a respectful and caring manner. We observed staff explaining what support they were providing and asking for consent before commencing.

4 January and 14, 15, 18 March 2013

During a routine inspection

The registered manager told us that Lifeways Swindon employed approximately 250 staff. Care was co-ordinated by a senior support manager, and three office based support managers. Nine team leaders reported to the support managers. The team leaders each managed one or more tenancies.

We first visited the Lifeways Swindon office on 4 January 2013; we found that some records held there were out of date. We revisited the Lifeways Swindon office on 18 March 2013

We visited service users in their tenancies on 14 and 15 March 2013. Some of the service users lacked capacity to consent to our visits. Because of this, our visits were organised and accompanied by colleagues from the local authority adult services team. We spoke with one service user but other service users living in the four tenancies we visited were unable to communicate verbally with us. Therefore we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us to understand the experience of service users who could not talk to us.

We also spoke with 16 staff, the registered manager and a relative during face to face and telephone discussions.