Archived: Lifeways Community Care Limited (Salford)

This service provides care and support to people living in 11 ‘supported living’ settings, so that they can live in their own home as independently as possible. The properties were situated throughout the Swinton area and each house visited supported either three or four people. People had their own bedrooms and shared communal areas such as lounge, kitchen and bathrooms. There was also an additional bedroom for staff which doubled as an office.

In supported living arrangements, people’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The service was last inspected on 16 May 2017 when we rated the service as ‘requires improvement’ overall and in the key questions, effective and well-led. We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regarding meeting people’s nutrition and hydration needs. We also made a recommendation that the provider reviewed its governance and auditing systems in relation to people’s specific dietary requirements.

Following the last inspection, the provider sent us an action plan detailing what they would do and by when to address the breach identified. At this inspection we found the provider had made the necessary improvements and was meeting all the requirements of the regulations.

At the time of the inspection the service had a registered manager. 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.

We found the service had an up to date policy and suitable safeguarding procedures in place, which were designed to protect vulnerable people from abuse and the risk of abuse. Recruitment procedures had been followed and employment checks had been completed prior to staff commencing in post.

The management of medicines promoted people’s safety. Appropriate arrangements were in place to ensure that medicines had been ordered, stored and administered appropriately.

People and relatives spoken with told us people were safe because of the care and support received. People were supported by staff that were creative in their ways of communicating with people to ensure they understood and met people’s needs.

There were comprehensive risk assessments and measures identified to reduce risks. Changes in risk were identified and support plans reviewed and updated to meet people’s needs. People and their relatives’ views and decisions about care provided were listened to and acted upon.

Staff demonstrated they provided care in line with people’s preferences and ensured the service was responsive to people’s individual needs.

Staff were working in line with the Mental Capacity Act (2005) and people were supported to make their own decisions. When required we saw evidence of best interest decisions being made and these were clearly documented to demonstrate the process followed.

People and their relatives praised the staff and were complimentary about the care they provided. Relatives were pleased they had some continuity of staff and felt this was imperative when caring for their loved ones.

The houses visited during the inspection were relaxed and people and staff were observably happy in each other’s company. We saw staff responded appropriately to people when upset or distressed and people were comforted and provided reassurance.

People’s privacy and dignity was maintained and opportunities explored to promote people’s independence. Staff spoke about people positively and were motivated to make a difference to people’s quality of life.

Stimulation, outings and activities were provided on an individual basis depending on people’s one to one hours and interests. Staff also supported people with activities of daily living and indoor activities such as movie nights and games to provide regular engagement.

The service had a complaints procedure in place and we saw complaints received had been responded to within required timeframes.

Staff completed ‘My Lifeways’ training which was an online programme that identified training requirements depending upon the staff members role within the service. Regular supervision and annual appraisal provided staff with the opportunity to explore training and development opportunities.

Staff spoke highly of the registered manager and the positive changes to the service under their leadership. There had been significant changes within the management team and delays encountered establishing a full management compliment which had resulted in some inconsistencies in the houses. However, at the time of our inspection this had been addressed and there were service managers and team leaders identified to provide operational oversight and support.

The service had a range of systems and procedures in place to monitor the quality and effectiveness of the service. Audits were completed both internally and at provider level, with action plans and checklists completed to ensure improvements were made.

Lifeways is a domiciliary care service. The agency's office is located in Salford, Manchester and the service provides flexible personalised care and support for people living with a learning disability who require additional support to live independently within the community.

At the time of the inspection there was a manager at the service who had applied to be registered by the Care Quality Commission. 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 we found the service to be in breach of one Regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the service did not always recognise and therefore failed to meet the requirements of people’s assessed nutritional requirements.

Feedback we received from people using the service and their families was positive, they indicated that staff were caring and supported them well. Staff gave relevant examples of how to care for a person in line with their individual needs and wishes.

Robust processes were in place to protect people and maintain a suitable environment for everybody living, visiting and working at the tenancies. Risk assessments were established to identify any risks associated with areas such as water temperature, sharps and substances hazardous to health (COSHH).

Suitable training was offered to staff to ensure they were competent in recognising the various signs and indicators of abuse and could appropriately and confidently respond to any safeguarding concerns and notify the relevant authorities when required.

The service had satisfactory staffing levels to support the operation of the service and provide people with safe and personalised support. Comments from people using the service, their relatives and staff supported this. Staff were expected to access a variety of training which ensured they were skilled and experienced in recognising the differing health needs and complexities of people using the service so that they could safely and effectively support each person.

Recruitment procedures were thorough and robust. Appropriate steps were taken to verify new employee's character and fitness to work. Staff induction processes contained the correct amount of detail to provide them with the knowledge to carry out their support role effectively and an appropriate level of training was offered to all staff, this ensured staff were equipped with the correct knowledge to support people effectively. People spoken with and their relatives told us staff were knowledgeable of their needs. Staff demonstrated a good understanding of their role and how to support people based on individual need and in a person centred way.

Regular staff meeting and supervisions were offered in line with procedural guidance. Staff felt they were supported well and always had support from the management structure when required. The service also ensured an on call service covered non office working hours, this enabled staff to access the management team both day and night.

The provider had appropriate processes in place for the safe administration of medicines which was in line with best practice guidance from the National Institute for Health and Care Excellence. Staff were trained in the administration of medicines and all medicines were stored securely and safely.

People were provided with personalised care and support based on their individual needs and requirements. Care files contained person centred assessments and support plans to enable the development of the care planning process and support the delivery of care. Effective systems were implemented to maintain independence, by providing a detailed plan covering essential information staff needed to follow. This ensured clear information about people's needs wishes, feelings and health conditions were kept under regular review. Changes to people’s needs and requirements were communicated well which meant staff were kept up to date with these changes.

Staff spoken with were aware of the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). These provide legal safeguards for people who may be unable to make their own decisions. The management team also demonstrated their knowledge about what process they needed to follow should it be necessary to place any restrictions on a person who used the service in their best interests.

Staff interacted in a positive way with people. Their demeanour was that of a caring, respectful and understanding nature. The promotion of people's dignity and rights were supported which ensured people maintained control over their lives. People were given information about their care and the service in general to help them make informed decisions. Their opinions were routinely sought and acted upon by means of questionnaires, one to one meetings. This enabled them to influence the service they received. Comments were received from people during the inspection which supported these observations.

The service had a range of systems and procedures in place to monitor the quality and effectiveness of the service. Audits were completed in areas such as care planning, personal files, staff rotas, people’s finance, staff sickness, daily diaries, food and mealtimes. These audits had oversight at director level.