Archived: Lillibet Manor

There were 23 people using the service at the time of this inspection, 12 of whom received a full residential care service whilst the remaining people had assisted living packages in place. The majority of the people receiving an assisted living package did not receive personal care, as regulated by us, the Care Quality Commission (CQC). Therefore information relating to them was not included in this report.

We originally carried out an unannounced comprehensive inspection of this service on 27 July 2016, and found that eight legal regulations had been breached.

The arrangements to manage and mitigate identified risks to people living at the service, were inadequate, and meant that people were being exposed to unnecessary risks. This was a breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

There were insufficient numbers of suitably qualified, competent, skilled and experienced staff to meet people's needs. This was a breach of Regulation 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

Recruitment procedures were not sufficiently robust enough to ensure new staff were safe to work at the service. This was a breach of Regulation 19 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

Care and support was not always provided with the consent of people using the service. This was a breach of Regulation 11 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

The registered person had not taken steps to meet people's nutritional and hydration needs, which was a breach of regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The registered person had failed to ensure that people consistently received care and support that met their individual preferences. This was a breach of Regulation 9 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

The registered person had failed to operate systems to ensure records were managed safely and effectively. Systems were inadequate in terms of assessing, monitoring and improving the quality and safety of the services provided. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that some statutory notifications were not being submitted to CQC as required. This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

Following this comprehensive inspection, we gave this location an overall rating of 'inadequate', and placed them into special measures.

We then carried out a focused inspection on 1 September 2016, to check progress with the proposed improvements in three of the most urgent areas requiring improvement; safe care and risk management, staff training and skill mix and quality assurance and governance systems. Although we found that improvements had been made during this inspection, it was clear that more time was needed to fully implement and embed the changes being introduced by the manager. At this time the service still remained in special measures.

The provider had submitted an action plan to tell us how they would meet these regulations and the timescale they intended to have met them by. We carried out this inspection on 22 February 2017, to see if the provider had made the necessary improvements to meet these breaches of regulations, and to see whether or not they should remain in special measures. We found that the provider had implemented systems to meet these regulations and, as such, the service is no longer in special measures.

During this inspection, we found that people felt safe at the service and were cared for by staff who were trained in safeguarding principles. Staff were knowledgeable about abuse and were prepared to raise any concerns they had. There were systems in place to assess and manage risks, and risk assessments were updated on a regular basis, to ensure they were accurate. The registered manager and consultant acknowledged that there was still further room for improvement in this area to ensure that they systems in place were fully robust. Staffing levels had improved and the provider had carried out recruitment to improve continuity of care. Systems for the administration of medication had been improved to ensure that this could be done safely; although we found that the electronic system in place could be utilised more effectively to ensure that stock levels of medication reconciled with what was in the service.

Staff training had improved and we saw that staff members now received regular training and refresher sessions, to ensure that their skills were up-to-date. Staff also received support from the registered manager, including regular supervision and appraisal meetings. People's consent to their care was sought, and systems for the implementation of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards had been developed. People had access to sufficient food and drink and were supported to see healthcare professionals when necessary.

Staff treated people with kindness and compassion and promoted their privacy and dignity. They spent time engaging with people in conversation and exchanging jokes. People were provided with information about their care, and there were plans in place to improve the recording of people's involvement in their care.

People's care plans were reviewed regularly, to ensure they were an accurate reflection of people's needs and wishes. The provider was in the early stages of using a new electronic care planning system, which would ensure that people were able to confirm their involvement in the care planning process. The activities programme was enjoyed by people, who were able to participate in a range of activities and there were plans to extend this father in the future. Policies and procedures for feedback from people and their family members were in place, and the registered manager sought out people's views to help develop the service provided.

There was clear leadership at the service. Staff and people were aware of who the registered manager was and were positive about the impact that they had at the service. The registered manager was aware of the requirement to send notifications to the CQC, and had done so where necessary. They had also implemented a number of checks and audits to ensure there were more effective quality assurance systems at the service.

At the last comprehensive inspection this provider was placed into special measures by CQC. Although we identified a number of areas during this inspection that still required improvement, we were satisfied with the progress that had been made and determined that the provider was no longer in breach of the Regulations of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 (Part 3) and the Care Quality Commission (Registration) Regulations 2009. The overall rating for this service is 'Requires Improvement'. This means that the service no longer requires to be in 'Special measures'.

Lillibet Manor is comprised of 34 single occupancy studio apartments within one converted building.

The service provides a choice of assisted living, with Assured Shorthold Tenancy provision and a choice of support options, or full residential care with accommodation and personal care, for adults of all ages who may have a range of needs. These include mental health, learning disabilities, physical disabilities, sensory impairments and dementia.

There were 23 people using the service at the time of this inspection, approximately half of whom received a full residential care service whilst the remaining people had assisted living packages in place. The majority of the people receiving an assisted living package did not receive personal care, as regulated by us, the Care Quality Commission (CQC). Therefore information relating to them could not be included in this report.

We carried out an unannounced comprehensive inspection of this service on 27 July 2016, and found that eight legal requirements had been breached. After the inspection the manager submitted a report which outlined the improvements she planned to make to address these areas. We carried out this inspection to check her progress with the proposed improvements in three of the most urgent areas requiring improvement – safe care and risk management, staff training and skill mix and quality assurance and governance systems. This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Lillibet Manor’ on our website at www.cqc.org.uk.

During this inspection we found that a manager was in post and our records showed they had applied to register with us, 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.

New systems had been introduced to ensure people were not being exposed to unnecessary risks, and that risks associated with people's care were managed appropriately.

Positive steps had been taken to ensure people received effective care from staff that had been equipped with the right skills and training to carry out their roles. Since our last inspection, the manager had reviewed internal processes to ensure staff skills and training reflected the diverse needs of the people living at the service. The manager had also allocated new champion roles to staff in key areas such as safeguarding, mental health, nutrition and falls. Specific training was being arranged for the champions, to support them in taking on their new lead roles and responsibilities.

The arrangements for monitoring the quality of the service provided had also been strengthened; to mitigate identified risks to people and ensure their health and wellbeing. The manager showed us a number of new checks she had introduced to improve the management and oversight of the service.

Although we found that improvements had been made during this inspection, it was clear that more time was needed to fully implement and embed the changes being introduced by the manager. We have therefore not changed the overall rating for the service on this occasion, because to do this would require consistent good practice over a sustained period of time. We plan to check these areas again, alongside the remaining outstanding breaches from the 27 July 2016 inspection, during our next planned comprehensive inspection.

The overall rating for this service therefore remains ‘Inadequate’ and the service is in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded. You can see what action we told the provider to take at the back of the full version of the report.

Lillibet Manor is comprised of 34 single occupancy studio apartments within one converted building. The service provides a choice of assisted living, with Assured Short hold Tenancy provision and a choice of support options, or full residential care with accommodation and personal care, for adults of all ages who may have a range of needs. These include mental health, learning disabilities, physical disabilities, sensory impairments and dementia.

There were 28 people using the service at the time of this inspection, approximately half of whom received a full residential care service, whilst the remaining people had assisted living packages in place. The majority of the people receiving an assisted living package did not receive personal care, as regulated by us, the Care Quality Commission (CQC). Therefore information relating to them could not be included in this report.

The inspection was brought forward due to a number of concerns being received, including the impact created by the diverse range of conditions and associated needs amongst the people living at, and receiving care from the service. We also received concerns about staff attitudes and the food provided. We looked at these areas during this inspection and identified a number of concerns.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

A manager was in post and our records showed they had applied to register with us, 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.

Not all staff were clear about their responsibilities in terms of keeping people safe, and protecting them from avoidable harm and abuse. They had not received recent training to recognise signs of potential abuse, and were unable to describe all the types of abuse that people might experience.

People were being exposed to unnecessary risks, because identified risks associated with people's care, such as an increase in falls or weight loss, were not being managed appropriately. This impacted upon people’s general health and well-being and meant that staff had failed to ensure appropriate control measures were in place to mitigate potential risk factors.

There were insufficient numbers of suitable staff to meet people’s day to day needs. People had to wait for help when they called for assistance.

The provider had not carried out robust checks on new staff. We found that a number of legally required checks were not in place before new staff started working at the service. This meant the provider had not checked first to make sure staff were safe to work at the service.

Systems were in place to ensure people’s daily medicines were managed in a safe way and that they got their medication when they needed it. However, we observed medication being administered that was unsafe, and was not in accordance with best practice guidelines.

People did not receive effective care because staff had not been equipped with the right skills and training to carry out their roles. The diverse range of needs people had, meant that staff had not been fully trained to provide them with appropriate care which met their needs in the right way.

We found inconsistencies in the way people’s consent was sought in line with legislation and guidance. People were not always given the chance to make independent decisions.

There were concerns about whether some people had enough to eat and drink. Staff were not always clear about the importance of nutrition and hydration for those people the service was responsible for supporting with maintaining a healthy, balanced diet.

There were inconsistencies in the way people were supported to access relevant healthcare services. One person had not been referred to a healthcare professional despite staff being aware of a significant change in their health care needs.

People provided mixed responses about whether staff treated them with kindness and compassion. We found the approach from staff to be task orientated at times which meant that people were not always supported in a meaningful way.

People were not involved in making decisions about their care and support. This meant that their privacy and dignity was not always upheld or promoted. Some people also felt their level of independence had decreased since coming to the service, which in turn had deskilled them.

People did not receive personalised care that was appropriate to meet their needs. A number of people told us the mix of needs being catered for at the service was an issue for them and affected their day to day routines and experiences, such as meal times.

Although people told us activities had improved recently, significant improvements were still required to meet the different needs and ages of people living at the service.

Systems were in place for people to raise concerns about the service; however not everyone was familiar with the process.

Legally required information was not always reported to, or provided upon request, to the CQC. Quality monitoring systems and assurance processes had failed to identify this and a number of shortfalls in the service provided; with some people being placed at risk of harm as a result.

You can see what action we told the provider to take at the back of the full version of the report.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

During the inspection, we gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with staff and looking at records.

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

Is the service safe?

Some of the care records that we looked at did not adequately demonstrate that people's care needs had been assessed properly, or that the most appropriate care and support was in place. For example, a pre admission assessment for one person did not record one of their main health care needs. This meant that the provider could not demonstrate that people's needs had been properly considered before they moved into the service, to determine whether their needs could be met.

Some people living with dementia had also not been adequately assessed to determine whether they were safe to use electrical items within their own living space, such as toasters and kettles. This placed them and ultimately other people living in the same building at possible risk.

Is the service effective?

Staff demonstrated that they understood the needs of the people they were supporting, and how best to communicate with them. People living in the home were observed to react positively to their approach and overall, people we spoke with confirmed that the staff supported them well.

Staff talked to us about recent training courses that they had attended. They told us they had the right training to carry out their roles. However, we found some gaps in the training provided to staff. For example, mental health training had not been provided, despite some people living at the home having this as an assessed need.

We identified concerns in the way the service ensured that staff had the right training to meet the needs of people using the service. This is because they relied upon training provided by other care providers, and did not check to ensure this was relevant to a staff member's new role. This meant there was a risk that some staff may not have had the appropriate training to meet the needs of the people living at Lillibet Manor. We also found inconsistencies in the frequency of formal supervision and appraisals being provided to staff, which the manager acknowledged and told us would be addressed.

Is the service caring?

We observed lots of positive interactions between staff and people living in the home.

Everyone we observed looked well cared for in terms of their personal appearance.

Is the service responsive?

We observed people's requests being met in a timely way. For example, one person living with dementia asked to go to the toilet, despite just coming back from the toilet. Staff supported the person to go back to the toilet without delay, demonstrating that they respected the person's request.

Is the service well-led?

A registered manager was in post.

Everyone we spoke with spoke positively about the manager. There was evidence that the service was being run in the best interests of the people living there. Despite this, we did find that some improvements were needed in respect of people's care records and the support provided to staff; to ensure the safety and wellbeing of people using the service at all times.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

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

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

Is the service caring?

People were supported by kind and responsive staff. We saw that relationships were very positive. We found that staff were respectful in their interactions with people and took interest in what they were saying. People's privacy and dignity were upheld. One person said, 'On the whole the staff are very good. They don't intrude, but they give me the help I need when I need it.'

Is the service responsive?

People told us that they felt comfortable to talk with the manager if they had any concerns. One person told us that a complaint had been dealt with appropriately and that they were happy with the response they received.

People who used the service and their relatives were invited to complete a regular satisfaction survey. Although the responses to the most recent survey had not been collated at the time of our visit, we saw an example of a previous survey report and action plan, which showed that a system was in place to address shortfalls or concerns that were raised.

We saw from records that people were supported to have access to other health and social care professionals as necessary, and that staff followed the advice given by these professionals. This meant that the service was responsive to people's health and social needs. A visiting social care professional told us that the service was flexible and responded well to the needs of the people who used the service.

Is the service safe?

People told us they felt safe. The provider had a safeguarding policy which told staff what action to take if they suspected abuse was happening. Staff understood their responsibilities in relation to protecting people from abuse and had confidence that the management would act on any concerns raised. Recent safeguarding concerns were found to have been reported appropriately to the local authority. People were protected from the risk of having their liberty unlawfully restricted because the manager and staff had a good understanding of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

People were involved in making their own decisions. There was an advocacy service available if people needed it which meant that, when required, people could access additional support.

People's health and care needs were assessed, and care was planned to meet people's individual needs and preferences. The service was registered to offer both residential care and supported living services. This meant that support could be planned to meet people's needs in ways that took account of, and respected, their own strengths and independence.

There were adequate numbers of suitably skilled and qualified staff to meet people's needs. People told us that there were enough staff and staff agreed with this. The manager confirmed that they took into account the number of people who used the service and the complexity of their needs when deciding how many staff were required.

Is the service well led?

We saw evidence that the service listened to the views of people who used the service and used this information to make improvements. We saw that care plans and risk assessments were regularly reviewed. This ensured that people received care that was appropriate to their current needs. Staff told us they felt well supported. We found that good systems were in place to support staff to communicate well with each other on shift. This helped to ensure that people received consistent care. There were systems in place to audit the quality of the service and to report and monitor accidents and injuries. This meant that the service was able to learn from adverse events and take action to make improvements when necessary.