Lifeways Community Care (Chorley) is a supported living service that provides care and support to people living in 44 supported living settings in Lancashire and Cumbria, 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.

At the time of the inspection there were approximately 138 people using the service.

At the last inspection in January 2018, the service was rated as 'Good'.

We undertook this announced focused inspection of Lifeways Community Care (Chorley) on 6, 7 and 10 December 2018. The inspection was undertaken due to concerns raised with us about the safety of people using the service. We wanted to be sure people were safe and that concerns that had been raised were being managed. We inspected the service against two of the five questions we ask about services; is the service safe and is the service well led.

No other risks or concerns were identified in the remaining key questions through our ongoing monitoring or during our inspection activity between 6 and 10 December 2018 so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection.

At the time of the inspection the registered manager was unavailable and had not been present at the service since September 2018. They returned to work prior to drafting this report. 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.

In the absence of a registered manager, the CQC had spoken with the provider prior to the inspection around concerns about the management of the service. As a result of this, the provider had put a senior manager from head office who was also a director in place who was managing the service. This person was present at the time of the inspection.

We initially became concerned about safety at the service when we were alerted about significant financial impropriety committed against people who use the service in the spring of 2018. The police, CQC and local authority safeguarding teams were kept informed of developments by the provider in the investigation into these matters.

During the course of the financial enquiry, we were advised by the provider that the registered manager was unavailable and that this was likely to be on a long term basis. We monitored that situation and during the same, became aware of concerns being raised by people, their relatives and social care professionals about the level of care and support that was being provided. This was in addition to the financial concerns we were already aware of.

Although we were satisfied that the provider had put steps in place to protect people using the service from further financial abuse and that the provider was reporting matters to the CQC, we were concerned about other issues. This included issues raised through contacts from staff employed in the service, a number of social care professionals and people who used the service and their relatives. All of these approaches to CQC raised similar concerns of poor staff attitude, lack of supervision and management and poor levels of care and support.

As a result of the additional concerns, we prepared to inspect and in so doing gave the provider 36 hours notice of the inspection as we needed to be sure that management staff would be available at the offices and schemes we visited during the inspection.

During this inspection, we found that the service was in breach of regulations in relation to failing to safeguard people from financial abuse, other saf

Lifeways Community Care (Chorley) is a supported living service that provides care and support to people living in 34 ‘supported living’ settings in Lancashire and Cumbria, 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.

At the time of the inspection there were approximately 100 people using the service.

At the last inspection in July 2016, the service was rated as 'Good'.¿

At this inspection we found the service remained 'Good'.

¿The inspection visit took place on 23, 24 and 25 January 2018 and was announced. We gave the service 48 hours notice of the inspection as the service is community based and we needed to ensure the registered manager would be available at the main office

The registered manager was in post at the time of our inspection and had been registered with the Care Quality Commission (CQC) since February 2015. A registered manager is a person who has registered with the CQC 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 using the service and their relatives told us that people were safe and well treated. During the inspection we saw that people appeared happy and content and not at risk of harm.

Safeguarding adult's procedures were robust and staff understood how to safeguard the people they supported from abuse. Staff also knew how to elevate any safety concerns to the appropriate authorities.

Appropriate recruitment checks took place before staff started work. People were being supported to have a healthy balanced diet. People's medicines were managed safely and they received their medicines as prescribed by health care professionals.

Staff had received training specific to the needs of people using the service, for example, mental health awareness and safeguarding adults. They received regular supervision and an annual appraisal of their work performance. The registered manager and staff demonstrated a clear understanding of the Mental Capacity Act 2005 and people consented to the care and support they received.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People and their relatives, where appropriate, and health and social care professionals had been involved in planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people to meet their needs. Staff encouraged people to be as independent as possible and to do things they wanted to do.

The registered manager and provider recognised the importance of regularly monitoring the quality of the service provided to people. The provider sought the views of people using the service, staff and health care professionals through annual surveys and regular meetings. They used feedback from these events to make improvements at the service. Staff said they enjoyed working at the service and received good support from the registered manager and provider.

People knew how to raise a concern or to make a complaint. The complaint's procedure was available and people said they were encouraged to raise concerns.

Further information is in the detailed findings below.

This inspection took place on 5 July 2016 and it was unannounced.

Lifeways is a national supported living scheme. It provides support for people living in the community with their family or in group home settings and caters for people with a diverse range of needs, such as learning disabilities, autism and acquired brain injuries. People using the service are enabled to live as independently as possible and are supported to maintain their interests on a daily basis. The agency office is located in Chorley town centre, being easily accessible by public transport. At the time of this inspection there were 76 people who used the services of the Chorley office.

At the time of our visit to the agency office the registered manager was on duty. He had been in post for a number of years. 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.

The last inspection of this service took place over four days during July and September 2015. At that time the service was found to be in breach of regulations in relation to safeguarding service users from abuse and improper treatment, safe care and treatment, staffing, person centred care and good governance. Lifeways [Chorley] was awarded an overall rating of 'Requires improvement' at that time.

During this inspection we established that some recent restructuring developments had taken place and we found that significant improvements had been made in all areas, which was pleasing to see.

Risks to the health, safety and wellbeing of people who used the service had been appropriately assessed and managed effectively. Where risks were identified these were addressed through robust care planning. However, we noted an occasional gap in dating, signing and recording of information. We made a recommendation about this.

The care planning system was in general person centred providing clear guidance for staff about people's needs and how these needs were to be best met. The plans of care had been reviewed periodically. However, more regular reviews would demonstrate that any updates had been considered. A recommendation was made about this.

The service had reported any safeguarding concerns to the relevant authorities. However, there was an isolated incident where staff had noticed a bruise of unknown origin on a person's arm. This had not been referred under safeguarding procedures because the individual was bumping into furniture very regularly. We made a recommendation about this.

Suitable arrangements were in place to ensure that sufficient staff were deployed, who had the necessary skills and knowledge to meet people's needs safely. Recruitment practices adopted by the agency were robust. Appropriate background checks had been conducted, which meant that the safety and well being of those who used the service was adequately protected.

Records showed that Mental Capacity Assessments had been conducted, in order to determine capacity levels. However, it was not always clear how outcomes had been achieved. A recommendation was made about this.

The rights of people who were not able to consent to their care was consistently protected as the service worked in accordance with the Mental Capacity Act and associated legislation. People's privacy and dignity was consistently respected.

Suitable arrangements were in place to ensure that sufficient staff were deployed, who had the necessary skills and knowledge to meet people's needs safely. Recruitment practices adopted by the agency were robust. Appropriate background checks had been conducted, which meant that the safety and well being of those who used the service was adequately protected.

There were effective systems in place for monitoring the safety and qual

During the course of this inspection we gathered evidence against the outcomes we inspected, to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found.

The summary is based on our observations during the inspection, speaking with support staff and the manager and from looking at records. We also visited one person in his own home, spoke with several other service users by telephone and obtained feedback from two relatives. Everyone, in general gave us positive responses to the questions we asked, If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

Service users we spoke with told us they felt safe and their dignity was always respected. Systems were in place to make changes in accordance with suggestions received from those using the service or their relatives. This helped the service to continually improve. People we spoke with told us they were not put at unnecessary risk and evidence was available to show they were fully involved in making decisions about the care and support provided.

Policies and procedures were in place, to make sure unsafe practices were identified, which helped to ensure people were protected from harm. People's needs were met by a well trained staff team and infection control policies were followed in day to day practice.

Is the service effective?

The health and personal care needs of those using the service had been thoroughly assessed, involving a range of people in their care and support. Systems were in place to ensure the agency was effectively assessed, so the quality of service provided could be consistently monitored.

People's privacy and dignity was always respected. Effective support was continuously provided by staff who had been appropriately trained to meet the specific needs of those in their care.

Is the service caring?

We spoke with two people residing in a communal living arrangement and one person living on his own. We asked them about the staff supporting them. Feedback was positive. They said staff were kind and caring towards them and helped them to meet their needs. When speaking with staff it was clear they genuinely cared for the people they supported and we observed one support worker speaking with the person in his care in a respectful and friendly manner.

People using the service and their relatives completed an annual satisfaction survey. Where shortfalls or concerns were raised these were taken on board and dealt with. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

Written policies and procedures outlined the importance of respecting people's privacy and dignity. We observed a staff member interacting well with one person living in the community. The service worked well with other agencies and services to make sure people received care in a consistent way. One person using the service told us, "The staff are great. They are very helpful and friendly. They take me out a lot to places I like going to."

Is the service well-led?

The service had a quality assurance system in place and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result, the quality of service provided was continuously monitored.

Staff spoken with had a good understanding of their roles. They were confident in reporting any concerns and they felt well supported by the managers of the service.

During our inspection we spoke with three people using the service, who all gave us positive feedback about the care and support they received. They told us that individual needs were being met by a kind and caring staff team and that independence was always promoted. They said that decision making was an important aspect of their daily routine and that they felt safe using the service. We also spoke with three relatives who were all very complimentary about the staff team and the managers of the agency.

Comments from those using the service and some relatives included:

"It is smashing. We all get on very well."

"I've just got a new support worker. She is really nice. I really like her."

"It is a very good service. We are very,very happy with it. Our daughter is well looked after. We have had a couple of minor issues, but Lifeways have acted very quickly to rectify anything we have raised."

"The level of support and commitment from the Lifeways team is phenomenal. The lines of communication are really good."

During our inspection we assessed standards relating to care and welfare and how people were supported to be involved in the planning of their own care. We also looked at how they were safeguarded from abuse. Standards relating to staff recruitment and monitoring the quality of service provision were also inspected. We did not identify any concerns in any of the outcome areas we assessed.

We spoke with the parents of six people using the service by telephone, who in general provided us with very positive feedback about the care and support their sons and daughters received from Lifeways. They told us privacy, dignity and independence were important aspects of the support provided. They felt their loved ones' needs were being fully met and people using the service were supported by competent staff, who ensured they were protected from harm.

Their comments included:

"The service manager is very good."

"My son is doing well and is a whole lot better since he started using Lifeways."

"We haven't had a team leader for some months now, but the service manager is our first port of call and she is extremely good. Nothing is too much trouble and if we raise any concerns they are sorted out straight away."

"The service my daughter receives is very good, but there's still some room for improvement. For example, the label of 'Learning Disabilities' or 'Autism' doesn't fit all."

"I can't fault Lifeways really. The care and support my son receives is just marvelous."

Lifeways is a national supported living scheme. It provides support for people living in the community with their family or in group home settings and caters for people with a diverse range of needs, such as learning disabilities, autism and acquired brain injuries. People using the service are enabled to live as independently as possible and are supported to maintain their interests on a daily basis. The office is located on the outskirts of Chorley town centre, being easily accessible by public transport. There is ample space to facilitate meetings, hold private interviews and provide staff training. Lifeways (Chorley) provide care and support to people over a wide area, which covers the whole of Lancashire and encompasses several neighbouring counties. At the time of this inspection the service was supporting 113 people living in the community and 194 support staff, including community managers.

Staff working for the agency provide personal care and support for people who use the service, as well as helping with domestic chores. Good support is provided by the administrative staff working in the agency office. Lifeways Community Care (Chorley) is owned by Lifeways Community Care Limited and is inspected by the Care Quality Commission.

Due to some concerns raised this inspection was conducted over four days, during which time we visited people within the community and we visited the agency office on three separate occasions. We gave the registered manager two days’ notice of two of our visits. This was so that someone could be available to access all the records we needed to see. The other day to the agency office was unannounced, which meant people did not know we were going to visit. The registered manager was on duty on our first and third visits to the agency office, but not on the second. 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 management of medications could have been better. Despite clear medication policies and procedures being in place and staff having relevant training we established there had still been 13 medication errors since our last inspection. One recent medication error was reported, as a result of a new and inexperienced employee being assigned duties for which they were not competent. The provider informed us that this member of staff had received the appropriate training and that they had been assessed as being competent. The provider also told us that once the error had ben identified then appropriate action had been taken.

People who used the service had given their consent before care and treatment was provided. Staff were confident in reporting any concerns about a person’s safety and were aware of safeguarding procedures. Recruitment practices were robust, which helped to ensure only suitable people were appointed to work with this vulnerable client group.

Staff were seen to respect people’s privacy and dignity and it was clear that good relationships had been developed between service users and support staff. In general people were provided with the same opportunities and were usually involved in the planning of their own care.

Records showed new staff received a good induction and that staff were regularly observed at work by supervisors. The staff team were well trained and those we spoke with provided us with some good examples of modules they had completed. Regular supervision records were retained on staff personnel files and annual self-assessment competency checks had been conducted.

The planning of people’s care was based on an assessment of their needs, with information being gathered from a variety of sources. However, the provider did not always have systems in place to identify when people were at risk of unlawful restrictions, which may have amounted to deprivation of their liberty and to ensure any such situations were brought before the Court of Protection (COP). The COP is a high court set up to deal with such issues and protect people’s rights.

The plans of care varied in quality. Some were well written; person centred documents, but others we saw provided basic information only and lacked a person centred approach. There were no care files available for three people, at the time we visited them within their own homes. This was concerning as it meant that staff supporting these people were unable to refer to information about the needs of those in their care. This incident is referred to within several sections of this report.

A wide range of policies and procedures were in place in relation to a variety of health and safety topics. Areas of risk had been identified within the care planning process and assessments had been conducted within a risk management framework, which outlined strategies implemented to help to protect people from harm. Complaints were well managed and people were enabled and supported to make choices about the care they received.

We found the service to be in breach of several regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in respect of safeguarding service users from abuse and safe care and treatment.

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You can see what action we have asked the provider to take at the end of this report.