Background to this inspection
Updated
19 May 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
This inspection was carried out by two inspectors.
Service and service type
Lilas House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Lilas House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
At the time of our inspection there was a registered manager in post. The registered manager was in the process of deregistering and the service was being overseen by an acting manager.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all of this information to plan our inspection.
During the inspection
We spoke with two people who used the service, the acting manager, deputy manager, one senior support worker and two support workers. We also contacted two health and social care professionals for feedback.
We reviewed a range of records. These included the care records and medicine records for two people, and three staff recruitment files. We also reviewed a range of records in relation to the management and auditing of the service.
After the inspection
We continued to seek clarification from the provider to validate the evidence found.
Updated
19 May 2022
About the service
Lilas House is a residential care home providing accommodation and personal care to up to six people. The service is in a Victorian building with shared communal areas and a courtyard garden. The service provides support to people who are living with a learning disability or autistic spectrum disorder. At the time of our inspection there were five people using the service, and one person was in hospital.
People’s experience of using this service and what we found
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 did not always support this practice as it was not clearly documented why decisions were being made in people’s best interests and how their independence could be maximised. However observations and feedback showed staff understood how to promote people to have choice and control.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
Based on our review of key questions of safe, effective and well-led the service was not able to demonstrate they were meeting some of the underpinning principles of Right support, right care, right culture.
Right support
People were supported to have choice and control over their lives, as well as pursue their interests. However, there was a lack of guidance around where people required decisions being made in their best interests. Despite the lack of written guidance, people were supported by staff who knew them well and who understood their care and support needs, and what was important to them.
Right care
Risks were not always identified and therefore not adequately managed. People’s care records lacked detail about how people communicated their wants and wishes, however, this was mitigated because of how well staff knew people.
Right culture
Whilst the service promoted an inclusive culture, there still remained a lack of effective governance systems to monitor and assess the quality of service people received.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was inadequate (published 13 October 2021) and there were breaches of regulation. We imposed conditions on the provider’s registration, and they sent us action plans each month. At this inspection we found some improvements had been made, but the provider remained in breach of regulations.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
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.
You can see what action we have asked the provider to take at the end of this full report.
Enforcement and Recommendations
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified breaches in relation to safe care and treatment and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.