This announced inspection took place on 23 October 2018.

Lifeways Community Care (Swindon) is part of a national organisation which provides care to people with special needs living in different communities. The Swindon office manages supported living services for people living around Swindon. At the time of the inspection the service was supporting 24 people. People supported by Lifeways Swindon have physical and learning disabilities, profound difficulties in communicating and can, at times, display behaviours that may challenge.

There was a registered manager in post. 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.

At our last inspection the service had been rated Good. At this inspection we found the service remained good.

The service had improved to ‘outstanding’ in the ‘responsive’ domain. The service was extremely responsive to people’s needs and wishes. People’s relatives told us that staff had gone over and above their duty this had made a difference to people's lives. People received support to set and achieve goals for themselves. The service had gone the extra mile in providing people with a wide range of activities to prevent social isolation.

The service remained safe. People were safeguarded from potential harm and abuse. Staff undertook safeguarding training. Risk assessments helped to enable people to develop their independence while minimising any potential risks. Any issues raised were fully investigated. Care and treatment were planned and delivered to help people retain their health and safety. There were enough staff to meet people’s needs. Recruitment processes remained robust to protect people from being supported by any unsuitable staff members. Medicines were dispensed by staff who had received training to undertake this safely.

The service remained effective. Staff were provided with training to help them care for people. Staff received supervision and appraisals which helped to develop skills of the staff members. People's dietary needs were recognized. If staff had any concerns regarding people’s needs, people were referred to relevant health care professionals to help maintain their well-being.

People's rights were protected in line with the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager understood their responsibilities regarding this.

The service remained caring. Staff supported people with kindness, dignity and respect. Staff respected people's individuality and encouraged them to maintain their independence to live the lives they wanted.

The service remained well-led. The registered manager, staff and the management team carried out checks and audits of the service. Investigations of incidents and accidents took place and any learning from these issues was implemented to help to maintain or improve the service provided.

We inspected Lifeways Community Care (Swindon) on 3 and 6 June 2016. It was a full comprehensive inspection which was also carried out as a follow-up to our previous visit in November 2015.

We had found four breaches of the regulations at our previous inspection in November 2015. At this inspection we aimed to see what measures had been taken to ensure the quality of the service had improved and check if these measures had been effective. The provider had told us that all the corrective actions specified in their action plans would have been implemented by the end of April 2016. During our inspection on 3 and 6 June 2016 we found that all the recommended actions had been completed.

Lifeways Community Care (Swindon) is part of a national organisation which provides care for people with special needs living in different communities. The Swindon office manages supported living services for people living the area of Swindon. At the time of the inspection the service was supporting 24 people. People supported by Lifeways Swindon have physical and learning disabilities, profound difficulties in communicating and can, at times, display behaviours that may challenge.

There was a registered manager in post. 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.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care being provided.

Medicines administration was in line with recognised good practice, which significantly reduced the risk of people being subject unsafe medicines administration.

We found recruitment procedures were safe with appropriate checks undertaken before new staff members commenced their employment. Staff told us their recruitment had been thorough and professional.

People told us they felt safe when they received care and support from staff employed by the service. Staff were aware of their responsibilities to report any safeguarding concerns they may have.

Staff felt supported by the registered provider. Staff received regular supervision and appraisal to reflect on good practice and areas for improvement.

The registered manager and staff had a clear understanding of the Mental Capacity Act 2005 and implemented its principles in their practice. They were knowledgeable about protecting the legal rights of people who did not have the mental capacity to make decisions for themselves. The service acted in accordance with legal requirements to support people who may lack capacity to make their own decisions.

People were provided with meals and liquid in sufficient quantities. People were offered choices about the food and drinks they received. Staff supported people to maintain good health and access health care professionals when needed.

Care records showed that people's needs had been assessed before they started using the service and care plans were written in a person-centred way. We saw these care plans were reviewed regularly and with the involvement of people who use the service, relatives and healthcare professionals. We saw professional advice was incorporated into care planning and delivery.

The service had a complaints procedure which was made available to people they supported. People told us they knew how to make a complaint if they had any concerns.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included satisfaction surveys, spot check and care reviews. We found people were satisfied with the service they received.

We inspected Lifeways Community Care (Swindon) on the 18, 20 and 27 November 2015; this was a full comprehensive inspection to also follow up to our previous visit in May 2015. Lifeways Community Care (Swindon) is part of a national organisation which provides care for people with specialist needs living in the community. The Swindon office manages supported living services for people living in a range of housing provision in Swindon. At the time of this inspection the service was supporting 29 people. People supported by Lifeways Swindon may have physical and learning disabilities, profound difficulties in communicating and presenting behaviour that may challenge.

There was not a registered manager in post at the time of our inspection as the person who had been recruited had only been in post eight weeks and had only just started the application process to become 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.

At our last inspection on 8 and 15 May 2015, we followed up action we required the service to make following breaches identified in a range of areas in December 2014. The December inspection was also an inspection where we followed up breaches in regulation 9 and 21, which now correspond to regulation 12 and 17 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At our inspection in May 2015 we found there had been improvements, but some improvements were still required and we identified continued breaches in four regulations, 9, 12, 18 and 11. This was due to continued concerns relating to a number of areas, such as; the way staff were being deployed was still not always meeting people’s needs or supporting their well-being and staff we spoke with still did not receive appropriate support and professional development to enable them to carry out their roles effectively. We also found people’s capacity was still not being assessed to ensure their right to make their own choices was being respected. In addition to this, people’s care and treatment was still not always planned in a way that considered all risks and their preferences and people were still not always involved in the design or review of their own care.

At this most recent inspection in November 2015, we found action had been taken to increase the standards of service for people further in all areas, but there were still improvements to be made.

People’s needs were assessed and these assessments were used to create support plans. New support plans were designed in a more person centred way, but they were still not evidencing a person centred process in practise. Relative’s we spoke with were still not involved fully. Whilst support plans identified risks associated with people’s needs, some of these plans did not contain accurate guidance on what actions were needed to mitigate these risks.

The service had been working hard to increase their numbers of staff with the right mix of skills and attitudes. There were enough suitably qualified staff to meet people’s needs and an increased effort had been made to ensure that staffing was deployed in a way that maintained people’s well-being. However there were still occasions where staff were not being deployed in this way.

The numbers of staff trained in the MCA had increased and more staff were able to demonstrate a clear understanding of the act and its principles. However, some staff were still not able to fully understand the key principles of the act and we also observed practise that was not adhering to these principles. In addition, documentation regarding the MCA was still not following the correct process in line with the Act. Staff were not always supported and empowered through supervision to carry out their roles effectively.

Relatives we spoke with felt that staff were caring and shared that staff were becoming more consistent. This was supported by our observations in most of the locations we visited. In one location we found some staff were still not respecting the service as peoples own homes. At the inspection in May 2015 we recommended the service ensure people had more access to Advocacy at our previous inspection in May. We found the provider had taken positive action to ensure advocacy was available to people using the service.

There was a system in place to monitor the quality and safety of the service. Each location since our inspection in December 2014 had received an individual audit with action points feeding in to the wider action plan. At our last inspection in May 2015 we found a number of these improvements had been actioned but some were not completed. At this inspection in November 2015, we found the system had continued to be effective in ensuring tasks had been completed in line with the services action plan, however the system was not always assessing the quality of the tasks completed. This system had also not identified the areas of improvement identified at our inspection. We had required the service to make the necessary improvements to bring some of these areas up to the required standard for the past two inspections.

We identified 4 breaches of the Health and Social Care Act 2008 Regulated Activities Regulations 2014. You can see what action we have asked the provider to take in the main body of this report.