Date of assessment: 26 November 2024 to 17 December 2024. The assessment included site visits to the service’s office and 11 of the supported living houses on 26, 27, 28 November and 2 and 8 December one of which was outside of normal working hours. Lifeways Community Care (Halifax) is a supported living service providing personal care to people. The service provides support to people with mental health needs, people with a learning disability and autistic people. We have assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted. At the time of our inspection there were 26 people receiving personal care across 11 ‘supported living’ houses. People were safeguarded from abuse and avoidable harm and their medicines were safely managed. People had access to health professionals when required and the provider was working collaboratively with external stakeholders. Care was person centred, and people were supported to make decisions about their lifestyles and increase their independence. People were supported by kind, caring and well-trained staff who knew them well. Staff said they felt supported, involved and listened to. The new registered manager demonstrated positive values and strong leadership skills, and the service was well run and managed. The provider demonstrated significant improvements since our last inspection and this is reflected in the outstanding rating for the well led domain. This service has been in Special Measures since 28 September 2022. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
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Lifeways Community Care (Halifax) was rated Inadequate overall following a focused August 2022 inspection, with breaches across safe care and treatment, staffing, person-centred care, and governance placing people at risk of avoidable harm. The service was placed in special measures, with widespread failures in medicines management, incident learning, notification duties, and care planning identified alongside ineffective governance systems.
Concerns (12)
criticalMedication management: “we observed one person being supported by staff with medication, but there was no medication administration record. At another setting, medicines were stored in an unlocked wardrobe”
criticalSafeguarding: “The provider had failed to tell CQC about significant events such as allegations of abuse, which meant they did not fulfil their legal responsibility”
criticalStaffing levels: “one person should have received 56.5 hours over a week but had only received 49 hours”
criticalGovernance: “The provider had completed quality audits, but these were not effective and did not drive the required improvements.”
criticalIncident learning: “one person had three falls in August 2022 and was admitted to hospital after the third fall. The person's risk assessment and support plan had not been reviewed”
criticalLeadership: “Leaders did not have the knowledge, experience and oversight to lead a safe service. This placed people at increased risk of harm.”
moderatePerson-centred care: “one person's care records stated they liked to assist staff to do the household weekly shopping. Staff confirmed the person did not participate in the household shopping”
moderateCare planning: “one person had a personal choice record which was detailed and specific but had not been reviewed since March 2018 and was out of date.”
moderateCommunication with families: “A relative raised a concern with us because the service had not involved them in developing the person's care and support.”
moderateRecord keeping: “at one setting, there were missing sections of care records. At another setting, daily records lacked evidence of a person-centred approach.”
moderateStaff training: “Staff told us they had received appropriate training, but we did not receive training records to confirm this.”
minorInfection control: “we saw several examples where staff were not wearing face masks even though national guidance stated these should always be worn.”
Strengths
· Recruitment processes were robust and ensured staff were suitable to work with people who used the service.
· People who used the service told us they were happy with the staff who supported them; staff were observed interacting positively with people.
· The provider had improved their arrangements for safeguarding people's finances, introducing a clear protocol for managing people's monies.
· Settings visited looked clean and infection control environments were satisfactory.
· The management team were responsive to inspection findings and gave assurances of corrective action.
Quality-Statement breakdown (14)
safe: Assessing risk, safety monitoring and managementInadequate
safe: Staffing and recruitmentInadequate
safe: Using medicines safelyInadequate
safe: Learning lessons when things go wrongInadequate
safe: Preventing and controlling infectionRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Supporting people to develop and maintain relationships; support to follow interests and take part in activitiesRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirements; Continuous learningInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringInadequate
well-led: How the provider understands and acts on the duty of candourInadequate
Lifeways Community Care (Halifax) was rated Inadequate overall at this focused inspection (January 2023), remaining in special measures, with continued regulatory breaches across safe care, medicine management, staffing, person-centred care, and governance. Despite some strengths in safeguarding, infection control, and communication support, widespread failures in risk management, training compliance, care planning, and quality oversight meant people were at risk of avoidable harm.
Concerns (10)
criticalMedication management: “across all 7 settings we visited we found discrepancies with the amount of medication in place compared with what their records stated they should have.”
criticalCare planning: “The provider had failed to maintain contemporaneous care records and we saw conflicting information in some people's care records, and missing information in others.”
criticalGovernance: “Systems and processes for monitoring quality and safety were not implemented effectively. Issues we identified had not been addressed prior to inspection.”
criticalStaffing levels: “One service continually under delivered on the commissioned hours by significant amounts. Some staff worked 57 and 59 hours in a week.”
criticalStaff training: “basic life support training had only been completed by 24.7% of staff. This meant the provider only had evidence 58 staff out of 234 had completed basic life support training.”
criticalIncident learning: “after a person had been subject to a serious incident, the incident form had not been completed with actions taken and mitigation for future occurrences.”
moderatePerson-centred care: “1 person confirmed the only day they could go out was on a Monday due to the service not having enough staff who could drive, contradictory to the support plan.”
moderateRecord keeping: “care documents were still not consistently accurate, and some were missing important risk assessments. The providers audit system had failed to identify these discrepancies.”
moderateCommunication with families: “I used to be involved in reviews but there hasn't been one for the past 3 years. I don't have a date for one in the future.”
moderateConsent / capacity: “staff restricted the number of cigarettes this person could have, without a capacity assessment or best interest decision to support this action.”
Strengths
· Safe and robust recruitment processes ensured staff were suitable to work with people who used the service.
· New systems and processes introduced for managing and monitoring people's finances, reducing risk of financial abuse.
· Staff had received safeguarding training and knew how to report concerns and identify different types of abuse.
· Communication needs were being met effectively with detailed, individual-specific communication support plans.
· Settings were clean, well maintained with all safety and equipment maintenance checks completed.
Quality-Statement breakdown (14)
safe: Assessing risk, safety monitoring and managementInadequate
safe: Learning lessons when things go wrongInadequate
safe: Using medicines safelyInadequate
safe: Staffing and recruitmentInadequate
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
responsive: Planning personalised care to ensure people have choice and controlInadequate
responsive: Supporting people to develop and maintain relationships; activities and social inclusionInadequate