Lifestyles

About the service

Lifestyles is a residential care home providing personal care for up to 19 people. The service can support people with mental health needs, a learning disability and autistic people and people with a sensory impairment. At the time of the inspection, 18 people were using the service.

People’s experience of using this service and what we found

The service demonstrated how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support

People achieved their goals and positive outcomes through accessing a wide variety of opportunities and activities with the support of dedicated staff.

People’s independence was promoted as staff encouraged choice, control and inclusion in the local community.

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

The home was clean and regularly maintained. Staff wore personal protective equipment (PPE) appropriately which helped to protect people from the risk of infection.

Right Care

Staff maintained professional boundaries and kept people safe, as they understood how to protect people from harm and abuse.

People were protected by the provider's recruitment processes as appropriate checks were completed; ensuring staff were suitable to work with people who used the service.

Risks to people’s safety and wellbeing were well managed by staff and clearly recorded in people’s care plans. People’s independence was promoted through appropriate support for people to take positive risks. People took part in a wide range of activities and interests in the local community.

Right culture

The service was well-led and the registered manager promoted a positive culture and effective working relationships within the team and with relevant professionals which helped people to achieve good outcomes.

The registered manager valued their staff and supported them to maintain their wellbeing which meant they were more able to support people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 17 July 2018).

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We received a concern in relation to restrictions for people. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained the same based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lifestyles on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Safe arrangements were in place for professionals visiting the service. This included a confirmed negative lateral flow test result, proof of vaccination against COVID-19, the requirement to show a COVID-19 pass, hand sanitisation and wearing personal protective equipment (PPE).

The service was clean and fresh, staff carried out a number of additional tasks, such as cleaning of any high touchpoint surfaces. Regular infection control audits took place and actions had been followed up when required. The registered manager had a refurbishment plan in place to address maintenance work required at the service.

The registered manager had a good understanding about the impact of the pandemic on the people they supported. They recognised the particular difficulties they faced and did all they could to make reasonable and safe adjustments to support people and meet their needs.

The registered manager and staff demonstrated a commitment to providing people with continuity of care and support and stated they had received good support from the provider, relatives and the local health professionals during the COVID-19 pandemic.

Lifestyles is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service provides accommodation for up to 19 adults who have mental health needs. Five people living at the service had a learning disability.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The house is made up of three converted properties in a residential area of York and blends well into a row of town houses.

The care service has been developed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism who used the service could live as ordinary a life as any citizen.

There was a registered manager employed at Lifestyles.

People told us they were safe and we saw that policies and procedures were followed by staff to support this.

Risks to people’s health and safety had been identified. Medicines were managed safely.

Staff recruitment was robust. There were sufficient staff on duty to meet people’s needs. They had been trained in subjects that were relevant. Staff told us they were well supported by the registered manager and through regular supervision.

People were encouraged to eat a nutritious diet and their choice of what to eat respected. People assisted with cooking.

Care plans were personal to each individual giving clear information about their needs. These were reviewed regularly.

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.

Activities were chosen by people and their choices supported by staff. Where those activities posed a risk staff worked with people to keep them safe.

Staff were positive in their praise of the management team and enjoyed working at the service.

Further information is in the detailed findings below.

The home is registered to provide accommodation and care for up to 19 people with mental health needs and / or a learning disability. On the day of the inspection there were 15 people living at the home. Two people share a flat within the premises and other people are provided with a single bedroom. The home is situated in the city of York, in North Yorkshire close to transport routes and local amenities. There are various communal areas where people can spend the day and a small garden. The first and second floors of the home are accessed by stairs so people who live at the home have to be active enough to manage the stairs.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was registered with the Care Quality Commission (CQC). 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.

On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people's individual needs. New staff had been employed following robust recruitment and selection policies and this ensured that only people considered suitable to work with vulnerable people worked at Lifestyles.

People told us that they felt safe living at the home. People were protected from the risks of harm or abuse because there were effective systems in place to manage any safeguarding concerns. The registered manager and care staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

Any identified risks had been considered and risk assessments recorded how to manage these risks to promote people's safety and well-being. Accidents and incidents had been recorded and appropriate action taken to address any risks, although more analysis of accidents and incidents would help to identify any trends that were emerging.

Staff told us that they were well supported by the registered manager, and felt that they were valued. They confirmed that they received induction training when they were new in post and told us that they were happy with the training provided for them. This included training on the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Discussion with the registered manager and staff showed that the principles of this legislation was understood.

We checked medication systems and saw that medicines were recorded and administered safely. We had some concerns about the recording of controlled drugs (CDs) and these have since been rectified. Staff who had responsibility for the administration of medication had received appropriate training.

People who lived at the home, visitors and social care professionals told us that staff were caring and that they respected people’s privacy and dignity. We saw that there were positive relationships between people who lived at the home, visitors and staff.

People told us that they were very happy with the food provided and people's nutritional needs had been assessed. We observed that people’s individual food and drink requirements were met. People were able to use the kitchen to prepare meals if they wished to do so, within a risk management framework.

No complaints had been made to the home during the previous twelve months but people were aware of how to make a complaint and told us there was always a member of staff for them to speak to if they had any concerns. There were systems in place to seek feedback from people who lived at the home, care professionals and staff.

Staff, people who lived at the home, visitors and social care professionals told us that the home was well managed. Quality audits undertaken by the registered provider and registered manager were designed to identify any areas of improvement to staff practice that would promote people’s safety and well-being. Staff told us that, on occasions, feedback received at the home was used as a learning opportunity and to make improvements to the service provided.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff who supported them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. All staff had received training in this area and the staff we spoke with confirmed that they understood when an application should be made, and how to submit one. This meant that people were safeguarded as required.

People received an assessment which helped to ensure that the home was able to meet their needs. We saw care plans and risk assessments were in place to help ensure people's safety and welfare. Information was reviewed regularly to ensure that it was up to date and reflected any changes.

Systems to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations were evident although the home could have developed these further. This helped to reduce the risks to people and helped the service to continually improve.

Records were in place detailing how people should be cared for. Records were stored securely so that the information remained confidential and accessible only to those who needed them.

Is the service effective?

The home had appropriate arrangements in place for gaining people's consent. People's health and care needs were assessed with them, and they were involved in decisions regarding their plans of care. This meant that staff were able to deliver care in a way that supported people.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, 'The staff here are the best I have ever had" and "The staff do anything. We have fun here, it's like one big family."

People's preferences, interests, aspirations and diverse needs had been recorded and care and support was being provided in accordance with people's wishes.

Is the service responsive?

Since our last visit the service had reviewed records and systems to ensure the care being delivered was appropriate for those who lived there. They had responded to advice from other professionals including the local authority and had developed the service that people received. We saw that the home had responded to suggestions made within questionnaires and people were confident that the home would respond to any concerns if they were unhappy.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. Staff confirmed that the management were supportive.

People told us that they liked living at Lifestyles. Comments included "Things couldn't be better" and "I go out whenever I like, sometimes I go fishing overnight." Another person told us "I get on well with the staff, they help us when we need it. I have a care plan it is kept in the office (my choice) but I can look at it when I want to."

We spoke with the provider, manager and staff on duty during our visit. They told us that the restrictions which were previously in place for some people, (for example, times to be in by) had been lifted. However, they also told us that they were waiting for input from other health professionals to support them in writing care plans where risks had been identified to help people remain safe and to minimise risks.

We found that the manager had reviewed and updated the care records since our last visit. There were clear strategies in place for supporting people in managing difficult or potentially challenging behaviour. The home had a safeguarding procedure in place and all staff had received training in safeguarding adults. They had responded positively to the previously identified concerns and were working closely with lead agencies to implement improvements. This helped to protect people.

People were not sufficiently protected from the risk of abuse as the provider had failed to respond appropriately to allegations of abuse. Some people had restrictions in place which had not been dealt with under proper legal safeguards.

We found that people were protected from the risks of infection and people were cared for in a clean and hygienic environment.

In the main people were protected from the risks of unsafe or unsuitable premises and people told us they liked their rooms. Some improvements have been suggested by the Community Infection Prevention and Control Nurse and the home is taking action to address these.

Appropriate checks were carried out before staff began work and people were supported by suitably qualified and experienced staff. People were positive about the staff who supported them.

Poor record keeping meant that people were not always protected against the risks of inappropriate or unsafe treatment as their records were not always fit for purpose.