Archived: Lifeways Community Care (Chorley)

At the time of the inspection there were approximately 138 people using the service.

At the last inspection in January 2018, the service was rated as 'Good'.

We undertook this announced focused inspection of Lifeways Community Care (Chorley) on 6, 7 and 10 December 2018. The inspection was undertaken due to concerns raised with us about the safety of people using the service. We wanted to be sure people were safe and that concerns that had been raised were being managed. We inspected the service against two of the five questions we ask about services; is the service safe and is the service well led.

No other risks or concerns were identified in the remaining key questions through our ongoing monitoring or during our inspection activity between 6 and 10 December 2018 so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection.

At the time of the inspection the registered manager was unavailable and had not been present at the service since September 2018. They returned to work prior to drafting this report. 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.

In the absence of a registered manager, the CQC had spoken with the provider prior to the inspection around concerns about the management of the service. As a result of this, the provider had put a senior manager from head office who was also a director in place who was managing the service. This person was present at the time of the inspection.

We initially became concerned about safety at the service when we were alerted about significant financial impropriety committed against people who use the service in the spring of 2018. The police, CQC and local authority safeguarding teams were kept informed of developments by the provider in the investigation into these matters.

During the course of the financial enquiry, we were advised by the provider that the registered manager was unavailable and that this was likely to be on a long term basis. We monitored that situation and during the same, became aware of concerns being raised by people, their relatives and social care professionals about the level of care and support that was being provided. This was in addition to the financial concerns we were already aware of.

Although we were satisfied that the provider had put steps in place to protect people using the service from further financial abuse and that the provider was reporting matters to the CQC, we were concerned about other issues. This included issues raised through contacts from staff employed in the service, a number of social care professionals and people who used the service and their relatives. All of these approaches to CQC raised similar concerns of poor staff attitude, lack of supervision and management and poor levels of care and support.

As a result of the additional concerns, we prepared to inspect and in so doing gave the provider 36 hours notice of the inspection as we needed to be sure that management staff would be available at the offices and schemes we visited during the inspection.

During this inspection, we found that the service was in breach of regulations in relation to failing to safeguard people from financial abuse, other safety matters including poor medicines management, staffing issues and poor management and governance. These breaches are under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and are summarised below. For full details, please refer to the 'safe' and 'well-led' sections of this report. You can see what action we told the provider to take at the back of the full version of the report.

The service was not safe because there had been failing in safeguarding people from financial abuse. The registered provider only established a robust system to prevent abuse after people had been put at risk.

On occasions, medicines administration had been poor because of failures of staff to follow policy and procedure.

We noted that some records were kept in relation to incidents that had occurred at the schemes run by the service. There was however a lack of management input, checking and investigation around these matters.

Staffing arrangements were not appropriate and records supported that some training, staff supervisions and appraisals were not taking place.

The service's registered manager had been unavailable for a substantial period of time and there was a lack of management oversight of the schemes and supervision of staff during this time .Staff and people who used the service also told us the service was not well run.

Training records we looked at showed that safeguarding adults was an annual, mandatory course but some members of staff had not been trained in this area for 12 months. Other safeguarding records we looked at showed that the registered provider had notified the appropriate authorities when a safeguarding concern had been raised. There were no concerns around the provider making appropriate notifications and fulfilling their related regulatory responsibilities.

We looked at how risks to people’s individual safety and well-being were assessed and managed. Care records contained risk assessments in relation to areas such as mental well-being and incidents but these were often out of date and had not been reviewed.

All the staff we spoke with, told us they had received training and were aware of their responsibilities in relation to infection control. The service had an infection control policy to guide staff in their roles and to reduce the risk of cross infection.

Throughout our inspection we were assisted by a senior executive from head office who the provider had put in place as an interim manager in the absence of the registered manager. Other senior staff from the head office had assisted in enquiries raised by CQC particularly around the ongoing financial investigation. At the inspection we saw that substantial work was being conducted into this and that the police were being provided with helpful material to assist them in the investigation.

At the time of the inspection there were approximately 100 people using the service.

At the last inspection in July 2016, the service was rated as 'Good'.¿

At this inspection we found the service remained 'Good'.

¿The inspection visit took place on 23, 24 and 25 January 2018 and was announced. We gave the service 48 hours notice of the inspection as the service is community based and we needed to ensure the registered manager would be available at the main office

The registered manager was in post at the time of our inspection and had been registered with the Care Quality Commission (CQC) since February 2015. A registered manager is a person who has registered with the CQC 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 using the service and their relatives told us that people were safe and well treated. During the inspection we saw that people appeared happy and content and not at risk of harm.

Safeguarding adult's procedures were robust and staff understood how to safeguard the people they supported from abuse. Staff also knew how to elevate any safety concerns to the appropriate authorities.

Appropriate recruitment checks took place before staff started work. People were being supported to have a healthy balanced diet. People's medicines were managed safely and they received their medicines as prescribed by health care professionals.

Staff had received training specific to the needs of people using the service, for example, mental health awareness and safeguarding adults. They received regular supervision and an annual appraisal of their work performance. The registered manager and staff demonstrated a clear understanding of the Mental Capacity Act 2005 and people consented to the care and support they received.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People and their relatives, where appropriate, and health and social care professionals had been involved in planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people to meet their needs. Staff encouraged people to be as independent as possible and to do things they wanted to do.

The registered manager and provider recognised the importance of regularly monitoring the quality of the service provided to people. The provider sought the views of people using the service, staff and health care professionals through annual surveys and regular meetings. They used feedback from these events to make improvements at the service. Staff said they enjoyed working at the service and received good support from the registered manager and provider.

People knew how to raise a concern or to make a complaint. The complaint's procedure was available and people said they were encouraged to raise concerns.

Further information is in the detailed findings below.

Lifeways is a national supported living scheme. It provides support for people living in the community with their family or in group home settings and caters for people with a diverse range of needs, such as learning disabilities, autism and acquired brain injuries. People using the service are enabled to live as independently as possible and are supported to maintain their interests on a daily basis. The agency office is located in Chorley town centre, being easily accessible by public transport. At the time of this inspection there were 76 people who used the services of the Chorley office.

At the time of our visit to the agency office the registered manager was on duty. He had been in post for a number of years. 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.

The last inspection of this service took place over four days during July and September 2015. At that time the service was found to be in breach of regulations in relation to safeguarding service users from abuse and improper treatment, safe care and treatment, staffing, person centred care and good governance. Lifeways [Chorley] was awarded an overall rating of 'Requires improvement' at that time.

During this inspection we established that some recent restructuring developments had taken place and we found that significant improvements had been made in all areas, which was pleasing to see.

Risks to the health, safety and wellbeing of people who used the service had been appropriately assessed and managed effectively. Where risks were identified these were addressed through robust care planning. However, we noted an occasional gap in dating, signing and recording of information. We made a recommendation about this.

The care planning system was in general person centred providing clear guidance for staff about people's needs and how these needs were to be best met. The plans of care had been reviewed periodically. However, more regular reviews would demonstrate that any updates had been considered. A recommendation was made about this.

The service had reported any safeguarding concerns to the relevant authorities. However, there was an isolated incident where staff had noticed a bruise of unknown origin on a person's arm. This had not been referred under safeguarding procedures because the individual was bumping into furniture very regularly. We made a recommendation about this.

Suitable arrangements were in place to ensure that sufficient staff were deployed, who had the necessary skills and knowledge to meet people's needs safely. Recruitment practices adopted by the agency were robust. Appropriate background checks had been conducted, which meant that the safety and well being of those who used the service was adequately protected.

Records showed that Mental Capacity Assessments had been conducted, in order to determine capacity levels. However, it was not always clear how outcomes had been achieved. A recommendation was made about this.

The rights of people who were not able to consent to their care was consistently protected as the service worked in accordance with the Mental Capacity Act and associated legislation. People's privacy and dignity was consistently respected.

Suitable arrangements were in place to ensure that sufficient staff were deployed, who had the necessary skills and knowledge to meet people's needs safely. Recruitment practices adopted by the agency were robust. Appropriate background checks had been conducted, which meant that the safety and well being of those who used the service was adequately protected.

There were effective systems in place for monitoring the safety and quality of the service. Audits viewed had identified any areas which were in need of improvement and action was taken to address these shortfalls.

Complaints were managed well and people we spoke with were aware of how to raise concerns, should they need to do so. Systems were in place to ensure that any complaints received were responded to in a timely manner and a thorough investigation was conducted. The service had reported any safeguarding concerns to the relevant authorities. However, there was an isolated incident where staff had noticed a bruise of unknown origin on a person's arm. This had not been referred under safeguarding procedures because the individual was bumping into furniture very regularly. We made a recommendation about this.

Procedures for managing people's medicines were found to be satisfactory. This helped to protect people who used the service from the unsafe management of medications. The service worked well with a range of community professionals. This helped to ensure that people's health care needs were being appropriately met.

People we spoke with were highly complimentary about the staff team. They felt that they were treated in a kind, caring and respectful manner. People expressed their satisfaction about where they lived and the activities they were supported to enjoy.

Regular meetings were held for those who used the service. This enabled people to discuss topics of interest in an open forum and people's views were also gained through processes, such as satisfaction surveys.

During this inspection we found that improvements had been made and we did not identify any breaches of regulations.

The summary is based on our observations during the inspection, speaking with support staff and the manager and from looking at records. We also visited one person in his own home, spoke with several other service users by telephone and obtained feedback from two relatives. Everyone, in general gave us positive responses to the questions we asked, If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

Service users we spoke with told us they felt safe and their dignity was always respected. Systems were in place to make changes in accordance with suggestions received from those using the service or their relatives. This helped the service to continually improve. People we spoke with told us they were not put at unnecessary risk and evidence was available to show they were fully involved in making decisions about the care and support provided.

Policies and procedures were in place, to make sure unsafe practices were identified, which helped to ensure people were protected from harm. People's needs were met by a well trained staff team and infection control policies were followed in day to day practice.

Is the service effective?

The health and personal care needs of those using the service had been thoroughly assessed, involving a range of people in their care and support. Systems were in place to ensure the agency was effectively assessed, so the quality of service provided could be consistently monitored.

People's privacy and dignity was always respected. Effective support was continuously provided by staff who had been appropriately trained to meet the specific needs of those in their care.

Is the service caring?

We spoke with two people residing in a communal living arrangement and one person living on his own. We asked them about the staff supporting them. Feedback was positive. They said staff were kind and caring towards them and helped them to meet their needs. When speaking with staff it was clear they genuinely cared for the people they supported and we observed one support worker speaking with the person in his care in a respectful and friendly manner.

People using the service and their relatives completed an annual satisfaction survey. Where shortfalls or concerns were raised these were taken on board and dealt with. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

Written policies and procedures outlined the importance of respecting people's privacy and dignity. We observed a staff member interacting well with one person living in the community. The service worked well with other agencies and services to make sure people received care in a consistent way. One person using the service told us, "The staff are great. They are very helpful and friendly. They take me out a lot to places I like going to."

Is the service well-led?

The service had a quality assurance system in place and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result, the quality of service provided was continuously monitored.

Staff spoken with had a good understanding of their roles. They were confident in reporting any concerns and they felt well supported by the managers of the service.

Comments from those using the service and some relatives included:

"It is smashing. We all get on very well."

"I've just got a new support worker. She is really nice. I really like her."

"It is a very good service. We are very,very happy with it. Our daughter is well looked after. We have had a couple of minor issues, but Lifeways have acted very quickly to rectify anything we have raised."

"The level of support and commitment from the Lifeways team is phenomenal. The lines of communication are really good."

During our inspection we assessed standards relating to care and welfare and how people were supported to be involved in the planning of their own care. We also looked at how they were safeguarded from abuse. Standards relating to staff recruitment and monitoring the quality of service provision were also inspected. We did not identify any concerns in any of the outcome areas we assessed.

Their comments included:

"The service manager is very good."

"My son is doing well and is a whole lot better since he started using Lifeways."

"We haven't had a team leader for some months now, but the service manager is our first port of call and she is extremely good. Nothing is too much trouble and if we raise any concerns they are sorted out straight away."

"The service my daughter receives is very good, but there's still some room for improvement. For example, the label of 'Learning Disabilities' or 'Autism' doesn't fit all."

"I can't fault Lifeways really. The care and support my son receives is just marvelous."