Lifeways Community Care (Swindon)

Lifeways Community Care (Swindon) is part of a national organisation which provides care to people with learning disabilities living in different communities. The Swindon office manages supported living services for people living in the area of Swindon and Gloucestershire. At the time of the inspection the service was supporting 45 people in 17 different locations. People supported by Lifeways Community Care (Swindon) have physical and learning disabilities, profound difficulties in communicating and can, at times, express emotional distress.

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

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Based on our review of key questions Safe, Responsive and Well-led

Right support: Although the care plans and risk assessments were reviewed, they did not always effectively identify all shortfalls noted during this inspection. Not all risks had been considered in relation to people's specific health needs. The service did not always follow best practice with regard to controlled medicines patches. The manager took immediate action to put things right and make improvements. The service supported people to have as much choice, control and independence as possible. The service supported people to have the maximum possible choice, control and independence be independent and they had control over their own lives. Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs. Staff supported people to play an active role in maintaining their own health and wellbeing.

Right care: The service did not always ensure that care plans were up-to-date and that risks faced by people had been identified, assessed and planned for. Staff promoted equality and diversity in their support for people. They understood people's cultural needs and provided culturally appropriate care. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had received training on how to recognise and report abuse and they knew how to apply it. People using their individual ways of communicating could interact comfortably with staff and others involved in their care and support because staff had the necessary skills to understand them.

Right culture: People received good quality care, support and treatment because suitably trained staff were able to meet their needs and wishes. People's support plans were not always up to date, reflect their needs or demonstrate that the person's care had been reviewed. Checks to ensure that records were up-to-date were not always effective. The provider demonstrated a commitment to create a culture of improvement that provided good quality care to people. However, the success of this approach had been affected by changes in leadership at the service and the high use of agency staff. Staff placed people's wishes, needs and rights at the heart of everything they did. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity. People and those important to them, including advocates, were involved in planning their care.

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 23 November 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 identified breach in relation to safe care and treatment at this inspection.

Please see the action we have told the provider to take at the end of this 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.

Lifeways Community Care (Swindon) is part of a national organisation which provides care to people with special needs living in different communities.Lifeways Community Care (Swindon) manages supported living services for people living in the area of Swindon. At the time of the inspection the service was supporting 51 people. People supported by Lifeways Swindon have physical and learning disabilities, profound difficulties in communicating and can, at times, display behaviours that may challenge.

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

Risks to people's health, safety and well-being were assessed and care plans were in place to ensure risks were mitigated as much as possible. People’s relatives told us their family members were safe. Staff knew how to recognise and report abuse. Medicines were managed safely. Incidents and accidents were managed effectively; lessons were learned to prevent future risks.

All staff had been trained in infection prevention and control (IPC) and the use of personal protective equipment (PPE). We observed staff followed current IPC guidance and practice throughout our visit. The service had plans in place to respond immediately and appropriately to an outbreak of infection to ensure the safety of people and staff.

Quality assurance systems were in place to assess, monitor and improve the quality and safety of the service provided. Some people’s relatives told us that communication could be improved between the service management and relatives. Following our feedback the provider was going to introduce appropriate measures to improve communication between the management and relatives of people using the service.

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

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People lived in a service that supported them with their independence. Care was person-centred and promoted people's dignity, privacy and human rights. The culture of the service focused on the best outcomes for people. Most of people's relatives and staff praised the management team and the leadership of the service. The manager and the staff team had a good set of values focused on promoting the wellbeing of the people they supported. The ethos of the service was aimed to enable people using services to lead empowered lives.

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 23 November 2018).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about staff not wearing appropriate PPE, poor care planning and alleged neglect. The overall rating for the service has not changed following this targeted inspection and remains good.

The CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm resulting from these concerns.

We looked at infection prevention and control measures under the Safe and the Well Led key questions. We look at this in all supported living inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Lifeways Community Care (Swindon) is part of a national organisation which provides care to people with special needs living in different communities. The Swindon office manages supported living services for people living around Swindon. At the time of the inspection the service was supporting 24 people. People supported by Lifeways Swindon have physical and learning disabilities, profound difficulties in communicating and can, at times, display behaviours that may challenge.

There was a registered manager in post. 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.

At our last inspection the service had been rated Good. At this inspection we found the service remained good.

The service had improved to ‘outstanding’ in the ‘responsive’ domain. The service was extremely responsive to people’s needs and wishes. People’s relatives told us that staff had gone over and above their duty this had made a difference to people's lives. People received support to set and achieve goals for themselves. The service had gone the extra mile in providing people with a wide range of activities to prevent social isolation.

The service remained safe. People were safeguarded from potential harm and abuse. Staff undertook safeguarding training. Risk assessments helped to enable people to develop their independence while minimising any potential risks. Any issues raised were fully investigated. Care and treatment were planned and delivered to help people retain their health and safety. There were enough staff to meet people’s needs. Recruitment processes remained robust to protect people from being supported by any unsuitable staff members. Medicines were dispensed by staff who had received training to undertake this safely.

The service remained effective. Staff were provided with training to help them care for people. Staff received supervision and appraisals which helped to develop skills of the staff members. People's dietary needs were recognized. If staff had any concerns regarding people’s needs, people were referred to relevant health care professionals to help maintain their well-being.

People's rights were protected in line with the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager understood their responsibilities regarding this.

The service remained caring. Staff supported people with kindness, dignity and respect. Staff respected people's individuality and encouraged them to maintain their independence to live the lives they wanted.

The service remained well-led. The registered manager, staff and the management team carried out checks and audits of the service. Investigations of incidents and accidents took place and any learning from these issues was implemented to help to maintain or improve the service provided.

We had found four breaches of the regulations at our previous inspection in November 2015. At this inspection we aimed to see what measures had been taken to ensure the quality of the service had improved and check if these measures had been effective. The provider had told us that all the corrective actions specified in their action plans would have been implemented by the end of April 2016. During our inspection on 3 and 6 June 2016 we found that all the recommended actions had been completed.

Lifeways Community Care (Swindon) is part of a national organisation which provides care for people with special needs living in different communities. The Swindon office manages supported living services for people living the area of Swindon. At the time of the inspection the service was supporting 24 people. People supported by Lifeways Swindon have physical and learning disabilities, profound difficulties in communicating and can, at times, display behaviours that may challenge.

There was a registered manager in post. 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.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care being provided.

Medicines administration was in line with recognised good practice, which significantly reduced the risk of people being subject unsafe medicines administration.

We found recruitment procedures were safe with appropriate checks undertaken before new staff members commenced their employment. Staff told us their recruitment had been thorough and professional.

People told us they felt safe when they received care and support from staff employed by the service. Staff were aware of their responsibilities to report any safeguarding concerns they may have.

Staff felt supported by the registered provider. Staff received regular supervision and appraisal to reflect on good practice and areas for improvement.

The registered manager and staff had a clear understanding of the Mental Capacity Act 2005 and implemented its principles in their practice. They were knowledgeable about protecting the legal rights of people who did not have the mental capacity to make decisions for themselves. The service acted in accordance with legal requirements to support people who may lack capacity to make their own decisions.

People were provided with meals and liquid in sufficient quantities. People were offered choices about the food and drinks they received. Staff supported people to maintain good health and access health care professionals when needed.

Care records showed that people's needs had been assessed before they started using the service and care plans were written in a person-centred way. We saw these care plans were reviewed regularly and with the involvement of people who use the service, relatives and healthcare professionals. We saw professional advice was incorporated into care planning and delivery.

The service had a complaints procedure which was made available to people they supported. People told us they knew how to make a complaint if they had any concerns.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included satisfaction surveys, spot check and care reviews. We found people were satisfied with the service they received.

We found that staff were receiving training in adult protection and were aware for the process for reporting concerns. The service had appropriately reported safeguarding issues and where required had correctly investigated concerns.

We found that staff were receiving regular supervision and that systems were in place to monitor this process. Supervisions were recorded. Staff we spoke with said they were well supported by their colleagues and the majority of people said they were well supported by their line manager. Some staff told us they thought the service managers could provide more support by visiting the tenancies they supervised more often. Staff were undertaking regular training and there were processes in place for this to be monitored and future updates planned.

The service had systems and checks in place to monitor and audit the quality of service. Where shortfalls were identified action plans were completed with appropriate timescales. The provider had completed a recent questionnaire survey of people who used the service, their relatives and care managers.

We found that improvements had been made to the support planning process. Improvements had been made to the involving of people in the planning and reviewing of their care and support.

People who used the service told us they were well treated by the staff and we observed positive and respectful interaction between tenants and support staff.

Relatives we spoke with were positive about the care staff but some people felt that improvements could be made to the liaison between the staff and themselves. Two relatives told us they thought they could be kept better informed by Lifeways about issues or concerns regarding their relatives care and support.

Staff were receiving regular supervision meetings and there were regular staff team meetings taking place.

People we visited had the right equipment in place to support their personal care needs and the staff had undertaken the appropriate training to use this equipment.

We observed staff and managers interacting with people who used the service in a respectful and caring manner. We observed staff explaining what support they were providing and asking for consent before commencing.

We first visited the Lifeways Swindon office on 4 January 2013; we found that some records held there were out of date. We revisited the Lifeways Swindon office on 18 March 2013

We visited service users in their tenancies on 14 and 15 March 2013. Some of the service users lacked capacity to consent to our visits. Because of this, our visits were organised and accompanied by colleagues from the local authority adult services team. We spoke with one service user but other service users living in the four tenancies we visited were unable to communicate verbally with us. Therefore we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us to understand the experience of service users who could not talk to us.

We also spoke with 16 staff, the registered manager and a relative during face to face and telephone discussions.