Archived: Lifeways Community Care (Taunton)

Lifeways Community Care Taunton is registered for the provision of personal care in people's own homes. This includes support with personal care, such as assistance with bathing, dressing, eating and medicines. We call this type of service a 'supported living' service. 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. At the time of the inspection 25 people were receiving a service over 17 different locations.

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

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People had good community networks which were personal to them. This included work opportunities, day service and supporting people to use technology to connect with family and friends. People had been supported to develop and maintain positive relationships with friends and family. Equality, Diversity and Human Rights (EDHR) were promoted and understood by staff.

A recruitment drive was taking place at the time of the inspection. A number of staff had left the service. The registered manager told us they were addressing the current vacancies and filling gaps with regular agency staff. Staff told us although a number of staff had left this has improved the culture of the service. Following risks identified where people may not have the correct staff in place action had been taken to ensure a core member of staff was on duty to cover any gaps.

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

People's rights to make their own decisions was respected. People were supported to access healthcare services if needed. Staff had appropriate skills and knowledge to deliver care and support in a person-centred way. People were supported to have enough to eat and drink.

Staff were well trained and skilled. They worked with people to overcome challenges and promote their independence. The emphasis of support was towards enabling people to learn essential life skills. Staff encouraged positive risk taking so people could experience new things and develop.

People received personalised support based on assessed needs and preferences. Staff knew how to support people in the way that they preferred. People knew how to complain if they needed to.

People received support to take their medicines safely. Risks to people's well-being and their home environment were recorded and updated when their circumstances changed. Where errors occurred, the service learnt lessons.

The service was managed by a registered manager who had a clear vision about the quality of care they wanted to provide. Staff were aware of their roles and responsibilities. A range of quality assurance checks were carried out to monitor and improve standards. We received positive feedback regarding the leadership and management of the service.

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

The last rating for this service was Good ( published 08 December 2018.)

Why we inspected

The inspection was prompted in part due to concerns received about staffing, medicine errors and the culture of the service. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from these concern. Please see the safe domain section of this full report.

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

We gave the provider 48 hours' notice because we needed to be sure the registered manager would be available for the inspection. It also allowed us to arrange to speak with people receiving the service.

The service is registered for the provision of personal care in people's own homes. This includes support with personal care, such as assistance with bathing, dressing, eating and medicines. We call this type of service a 'supported living' service. At the time of this inspection the service supported 55 people living in seven different premises, including single occupancy and shared occupancy properties, 37 out of 55 people received a regulated activity.

People's accommodation was provided by separate landlords, usually on a rental or lease arrangement. The service was only responsible for the provision of personal care and not for the provision of the seven premises. People who used the service had a wide range of cognitive impairment and/or other support needs, ranging from mild to severe learning disabilities or autistic spectrum disorders. Some of the people had very complex support needs and required support from the service 24 hours a day. Other people were more independent and received support for just a few hours a day to help with their daily routines.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The provider had appointed a new manager, they had been in post for four months and clearly had a commitment to improvement. Although the new manager had submitted their application to become the registered manager of Lifeways Community Care, this had not been finalised. Therefore, in this report when we speak about the registered manager, we refer to them as being, 'the new manager’. The new manager was supported by four service managers who oversaw the staff based in people’s houses or flats. For this report when we refer to the service manager we mean the direct line manger to that staff team, not the new 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.

People told us they felt safe with staff supporting them from Lifeways. Staff understood how to recognise and report signs of abuse and there were safeguarding policies and procedures available for staff to access. Staff received safeguarding training and the new manager understood their responsibilities to raise concerns both internally and externally.

Staff carried out risk assessments that included any environmental risks in people’s homes and any risks in relation to the care and support needs of the person. There was a lone working policy and on call procedure which staff were aware of.

The provider had sufficient staff to keep people safe and their recruitment processes minimised the risk of unsuitable staff being employed. The provider obtained references and completed a Disclosure and Barring Service (DBS) check. A DBS check ensures the provider can identify people barred from working with certain groups such as vulnerable adults.

Staff followed a comprehensive medicines policy. Staff received medicines training on induction and were assessed annually to ensure they were competent and safe to manage people’s medicines. Medicines incidents were reported. Staff took further training if needed and incidents were used to improve systems safety. Staff followed good infection control practices that protected people and accident and incident reporting was robust.

The provider had systems in place to assess people’s needs and choices. Nobody we spoke with (for example people who used the service and staff) said they felt they had been subject to any discriminatory practice, for example on the grounds of their gender, race, sexuality, disability, or age.

Staff had the right skills, knowledge and experience to deliver effective care and support. Staff completed an induction when they started employment at Lifeways. There were records of individual staff appraisals and regular supervision.

Staff understood the Mental Capacity Act 2005 (MCA) and what actions they would need to take to ensure the service adhered to the code of practice. People we spoke with confirmed staff asked for their agreement before they provided any care or support. Care records showed that people gave their consent to the care and support provided.

People received care and support which was personalised to them. Care plans contained comprehensive information about people’s wishes or preferred routines. Staff treated people with kindness and respected people’s privacy they made sure care was provided in a dignified way and they encouraged people to be as independent as possible.

The provider had a clear vision to deliver high-quality care and support that promoted a positive

culture. There were effective quality assurance systems in place to monitor care and plan ongoing improvements. The registered manager was aware of their legal responsibilities and worked in partnership with other organisations and there was a system in place to manage and investigate any complaints.

Further information is in the detailed findings below