Archived: Life Path Trust Limited

Life Path Trust is a supported living service providing personal care. The service provides support to people with learning disabilities and autistic spectrum disorders. At the time of our inspection there were 117 people using the service. 45 people using the service were receiving personal care.

Not everyone who used the service received personal care. In this service, the Care Quality Commission can only inspect the service received by people who get support with personal care. This includes help with tasks related to personal hygiene and eating. Where people receive such support, we also consider any wider social care provided.

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

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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of underpinning principles of “Right Support, Right Care, Right Culture.

Right support:

People were not supported to have maximum choice and control of their lives, the policies and systems in the service did not support this practice. Staff did not have a thorough understanding of the Mental Capacity Act 2005 and how to support people who did not have capacity to make decisions. People and relatives told us they thought permanent staff had good skills and knowledge. However, staff did not always feel they had the appropriate training to complete their roles effectively.

Pre-employment checks were completed to ensure staff were of suitable character. People who were prescribed medicines were administered these safely by staff who had received training.

People were supported to maintain contact with people important to them and to follow their interests.

Right Care:

People did not receive safe care. Allegations of abuse were not always referred to the appropriate organisations to be investigated and actions were not taken to protect people from further harm. Risks to people's health and wellbeing were not always assessed and information was not available to staff about how to support people safely.

The provider was undertaking work to improve care records however, we found these were not always personalised and did not always contain accurate information.

Staff had guidance about people's communication styles but did not always consider how they would support people who did not communicate verbally to be involved in reviewing their care. Staff had received training in how to protect people from harm and knew how to report any concerns for people's safety.

Right Culture:

People, relatives and staff did not know who the manager of the service was or who to contact if they had concerns. There was not a culture within the service to empower people, relatives and staff to be involved in making improvements. Audits and quality assurance checks within the service did not drive improvements. The provider had arranged for comment cards to be available in each person’s home to promote more feedback from people.

Language used to describe people and their behaviours was not always respectful and did not always reflect a positive ethos. Audits used to monitor the quality of care people received were not always effective in identifying and driving the required improvements.

People and relatives spoke positively of permanent staff who knew them well and treated them with respect. However, people and relatives stated the care provided by agency staff was not of the same standard and agency staff did not always know them well.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Last rating and update

The last rating for this service was Inadequate (published 26 October 2021).

At our last inspection we found breaches of the regulations in relation to safe care and treatment, protecting people from the risk of abuse, need for consent, treating people with dignity and respect and good governance of the service.

The provider completed an action plan after the last inspection to tell us what they would do and by when to improve.

At this inspection, we found the provider remained in breach of regulations.

Why we inspected

We carried out this inspection to follow up on action we told the provider to take at the last inspection.

Enforcement

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 found breaches in relation to safe care and treatment, protecting people from the risk of abuse, good governance and failure to notify of other incidents at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is inadequate and the service remains in in special measures. This means we will keep the service under review and will re-inspect within six months of the date we published this report to check for significant improvements.

If the registered provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question, we will take action in line with our enforcement procedures. This usually means that if we have not already done so, we will start processes that will prevent the provider from continuing to operate the service.

For adult social care services, the maximum time for being in special measures will usually be 12 months. If the service has shown improvements when we inspect it, and it is no longer rated inadequate for any of the five key questions, it will no longer be in special measures.

Life Path Trust is a supported living service which at the time of our inspection supported 127 people with learning disabilities or autism spectrum disorder with personal care. People lived in their own homes and some people lived in shared accommodation with private bedrooms and shared communal areas. People had differing levels of support needs, some people required 24-hour support whilst other people required support only at specific times. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

People did not receive safe care. People were not protected from abuse and mistreatment and did not always feel safe with the staff who supported them. Allegations of abuse were not always referred to the appropriate organisations to be investigated and actions were not taken to protect people from further harm. Risks to people’s health and wellbeing were not always assessed and information was not available to staff about how to support people safely. Risks relating to COVID-19 were not always adequately assessed and actions were not taken to reduce the risk of transmission of infection when staff worked at more than one location. Pre-employment checks were not always completed to ensure staff were of suitable character. Staff were supplied with and wore appropriate personal protective equipment (PPE) to reduce the spread of infection. People who were prescribed medicines were administered these safely by staff who had received training.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. There was conflicting information about people’s dietary requirements.

People were not supported in a caring way and some people experienced discrimination from staff. Staff did not always respect people’s confidentiality and private information had been shared with people who were not entitled to it.

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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture. People were not involved in decisions about their care and restrictions were in place which reduced their independence and choice. The care provided was not person centred and did not respect people’s dignity, privacy and human rights. There was a culture within the service which dismissed concerns raised by people and they were labelled as people who make false allegations. This resulted in people experiencing abuse and harm even after they had reported it.

Complaints and concerns were not always responded to in line with the providers complaints policy. Complaints were not used to improve the quality of the service. People and relatives were not meaningfully involved in planning or reviewing care. People were not always supported to follow their hobbies and interests. People receiving end of life care received support based on their preferences.

The service was not well led. Governance systems, and management and provider oversight of the service, were inadequate. Systems and processes designed to identify areas of improvement were ineffective. They had not identified the concerns we found.

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 30 November 2017)

Why we inspected

The inspection was prompted in part due to concerns received about people being subject to abuse. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well Led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to keeping people safe from abuse, providing safe care and treatment, providing consent to care, treating people with dignity and respect and oversight of the service. We also identified the provider had not notified us of incidents they were required to.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service. We will work alongside the provider and local authority to monitor actions taken to address the concerns we identified. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We last inspected this service on 14 April 2015 and rated the service as Good. At this inspection we found the service remained Good overall.

There was a registered manager in post who was also the provider. 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 .

People described care workers as being very kind. People had developed meaningful relationships with the care workers who provided their support. Care workers understood the importance of respecting people's dignity and supported them to make decisions about how they wished to live their life. The registered manager and care staff demonstrated their commitment to providing support to people to maintain and develop new relationships.

Pre-employment checks were completed for all new staff to check that they were suitable to work with people who used the service. There were enough staff employed to meet people's needs and to attend each call.

People were kept safe by care workers who had received training on how to recognise and report any suspected abuse. Risks related to people's care were identified and procedures were put in place to minimise the risks. Procedures were in place to support people safely when they took their medicines.

Care workers received training to support people effectively. The registered manager understood the principles of the Mental Capacity Act 2005 and care workers understood the need to gain people's consent before providing care. Referrals were made to health and social care professionals when needed to make sure people received the support they needed.

People worked in partnership with the staff to plan their care and this was continually reviewed to meet their needs. Care workers had good knowledge of people's preferences and offered people choices.

People knew how to raise concerns and felt confident to do so. Two complaints had been received by the service in the 12 months prior to our visit which the registered manager had followed up appropriately.

Care workers received support from the registered manager to deliver high quality care.

People had opportunities to give their feedback about the service they received. The feedback was analysed to make sure the service continued to meet people's needs. The registered manager completed regular quality assurance checks to continually monitor the service people received.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

There were effective recruitment and selection procedures in place at the service. Staff records showed that all staff were trained in the needs of people who used the service.

Accidents and incidents were investigated and reported appropriately.

Written consent to care was not seen in any of the plans of care we looked at. We found that the service had not complied with the Mental Capacity Act 2005 in relation to obtaining the agreement to people's plan of care and support where people lacked the capacity to make decisions for themselves. We saw no evidence that people were deprived of their liberty, meaning that Deprivation of Liberty Safeguards were not breached.

Is the service effective?

Care plans were regularly reviewed. We saw that care plans were based on each person's needs. They were comprehensive and well written. Many care plans included evidence-based management plans for specific medical conditions. However, there was little evidence of consent being recorded for care given. We spoke with twelve relatives of people who used the service. All of these people thought that their relatives were not capable of giving consent for care. They also said that they were not involved in consent for their relatives. One person we spoke with said, "They (Life Path Trust) seem to have taken over that area (consent)." Another said, "They never ask for consent." Another relative said, "I ring them, but I never get a phone call from them (Life Path Care). They don't ask me for consent."

Is the service caring?

People were supported by caring staff. All plans of care were written to reflect each person's needs. We spoke with four people who used the service and they all said they were happy with the service given. One relative said, "(Relative) likes going there, they look after her well." However, other relatives of people said that they were not kept informed by Life Path Trust about significant events. One said, "The hospital rang me when (relative) was admitted, but Life Path hadn't told me. "Another said, "I only hear from them on their annual review."

Is the service responsive?

People's needs had been assessed before care started. Complaints were dealt with well and people knew how to make complaints. The provider regularly used surveys to obtain the views of people who used the service and their relatives. The provider also audited many aspects of the service and used these audits to improve care.

Is the service well-led?

The service had a system in place to obtain the views of people using the service. There was a system for recording formal and informal complaints. There were effective and safe recruitment procedures in place.

You can see our judgements on the front page of this report.

During our visit we looked at four case files of people who used the service. We saw care plans were tailored to meet individual needs as people who used the service required different levels of support.

We spoke with three people who used the service. They told us they were happy with the care they received. One person said, "I like my staff and where I live."

We spoke with four members of staff and the manager of the service during our inspection. Staff we spoke with told us they had received induction and training to assist them to meet people's specific needs safely and effectively.

Staff told us and records showed that all staff had received training in safeguarding vulnerable adults and whistleblowing. We saw training was updated regularly. Staff we spoke with told us how they would report any abuse they witnessed or suspected and how this would be investigated.

We saw processes were in place to monitor people's views about the service. We saw survey results from a recent stakeholder survey, a staff survey, and a customer satisfaction survey. We saw that a high percentage of people were happy with the service provided.

During our visit we looked at five case files of people who used the service. We also spoke with five people who had used the agency. We asked people if they were treated with consideration and respect. People told us they were treated with consideration and respect. One person told us 'I can choose my activities and the meals that I want.'

We asked people about their experience of the care provided, and if they were happy with the care they had received. People we spoke with told us they were happy with the care they received. One person told us 'Life path are good, you can choose who you have to care for you.'

We saw care plans were tailored to meet individual needs. Assessments were drawn up using a person centred approach to involve the individual in planning their own care.

We saw the agency had good auditing procedures in place. Evidence was available to show that checks were regularly made on records and care plans to monitor the quality of care being provided.