Background to this inspection
Updated
3 November 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
This was initially a targeted inspection to check a concern we had regarding the culture of the service, and how people who experienced emotional distress were supported by staff. Due to concerns identified we changed our approach and completed a comprehensive inspection.
Inspection team
The inspection was carried out by 3 inspectors, a regulatory officer, and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service provides care and support to people living in 13 ‘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.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 31 August 2023 and ended on 29 September 2023. We visited the location’s office on 31 August, 5 and 19 September 2023.
What we did before the inspection
We reviewed information we held about the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We visited 5 of the supported living settings, and met 13 people using the service. We spoke with 8 members of care staff, the registered manager, 4 service managers and 2 team leaders.
We looked at a sample of records relating to people’s individual care and records relating to the running of the service. This included 12 people’s care records, a sample of medication administration records and a variety of records relating to the management of the service, including a sample of accident and incident forms, staff debrief forms, training records, recruitment files, policies, and procedures.
An Expert by Experience spoke with 6 relatives about their family member's experience of the care provided, and following the visits a regulatory officer spoke to a further 4 care staff and 1 team leader over the telephone.
Updated
3 November 2023
About the service
Lifeways Community Care (Taunton) is a supported living service providing personal care to people with learning disabilities and autistic people living in their own homes. People were supported over 13 different properties with some people living in self-contained flats and others living in single or shared accommodation. 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 there were 34 people receiving personal care.
The service is also registered to provide domiciliary care services. At the time of the inspection the service was not providing domiciliary care services.
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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.
Right Support:
People were not always supported to have maximum choice and control of their lives; the policies and systems in the service to support this were not effective.
Where people lacked capacity to make decisions, the provider failed to follow the Mental Capacity Act (MCA) 2005 code of practice. Restrictions were placed on people without considering the principles of the MCA and there was not always clear evidence that the restrictions were in the person’s best interest. Not all options were considered when looking at the least restrictive option for people. Some practices restricted people's independence and choice, and breached their human rights.
People received their medicines from trained staff. However, improvements were needed to ensure guidance and administration records were accurate and up to date. Staff enabled people to access specialist health and social care support within the community.
The service completed assessments prior to people receiving a service, with care plans completed from the assessments. Care records viewed throughout the inspection were of mixed quality and were not always up to date.
Right Care:
People were not always protected from the risk of harm as staff did not always have all of the information needed to meet people's needs safely. Incidents were documented, however follow up processes and incident analysis needed improving to ensure people were given the appropriate support after an incident.
Recruitment processes were not always robust, and concerns were raised regarding staffing levels. Staffing levels were based on the needs of the people living at the supported living settings. The service was currently using agency staff to ensure safe staffing levels.
Staff received training in safeguarding vulnerable adults. Staff spoken with said they would be confident to report any concerns.
Right Culture:
There was lack of management oversight and reliable systems to inform the management of the quality of care people were receiving.
The culture within the service was not always positive. Staff did not always complete records about people in a dignified and respectful way, and improvements were needed to ensure people were involved in decisions about their care.
Staff did not always receive appropriate training and people were supported by staff who did not always understand best practice in relation to the wide range of strengths, impairments, or sensitivities people with a learning disability and/or autistic people may have. This meant people did not always receive empowering care that was tailored to their needs.
Most relatives were positive about the service their loved ones received and felt involved. Where concerns were raised, these were discussed with the registered manager.
The registered manager was open and honest throughout the inspection, accepted the shortfalls found and immediately sought to rectify them.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 4 July 2023, and this is the first inspection. Prior to the service becoming registered with us, the service was operating and being managed from another of the provider’s registered locations.
Why we inspected
The inspection was prompted in part due to concerns received about the culture of the service and how people who experienced emotional distress were supported by staff. A decision was made for us to inspect and examine those risks. Initially we completed a targeted inspection. Due to concerns identified during the targeted inspection, we changed our approach and completed a comprehensive inspection.
Enforcement
We have identified breaches in relation to governance, staffing, dignity and respect, consent, safeguarding, medicines, and risk management at this inspection.
You can see what action we have asked the provider to take at the end of this full report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.