This was a comprehensive inspection. The inspection took place on 11, 12 and 19 October 2018 and was announced.

Lifeways Community Care (Exeter) is a supported living service people with learning difficulties and mental illness who live in their own homes in the community. Most people who use the service live in shared houses with other service users. This service provides care and support to people living in ‘supported living’ settings, 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 this inspection there were 34 people with disabilities who received a range of support from the service, including personal care. Our inspection focussed on the support given to these 34 people. The service also provided support to people who did not require personal care. This part of the service is not covered by CQC legislation and therefore was not included in the inspection.

We checked the service was working in line with ‘Registering the right support’, which makes sure services for people with a learning disability and/or autism receive services are developed in line with national policy - including the national plan, Building the right support - and best practice. For example, how the service ensured care was personalised, discharge if needed, people’s independence and links with their community.

Rating at last inspection

At our last inspection we rated the service as Requires Improvement overall. We found some aspects of the leadership and responsiveness of the service required improvement, although the service was otherwise safe, effective and caring. At this inspection we found the service had improved and is now Good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

Why the service is rated Good.

People told us they felt safe. Comments included, “I like it here” and “Yes, I feel safe”. The provider and registered manager had effective safeguarding systems in place. All staff we spoke with had a good understanding of what to do to make sure people were protected from harm or abuse.

There were enough staff employed so that people received support when they needed it. Since the last inspection the turnover rate for staff had decreased. There were more permanent staff employed and less reliance on agency staff to fill vacant shifts. This meant people received a consistent service from staff they knew and trusted.

There were good systems in place to assess risk and to ensure people received safe care and support. Care plans contained evidence of risk assessments covering all anticipated risks and explained the actions staff must take to support the person to remain safe and well. People were supported to manage their medicines safely and people had been supported to make decisions about where they wanted their medicines to be stored.

People told us staff supported them effectively. People’s needs were assessed before they began receiving support from Lifeways and a plan of their support needs was drawn up. The plans contained detailed information about all aspects of each person’s support needs. Staff worked closely with health and social care professionals from other organisations to deliver effective care, support and treatment. Comments included “It’s nice” and, “We like the staff.”

Staff had the skills, knowledge and experience to deliver effective care and support. Staff received a comprehensive induction at the start of their employment and regular ongoing training and updates on topics relevant to people’s needs. Staff told us the training was good. The level of supervision to staff had improved over the last year, although the level of supervision was unlikely to reach the provider’s expectation of four supervisions per year. Sta

The inspection took place on 12 and 13 June 2017 and was announced. The last inspection of the service took place on 3 June 2016 when we rated the service as ‘Requires improvement’. There were no breaches but we made three recommendations relating to their complaints procedure, supporting people to understand the support and choices offered to them, and reviewing their quality monitoring system. During this inspection we found insufficient evidence of actions to address these areas.

Lifeways Community Care (Exeter) provides personal care and support to people living in their own homes in Exeter, Mid Devon, East Devon, North Devon, Plymouth and Newton Abbot areas. At the time of this inspection there were 32 people who received personal care. In addition they provided support to a further 109 people who required support without personal care. This part of the service is not covered by CQC legislation and therefore was not included in this inspection.

There was a registered manager in post who was appointed at the end of 2016. In the last year there have been three changes of 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 2008 and associated Regulations about how the service is run. Staff told us the new registered manager had introduced many positive changes and improvements. Comments on the registered manager included “Absolutely fantastic! Things filter down now. Praise for staff is passed on.”

The provider had systems in place to monitor the quality of the service. However, they did not always take prompt or effective action to address any areas where improvements were needed. We also found that where the provider had made improvements in the past, these had not always been sustained.

Staff morale had been very low in the last year, and staff turnover had been high. There were signs this was improving following a recent recruitment campaign that had resulted in most vacant posts being filled. Actions by the new registered manager had helped to build staff morale, for example by visiting most of the shared houses and meeting people who used the service and many of the staff team. However, some concerns raised by staff related to the provider’s management of the service. Team leaders had insufficient management hours to enable them to carry out their managerial tasks such as regular supervision for support workers. We also found some staff had not received supervision at the frequency laid down by the provider. In previous inspections we had also found there had been problems due to low staff morale and high staff turnover. Where improvements had been made, these had not been sustained.

Progress towards supporting people to achieve independence and control over their lives had been slow. Some positive steps had been taken, for example, forums had been set up in some areas to enable people to have greater involvement in the service. People had been involved in drawing up and agreeing their support plan before the service began. However, some people were unsure if they had been involved in regular reviews of their support plan. Progress toward supporting people to hold a copy of their support plan, or hold their own medications, had also been slow. Support plans provided staff with detailed and up-to-date information on all aspects of people's support needs but were not always provided in a format that enabled people to understand or be fully involved in planning their support needs.

New staff received induction training that provided them with a good basic level of knowledge and competence before they began working with people. There was an on-going training plan offering staff regular updates on health and safety related topics, including some topics relevant to the indi

This inspection was carried out on 3, 6 and 7 June 2016 and was announced. We gave the service 48 hours’ notice because we wanted to make sure we would be able to speak with staff and people who used the service.

Lifeways Community Care (Exeter) provides support with personal care to people with learning disabilities and/or mental illness. The support was provided to people living in a variety of settings, such as shared houses, flats and bungalows, and to people living on their own or with their families. The service covered many parts of Devon. People living in shared accommodation had an individual tenancy agreement. At the time of the inspection the service provided support with personal care to 38 people. In addition they also supported a further 105 people who did not require personal care. This part of the service is not covered by CQC legislation and therefore was not included in the inspection.

There was a new manager in post who had not yet been registered. 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. Staff were supported by a management structure that provided accountability at all levels.

The service was last inspected in April 2015 when we found some aspects of the service were not entirely safe, effective, caring, responsive or well-led. The overall rating was ‘requires improvement.’ At this inspection we found improvements had been made in many areas, although further actions were needed to ensure people have control over their own lives, and to ensure people are fully involved and consulted.

People did not have a support plan drawn up in a format they could understand. The support plans were detailed and covered all areas of support needs, but the lack of ‘easy read’ support plans meant people had not been supported to take control of, or be fully engaged in planning a service that met their needs. The support plans were regularly reviewed with people, which meant they had an awareness of the plans, and had been consulted about any changes where necessary. Staff told us the support plans provided them with good information about all aspects of each person’s support needs.

Most people received regular support from a small and consistent staff team. However, they did not always know the names of staff or the times staff would be supporting them because they were not given a timetable in a format each person could understand. People told us they were happy with the support they received, and told us the service was usually reliable. There were systems in place to plan staff rotas. This meant staff knew in advance the days and times they were expected to work each week and the people they would be supporting.

At the last inspection we found medicines were not always administered and recorded safely. At this inspection we found improvements had been made. Monitoring systems were in place to ensure medicines had been safely administered. Where errors were found, actions had been taken to reduce risks in future. Where people lived on their own in single accommodation storage of medicines had been risk assessed and people had control of their own medicines according to their individual needs and circumstances. However, medicines for people who lived in shared accommodation were usually stored centrally which meant people did not always have control of their own medicines.

The provider had a quality monitoring system that ensured checks were regularly carried out on many areas of the service. However, the quality monitoring system failed to show that they had identified areas for improvement such as promoting people’s independence and control by providing support plans and information in a format people could understa

People told us they were very happy with all aspects of the support they receive from the agency. They said the care workers were always friendly and treated them with respect. People have been encouraged to plan and direct their own care provision by supporting them to draw up their own person centred care plans. The agency asks each person to tell them the days and times they want the care workers to provide support each week and the care worker's rotas have been drawn up in response to this. This has enabled people to lead active lives and to be as independent as possible.

The inspection took place on 15, 20 and 24 April 2015. The first day of the inspection was unannounced.

Our previous inspection of the service was on 4, 7, and 8 August 2014 when we found the service was in breach of regulations 10: assessing and monitoring the quality of service provision, 20: records, and 23: supporting workers. The provider wrote to us with an action plan of improvements they intended to make. Since the last inspection we received some concerns about the safety and quality of the service. During this inspection we checked to see if actions had been taken by the provider out to improve the service.

Lifeways Community Care (Exeter) provides personal care and support to people with learning disabilities and mental illness living in their own homes in Exeter, Mid Devon, East Devon, North Devon and the Newton Abbot areas. At the time of this inspection there were 46 people who received support with their personal care from Lifeways Community Care (Exeter). Some people lived in shared houses and flats and others lived in single accommodation.

The support people received ranged from a few hours each week to 24 hours a day. This type of service is often referred to as a supported living service. Most people had a tenancy agreement with a landlord and received their care and support from Lifeways Community Care (Exeter). As the housing and care arrangements were entirely separate people could choose to change their care provider if they wished without losing their home.

There was a registered manager in post who also had responsibility for Lifeways Plymouth branch as well as the Exeter branch. 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.

We visited by agreement, three properties, one in Tiverton and two in Exeter and met five people who lived there. Some people we met were unable to communicate verbally and so we observed staff interacting with them. We saw staff supporting people in a caring and respectful manner. Staff supported people to lead active and fulfilling lives, keep in touch with family and friends, and go out and about in the local community.

People and staff told us things had improved since our last inspection. One person told us their care was poor last year but “Things are now lovely.” Comments from staff included “It’s good – getting better” and “Things are a lot better.” However, the registered manger and staff acknowledged they still had more to do. Staff morale had improved significantly and there was a positive attitude among the staff team. New staff had been recruited and this meant there was less reliance on agency staff to cover shifts. Safe recruitment procedures were followed.

Staff training was improving. All staff received training at the start of their employment covering essential health and safety topics. Some staff had also received training on other relevant topics. Approximately 40% of staff held, or were in the process of achieving a relevant qualification such as a National Vocational Qualifications (NVQ).

Medicines were generally managed safely. Records of medicines administered were completed accurately. However, there were no systems in place to monitor or check stock levels. People’s consent had not been obtained to allow their medicines to be stored and administered by the staff. The training records showed staff had received training where necessary on emergency medication administration for epileptic seizures.  After the inspection we were given information to show they had taken prompt action to address the issues raised including an assurance that all staff had received training on safe medication administration.

There were robust systems in place to ensure people’s cash or savings were managed safely.

The manager and staff were aware of the Mental Capacity Act and the need to apply to the Court of Protection where people’s liberty had been deprived. Applications had been submitted for some people whose liberty had been restricted and the manager was aware they may need to submit more applications. However, staff had not always fully consulted with people when assessing their support needs. Some people may have been at risk of their liberty being restricted or restrained because their capacity to make decisions had not been assessed. Staff had not sought relevant advice or best practice agreement from relevant professionals for some people.

People were involved and consulted in meal planning and preparation as far as they were able. Staff had a good awareness of people’s individual likes, dislikes and dietary needs although for some people the variety could be improved. People who were at risk of choking had been assessed by relevant health professionals. Staff had received training and guidance on how to reduce the risk of choking, although we found this was not always followed safely placing some people at risk.

Care records had been improved and were easy to read. The office records had been updated and now matched the information held in each person’s home. Support plans contained detailed up-to-date information about each person. There was evidence to show some people had been involved in their support plans, depending on their ability to communicate. However, some plans had not been drawn up to meet individual communication needs and this meant some people had not been involved or consulted. Staff told us a new and improved support planning system was about to be introduced and they were intending to involve people in this process. Prompt action had not always been taken to review, update and action care plans when necessary which meant some people may not have received the appropriate care.

The service was generally well-led. People told us they had confidence in the new management team to listen to any concerns or complaints and to take prompt action to address them. There were systems in place to monitor all routine tasks and make sure the service was running smoothly. However the quality audit process had not been effective in identifying or challenging the practices and issues we have raised in this report

We found a number of breeches of the Health and Social Care Act 2008 (Regulated Activities) Regulations (2014).You can see what action we told the provider to take at the back of the full version of the report