Archived: Lifeways Community Care (Exeter)

Updated 17 November 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This was a comprehensive inspection. The inspection took place on 11, 12 and 19 October 2018 and was announced. We gave the service 24 hours’ notice of the inspection visit because the location provides a supported living service for adults who are often out during the day. We needed to be sure that they would be in and people would be willing to speak with us. We also wanted to make sure the registered manager and/or members of their management team would be available at the time of the inspection.

The inspection was carried out by one adult social care inspector. Before the inspection we asked the provider to complete a Provider Information Return (PIR). The PIR is a form that asks the registered provider to give some key information about the service, what the service does well and improvements they plan to make. We also looked at information we had received about the service since the last inspection, such as notifications about significant incidents, and information from people who use the service, staff, relatives and other professionals. Before the inspection we sent out questionnaires to people who used the service, relatives, staff and health and social care professionals. We received responses from three people who used the service, 12 staff and five community professionals. We also received further e mail communication from two health and social care professionals and we spoke with one relative on the telephone.

On the first day of the inspection we visited the agency office where we spoke with the registered manager, the provider’s quality improvement manager and a senior support manager. We looked at records held in the agency office including four staff recruitment files, staff supervision records, four support plans and quality monitoring and improvement records.

On the second and third day of the inspection we visited and met with 15 people who received a service. We also met 16 members of staff and one relative. We looked at the records of care held in each person’s home including support plans, risk assessments, daily reports, medicine administration records, and records of support given to help people manage their weekly household budgets.

Updated 17 November 2018

This was a comprehensive inspection. The inspection took place on 11, 12 and 19 October 2018 and was announced.

Lifeways Community Care (Exeter) is a supported living service people with learning difficulties and mental illness who live in their own homes in the community. Most people who use the service live in shared houses with other service users. This service provides care and support to people living in ‘supported living’ settings, so that they can live as independently as possible. 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.

At the time of this inspection there were 34 people with disabilities who received a range of support from the service, including personal care. Our inspection focussed on the support given to these 34 people. The service also provided support to people who did not require personal care. This part of the service is not covered by CQC legislation and therefore was not included in the inspection.

We checked the service was working in line with ‘Registering the right support’, which makes sure services for people with a learning disability and/or autism receive services are developed in line with national policy - including the national plan, Building the right support - and best practice. For example, how the service ensured care was personalised, discharge if needed, people’s independence and links with their community.

Rating at last inspection

At our last inspection we rated the service as Requires Improvement overall. We found some aspects of the leadership and responsiveness of the service required improvement, although the service was otherwise safe, effective and caring. At this inspection we found the service had improved and is now Good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

Why the service is rated Good.

People told us they felt safe. Comments included, “I like it here” and “Yes, I feel safe”. The provider and registered manager had effective safeguarding systems in place. All staff we spoke with had a good understanding of what to do to make sure people were protected from harm or abuse.

There were enough staff employed so that people received support when they needed it. Since the last inspection the turnover rate for staff had decreased. There were more permanent staff employed and less reliance on agency staff to fill vacant shifts. This meant people received a consistent service from staff they knew and trusted.

There were good systems in place to assess risk and to ensure people received safe care and support. Care plans contained evidence of risk assessments covering all anticipated risks and explained the actions staff must take to support the person to remain safe and well. People were supported to manage their medicines safely and people had been supported to make decisions about where they wanted their medicines to be stored.

People told us staff supported them effectively. People’s needs were assessed before they began receiving support from Lifeways and a plan of their support needs was drawn up. The plans contained detailed information about all aspects of each person’s support needs. Staff worked closely with health and social care professionals from other organisations to deliver effective care, support and treatment. Comments included “It’s nice” and, “We like the staff.”

Staff had the skills, knowledge and experience to deliver effective care and support. Staff received a comprehensive induction at the start of their employment and regular ongoing training and updates on topics relevant to people’s needs. Staff told us the training was good. The level of supervision to staff had improved over the last year, although the level of supervision was unlikely to reach the provider’s expectation of four supervisions per year. Staff meetings were held monthly for teams of staff who worked with people living in the shared houses. Most staff told us they were happy with the level of supervision 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 were supported to eat and drink a healthy diet. Staff understood each person’s dietary needs and preferences. People were supported to attend health checks regularly. Staff had liaised with health and social care professionals to ensure people received the care and treatment they needed.

People told us they continued to receive a service that was caring. People told us they liked the staff. A person told us, “It’s nice. They are kind.” The service ensured that people were treated with kindness, respect and compassion. Staff we met were passionate about their jobs and making people’s lives as happy and fulfilling as possible. Comments from staff included, “As long as their life is enriched, that’s all I care about” and, “I like to go home and think I have brightened up their day”.

People now received a service that is responsive to their changing needs. People had been consulted and involved in drawing up and reviewing their support plans. Letters and information given to people used symbols as well as simple text to help people understand the content. Where people wanted support, staff read letters and information to them and checked they understood the content. Some people had information in symbol format in their rooms to help them find their belongings easily.

The provider plans to implement a new computerised care planning system in the next year. We have recommended that the provider ensures people are given a copy of their care plan in an accessible format suited to their individual needs.

Care plans were reviewed regularly and any changes to the care plans were updated on the agency records promptly. Changes to the management structure and recruitment of new team leaders meant there was more time for management tasks, such as updating care plans, to be completed. People were supported to talk about their wishes for care at the end of their lives and care plans setting out their last wishes were drawn up in a format people could understand.

People knew how to make a complaint and were confident any concerns or complaints would be listened to, investigated and addressed.

The management of the service had improved and was now well-led. Progress had been made to promote people’s independence and reduce the institutional aspects of the service. There was greater consultation with them about their belongings and where these should be kept. The management team had taken action to challenge staff where they found outdated practices and supported staff to consider new ways of working.

Staff turnover had reduced, and staff morale had improved. There was a clear management structure in place with sufficient management time allowed to carry out management tasks such as staff supervision and support. Staff told us the level of the support they received had improved significantly in the last year. Comments from staff included, “It’s good. I feel like I am supported. There is always someone there for advice on the phone” and, “The bosses are hands-on. They really care. We are very well looked after”

There were efficient systems in place to monitor the service and ensure all areas were running smoothly and safely. There were monthly audits carried out by team leaders, service managers and the registered manager covering all aspects of the service. Annual surveys were sent out to people using the service, community professionals, relatives and staff. The provider’s quality monitoring systems showed that improvements had been made in most areas in the last year.

Further information is in the detailed findings below