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

In this key question, we looked at 3 quality statements; ‘Safeguarding’, ‘Safe and effective staffing’, and ‘Medicines optimisation’. We found concerns in these 3 quality statements, and found breaches of regulation in relation to keeping people safe from abuse, staffing levels and oversight, and how medicines were managed within services.

This service scored 50 (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.

People we spoke with told us they felt safe when supported by staff and they knew who to contact to raise safety concerns. Comments included "I would speak to the manager, I've got her number in my phone," and, "I would either see [service manager] or the manager". We received mixed feedback from relatives regarding people’s safety. One relative told us they had concerns about the lack of leadership and the high level of agency staff. Another relative told us ““Well I’m not sure [person is safe], with the way everything has been lately, [person] is getting very poorly a lot. Other relatives we spoke with felt their relatives were safe and had no concerns.

Staff had received training in safeguarding and could describe different types of abuse. However, we were not assured that the manager had the understanding and oversight of safeguarding processes to keep people safe. We asked the manager about their process for responding to safeguarding concerns such as unexplained bruising and were told: “One [person] has historic bruising and has medication which causes bruising, the person has had falls, I think [person] has GP input.”

People mostly appeared to be supported safely.

Processes were not always in place or effective in keeping people safe. We saw some incidents were investigated, however found multiple incidents of unexplained bruising which had not been thoroughly investigated or reported to the local authority safeguarding team, as per the local authority's guidelines. There was no consistent evidence of learning from incidents and accidents, therefore, we saw that similar incidents occurred.

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.

Relatives told us they were generally happy with staff and felt their relatives were well supported, however some relatives expressed concern about the agency staff used and felt this impacted on their relative’s care. Most people told us they felt there was enough staff to support them when required, however one person told us that there was not enough staff to support them with their personal care when required. Some relatives told us that there were not always enough staff to support their family member safely and effectively. Comments included: "There wasn’t enough last week, there was only 1 [staff] on, and she couldn’t help [person] properly, they need more staff,” and “I think that’s a big issue.... I think there should always 2 people there but it’s regularly 1 person for [people using the service]. It’s not adequate." When asked about if there was enough staff, one family member told us "No there aren’t. The main issue is the lack of leadership. I met a new one today and she was already disheartened about the job because they have no leadership. They’ve also been told they can’t use the internet in the house so booking things like the cinema is difficult for some of them. They don’t seem to communicate very well either, I’m not sure if that’s because they don’t always know each other but it’s not good. You can also see that the people who live there have a change in behaviour when they have a lot of agency staff on, they seem anxious.”

Some staff told us that there were not always enough staff, and this impacted on people's ability to go out and do the things they enjoyed. Some staff told us they were concerned staffing levels were not always safe. Comments included: "I feel the level of staffing can be very dangerous sometimes when low," and: "We are extremely under staffed! Lifeways expect you to be picking up overtime as they will not get agency to come and cover these shifts. The weekends and lates are the hardest, they won’t get these covered leaving us either to move shifts around and to be covered by the staff or to run short". We were also told: "We are short staffed. Lifeways will not authorise agency over the weekend so that would mean someone being moved to work it or running short.” Staff told us that there were not enough management staff in place, this meant staff did not always receive adequate day to day support, they told us they felt this impacted their role. One staff member told us: "I think they do put a lot of pressure on managers which waterfalls down on staff and [people using the service], we have a big problem with retention of staff, I know every sector is struggling with staffing, but the main reason at Lifeways is that there is too much pressure. They expect a lot from staff, it's understandable but it needs to be balanced. Managers have too many services under them."

There appeared to be enough staff to support people, however we observed that 2 people whose care plans identified them as requiring 1:1 support at all times, received very little engagement from staff. One person was in their bedroom calling out and we observed staff did not check on this person. Another person was in a room with staff, but staff only engaged with this person once during our observation of 1 hour 45 minutes.

Staff were recruited safely and staff had completed mandatory training. However, we found there were some discrepancies in the number of hours of care recorded and the number of hours delivered for people using the services. We raised this with the manager and asked them to look into this but an outcome was not achieved.

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 mostly appeared to be supported safely with medicines, however there was one occasion where a person told a staff member they were in pain, and we saw this was verbally responded to, but no was action taken to reduce this person’s pain.

Staff told us they received annual medicines training and competency checks and were able to tell us how they supported each person in the home to take their medicines.

Staff took a person-centred approach to medicines. Medicines were stored securely in the home. However, we observed that some documentation to support staff to administer medicines correctly was missing from care plans. For example, there was no record of annual health checks taking place in people's care plans. This meant staff could not be sure when then next check was due without contacting the general practicioner (GP).

There were processes in place to ensure people received their medicines safely however, these were not always effective. Where people were prescribed medicines that required additional safety monitoring, these had not been risk assessed. Processes for sharing information about people’s medicines when going into hospital was not consistently understood by staff, this meant there was a risk incorrect information about medicines could be shared.