Archived: Lifeways Community Care (Gloucestershire)

Lifeways Community Care (Gloucestershire) provides care and support to people living in 'supported living' settings, so that they can live in their own home 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. Not everyone receives support with a regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating.

A registered manager was in post who had been registered with the Care Quality Commission (CQC) in April 2018. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

Each household had a service manager who was supported by the registered manager. Prospect House is the main office which is part of Lifeways Community Care Limited. 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.

Since our last inspection the service had decreased in size and people’s care needs were less complex than during our previous inspection. During this inspection there were four people receiving personal care in three different households. As part of our inspection we visited two of the households.

This inspection took place on 22 and 31 January 2019. At the last comprehensive inspection in June 2018 we rated the service “Requires Improvement”. Monitoring systems were not effectively operated to ensure the quality and safety of the care provided. At one household internal auditing and quality assurance systems were not planned for or carried out regularly. At this inspection we found the service had taken actions to improve and the legal requirements were met. The provider needed to make some further improvements to ensure when shortfalls in the service were identified prompt action would be taken to avoid breaching legal requirements again, and to improve the service.

During this inspection we found that staffing levels were kept under review as new people were registered with the service to ensure there were enough staff to meet people’s needs. For example, a new person moved into one of the households in 2018 and staffing was increased to ensure their needs were met. Staff recruitment had improved and were in place to ensure all necessary checks had been completed prior to employment. People told us they received their care how they wanted and it met their preferences.

During this inspection we found the service had made improvements to their auditing systems. For example, service managers and team Leaders completed quality assurance audits to monitor and assess the support needs and peoples experience of the service. This included improvements made to the way people were involved in their care. Whilst systems to monitor the experience of people using the service had improved, these needed more time to become fully imbedded to drive the quality of support for people. For example, in relation to ensuring identified staff received refresher training in a timely manner.

People were supported to have choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were involved in the planning and review of their care and support. They chose the activities or employment opportunities they wished to take part in. People went to a local disco, into town, shopping and to laser tag. People could attend local places of worship when they wished to. People kept in touch with those important to them through supported telephone calls or weekly visits.

People’s preferred forms of communication were highlighted in their care records. Staff were observed spending time chatting and socialising with people. Good use was made of easy to read information which used photographs and pictures to illustrate the text. People had access to easy to read guides about advocacy and complaints. Documentation to support decision making and best interest decisions were in picture and large font formats to support people to make their own decisions wherever possible.

People’s health and wellbeing was promoted. A weekly menu encouraged people to have vegetables and fruit in their diet and people helped to prepare and cook their own meals. People had access to a range of health care professionals and had annual health checks.

People’s medicines were safely managed. Staff knew how to keep people safe and how to raise safeguarding concerns. Risks were well managed, encouraging people’s independence.

Systems to identify when staff required training and supervision were not always effective.

Comments about Lifeways from people who use the service included, “They are a very good care team” and “I like all the staff."

Lifeways Community Care (Gloucestershire) provides care and support to people living in ‘supported living’ settings, so that they can live in their own home 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.

Not everyone receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating.

People using the service lived in four different supported living households across Gloucestershire. At the time of our inspection there were eight people receiving personal care in four different households. These were Davelia, Mildenhall, Woodend and Rowantree. As part of our inspection we visited Davelia, Mildenhall and Rowantree.

The service had a registered 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 and associated Regulations about how the service is run.

The inspection was also prompted in part by concerning information about the management of risk at Rowantree; including notification of an incident suggesting potential concerns relating to the management of medicines. This inspection examined those risks.

People using the service and their relatives provided some good feedback about the service. However, this was not consistent across the various schemes.

We found that the standard of services people received was inconsistent across the households. Risks to people at Davelia and Mildenhall were managed effectively. However, we found that people at Rowantree did not always have enough staff that knew them, which may have impacted on their safety and how well their needs were met. We made the local authority aware of our concerns.

The provider was aware of the risks in the service and had put plans in place to mitigate the impact on people whilst they recruited a full staff team. However, at the time of our inspection the Rowantree service manager and team leader were on annual leave. We found some of these actions for example, in relation to agency staff induction had not taken place to ensure staff understood how they needed to provide people’s support. During our inspection people had moved from Rowantree whilst their care arrangements were being reviewed.

The provider had been working with the local authority to address shortfalls in the service prior to our inspection. The provider used a number of in-depth quality-auditing systems. However, we found that these were not consistently effective at identifying and addressing risks to the health, safety and welfare of people. For example, Rowantree had been lacking sufficient management action when concerns were reported by staff.

The provider had completed an internal quality audit two days before our inspection and had identified the shortfalls we found. Time was needed for these plans to be completed and evaluated before we could judge them to have been effective in supporting the registered manager to make the required improvements

Whilst the quality of staff training was positive, staff did not always receive training relevant to their care roles. There was also varied support and supervision of staff across the households that sometimes undermined effective service delivery. Systems to identify when staff required training and supervision were not always effective.

Improvements were being made in how people’s medicines were managed however people’s records did not always support the safe administration of medicines at Rowantree. At Davelia and Mildenhall medicines were properly managed so that people were supported to take them safely.

People experienced good services in some respects. People were supported to maintain good health and eat healthily. The advice of community healthcare professionals was appropriately sought and acted on.

The service ensured that people were ordinarily supported by the same small team of staff. This helped to develop positive, caring relationships.

We found that most people and their relatives were involved in making decisions about care and support. The ethos of a person-centred, user-led approach by which to lead meaningful and fulfilling lives was being encouraged. Most people received personalised care that was responsive to their needs. For example, staff supported people to undertake planned activities at Davelia and Mildenhall and in the community. Improvements were needed at Rowantree to ensure staff support people appropriately in accordance with their wishes and preferences.

The service worked in line with the principles of the Mental Capacity Act 2005 in terms of people’s consent to care and acting in their best interests where appropriate.

The service had suitable systems for identifying and responding to allegations of abuse. Recruitment processes ensured that new staff were of good character and suitable to work with people.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.

Prospect House is part of Lifeways Community Care Limited. It is a domiciliary care agency that provides supported living services at a number of different addresses. People using the service receive personal care from the provider in their own homes for which they have a separate tenancy agreement with a housing provider. At the time of our inspection 25 adults with a range of needs including learning disabilities were using the service at nine separate addresses.

There was a registered manager at the service. 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 received a service that was safe. People were safe from harm because staff were aware of their responsibility and, knew how to report any concerns. There was enough skilled and experienced staff to safely provide care. Recruitment checks were carried out before staff worked with people to ensure they received care from suitable staff. Risks to people were assessed and action taken to manage these. People were protected from the risks posed by medicines because they were safely managed.

The service provided was effective. Staff received the training, supervision and support required to effectively meet people’s needs. The registered manager and staff understood the principles of the Mental Capacity Act (MCA) 2005 and, worked to ensure people’s rights were respected. Where individual’s required it, staff supported people to eat and drink. Staff ensured people received assistance from other health and social care professionals when required. People’s communication needs were assessed and plans put in place to help people.

People received a service that was caring. People received care and support from caring and compassionate staff who knew them well. Staff provided the care and support people needed and treated them with dignity and respect. People and, where appropriate, their families were actively involved in making decisions about their care and support.

The service was responsive to people’s needs. People received person centred care and support. The service listened to the views of people using the service and others and made changes as a result. People were supported to participate in a range of activities based upon their hobbies and interests.

The service was well-led. The registered manager and senior staff provided effective leadership and management. The vision and values of the service had been identified, with the registered manager using staff meetings and face to face communication to reinforce these. However, staff did not always show a good understanding of the implications of providing care in people’s own homes. Quality monitoring systems were used to further improve the service provided.

The registered manager had taken care to provide CQC with the information required prior to our inspection and, worked positively with CQC to pilot our improved arrangements for the inspection of providers supplying regulated activity(ies) to people living in 'Housing with Care' (HwC) services.

One person told us 'staff explain things' and 'I have lots of choices'. Where people were not able to communicate verbally other methods were used, including using pictures, showing people choices or noting body language and facial expressions.

Staff told us that the 'organisation is really good' and 'I feel as though I'm doing something worthwhile'; one member of staff said 'I love it' when talking about the service they were working in. We observed that the interactions between staff and people who use the service were positive and friendly, and people responded well to staff.

The analysis of the Lifeways group satisfaction survey results for 2013 identified the strongest and weakest areas statistically. Strongest areas included that people felt supported to get health services, people felt safe and people felt that staff had the right skills.

People told us about aspects of the service they particularly appreciated, such as having a key worker and "having staff here to help.' People said that they got on well with staff; for example the support staff were described as 'good.'

Staff told us they felt supported in their work and had good opportunities for training.

The provider kept good staff records. The provider had set up systems for gaining feedback from the people who used the service, for monitoring the quality of service that they received and for letting people know the results of the quality monitoring.