Lifeways Community Care (Swindon)

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed 3 quality statements in relation to safeguarding, safe and effective staffing and medicines management. Despite improvements having been made in these areas we found the storage of medicines was not in line with best practice guidelines for supported living services and some medicines drawers were not secure. The provider had now added more management support in the services where concerns had previously been identified. Although this had not been embedded at the time of the assessment the provider was in the process of training and developing new managers in their role. However, people were now being safeguarded from abuse, and staff and leaders had the required skills and knowledge to safeguard people. There were now enough staff to meet people’s needs.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Relatives we spoke with told us people were safe. Comments included, “[Person] is very safe, we nearly lost them last year after going into hospital. When [person] returned the staff were brilliant with them and looked after them so well” and “I can tell [person] feels safe and comfortable with staff as [person] is always smiling, holding their hands and cuddling up to them.”

Staff understood their responsibilities to keep people safe from avoidable harm and abuse. Since the last assessment staff and leaders had completed safeguarding training relevant to their role. Leaders told us they had changed the way incidents and safeguarding events were dealt with. For example, they told us, “Previously, when managers received the report, they were not identifying if something needed safeguarding or investigation and were not maintaining records. We had reports but nothing else.” To improve on their practices, leaders told us they, “had adapted their case management system to add prompts for managers to follow up on actions. The reports were now escalated to the area manager to probe further so everything was investigated thoroughly before closing.”

During the on-site visit people appeared happy, they were seen to engage with staff and were clean and well-dressed. We observed staff interacting with people positively.

Processes had been improved since our last assessment to keep people safe and safeguarded from harm. Safeguarding events and incidents were now being investigated, and a new approach had been implemented to escalate incidents to senior leaders.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Overall relatives told us they were happy with staffing levels and felt their relatives were supported well. However, some relatives told us there had been lots of changes in management in some of the services and one person told us, “I don’t know why they can’t keep managers.”

Staff told us in some services it was difficult for new members of staff to understand the job role and people’s needs, due to a lack of management support onsite. They told us this affected people using the service as staff did not always schedule in activities that people enjoyed. However, staff now told us there were now enough staff to meet people’s needs. Staff also told us where there had been consistent management in post, staff were receiving regular support and supervisions. Leaders told us they had filled staff vacancies and were supporting new staff with their inductions. Management oversight in the services where previous concerns were identified had been increased. For example, they had increased their team leaders from 1 to 3, so there was a team leader in each service. Leaders had identified changes needed to retain management and staff. For example, they adapted their recruitment and induction processes. When managers joined the service, a ‘buddy’ was provided, and they had taken a cautious approach to the settling in period rather than requiring managers to “get on with the role.”

Staff were available to meet people’s needs and engaged with people well. Staff were supporting people to get ready for activities outside the service.

Rotas reviewed as part of this assessment had a balance of experienced and new staff to ensure people's support needs were considered. The service was staffed according to a staff dependency tool to meet people’s needs. A supervision matrix was in place for staff, and we viewed records of where staff had received supervisions.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People appeared to be supported safely with their medicines. Relatives told us, “There’s never been any issues with medication as far as I’m aware. [Person] know why they need to take certain medication even though they can’t communicate it” and “[Person] knows what medicine they are taking and when they need to take it. [Person] even knows when the other people need to have their medication, they clock everything going on.”

Guidance for supported living services suggests people should have medicines stored in their room. We asked staff why medicines were not being stored in line with Right Support, Right Care, Right Culture guidance, and they told us, “This is because the rooms are small so there is a lack of space and staff got distracted and were making lots of errors, so they were brought into the medication room.” Leaders confirmed they wanted to reduce the number of medicine errors, and moving medicines to a centralised area was identified as the only viable option at the time. They told us they were in the process of adapting people’s rooms to manage medicines effectively and more in line with national guidance. Leaders confirmed since the new process of storing medicines in a centralised place was put in place, it had reduced medicines errors in the service as it was intended to do.

On review of the medicine's storage area, we identified some locked drawers where medicines were stored were not secure. Therefore, we were not assured people’s medicines were always stored securely. These concerns were fed back to the provider, and they took steps to immediately address the concerns.

The service’s model of medicine management was not always in line with current best practice guidance of Right Support, Right Care and Right Culture. Medicines were stored in a central location rather than in people’s individual rooms which was not in line with nationally recognised guidance for supported living services. However, when we discussed this arrangement with the provider, they confirmed the rationale for doing it had been to reduce the occurrence of medicine errors which had previously been an issue at the service. The provider was aware the current arrangement was not in line with national guidance, and they were already working towards returning medicines to people’s rooms in a safer way than before. There were now also processes in place to ensure people received their medicines safely and previous concerns around the recording for paraffin-based creams had been resolved. Medicines which required appropriate risk assessments to be in place had been reviewed and improved by the service. Hospital passports now contained relevant information to keep people safe. Staff had received annual medicines training and competency checks.