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Inspection carried out on 12 July 2019

During a routine inspection

About the service

Libury Hall is a residential care home providing personal care to 39 people aged 65 and over at the time of the inspection. The service can support up to 39 people.

Libury Hall accommodates people across several individual buildings. 11 people, who require higher levels of support, live within the main house. The remaining 28 people live within one of the 28 separate bungalows. These are designed to support their independence, whilst still retaining key safety features such as pendant alarms to alert staff if people require assistance.

People's experience of using this service

The service provided exceptionally responsive, person-centred support to people which consistently achieved outstanding outcomes for people. Staff consistently went the extra mile to find out what people have done in the past. This enabled people to carry out person-centred activities, which enriched the quality of their lives. People were supported to maintain and develop new relationships that mattered to them and protected them from the risk of social isolation and loneliness. The registered manager used concerns to improve the service. The service worked closely with healthcare professionals to support people with end of life care, which ensured people experienced a comfortable, dignified and pain-free death.

People were protected from avoidable harm and abuse by staff. Risks to people's safety had been identified and assessed. Staff followed people’s risk management plans to keep them safe. People received their prescribed medicines safely, from staff who had their competency to administer medicines assessed. People’s medicines were reviewed regularly to ensure continued administration was still required to meet their needs. Cleanliness and hygiene were maintained throughout the home, which reduced the risk of infection. Staff followed the required standards of food safety and hygiene, when preparing, serving and handling food.

Staff felt valued and respected by the management team. Staff had the required skills to meet people’s needs effectively, which led to good outcomes for people’s care and support and promoted their quality of life. People’s care plans were well maintained providing staff with the required information about their needs and how to meet them. The registered manager had worked effectively with local organisations, health and social care professionals and multi-disciplinary teams.

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.

People were supported by a stable core staff group who were kind, caring and inspired by the registered manager to deliver high quality, personalised care.

The service was led by a management team who were respected by staff and people, and who led by example. Governance systems in the service supported the high quality care people received and improvement plans continually sought ways to develop the care further.

Rating at the last inspection

At the last inspection on 23 November 2016 the service was rated Good (report published 11 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We did not identify any concerns at this inspection. We will therefore aim to re-inspect this service within the published time scale for services rated good. We will continue to monitor the service through the information we receive.

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

Inspection carried out on 23 November 2016

During a routine inspection

Libury Hall is registered to provide residential care for up 37 older people living with mental health needs. At the time of our inspection 32 people were living at Libury Hall.

The inspection took place on 22 November and 07 December 2016 and was unannounced. At our previous inspection on 08 November 2015 we found breaches of regulations 09, 12, and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because risk assessments had not been completed to safely manage identified risks of harm to people or others.

The registered manager had not sufficiently investigated and reviewed incidents to ensure people were kept safe. People’s medicines had not been safely managed. People were not always able to influence or contribute to their care, and people’s social needs were not consistently met.

Management systems and processes were not effectively established or operated to ensure people received a safe and high quality service, and records of care did not detail how people needed to be supported.

At this inspection we found significant improvements had been made in areas relating to managing risk, administering and management of medicines, supporting and developing staff, meeting people’s individual needs, and some improvements relating to the management of the service were found. However we also found improvements were still required in governance systems to ensure the service was well led and records relating to people's care were accurate.

Staff we spoke with were knowledgeable in relation to keeping people safe from harm and reporting incidents to the management. Risks to people’s well-being were managed positively by staff in a manner that promoted people’s choice and independence. People were supported by sufficient numbers of staff who responded promptly when they required assistance. People were supported by staff that had undergone a robust recruitment process to ensure they were of good character. People's medicines were managed safely as intended by the prescriber and staff had received appropriate training to do so.

Staff felt supported by the registered manager and management team who enabled them to carry out their role effectively. Staff had received training relevant to their role and further training for specialist areas had been identified and organised. People's consent had been sought prior to care being carried out and staff took time to talk to people to gain that consent. People's nutritional needs were met and their food and fluid intake and weight were monitored and people were able to choose what they ate from a varied menu. People`s health needs were met when needed with access to a range of health professionals when needed.

Staff spoke with people in a kind, patient and friendly way and respected people’s dignity. People felt listened to and told us they felt they could shape their own care to reflect their own personalised choices. Staff were aware of people's needs, choices and we saw that a friendly rapport had developed between people and staff who cared for them.

People received care that responded to their needs. People were supported to remain independent and pursue individual hobbies and pursuits. People and relatives felt able to raise complaint or concerns with management, and regular forums were held for people to do so. The Registered Manager operated a robust complaints process that when required reviewed and responded to complaints appropriately.

Governance systems and updates in people`s care records continued to be an area that was under development, however the registered manager was able to demonstrate to us how they were addressing these issues. People were positive about the management team and told us that significant improvements had been made across the home by the management team and the provider.

Inspection carried out on 8 November 2015

During a routine inspection

Libury Hall is registered to provide residential care for up 37 older people living with mental health needs. At the time of our inspection 36 people were living at Libury Hall.

The inspection took place on 09 November 2015 and was unannounced which meant the provider did not know we were inspecting. We previously inspected Libury Hall on 13 November 2013. During that inspection we found that the provider was meeting the requirements.

The home had a registered manager in post who had been registered since July 2015. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 this inspection we found sufficient numbers of staff were deployed to provide care safely to people living in Libury Hall. The registered manager had not made arrangements to review and investigate incidents and accidents to keep people safe from the risk of harm or abuse. Risk assessments had not always been developed to positively manage risks to people and where risks were identified staff minimised the importance of these. People’s medicines were not always stored safely and information was not always available to staff about how to manage medicines. People were supported by staff who had undergone a robust recruitment process to ensure they were of sufficiently good character to provide care to people.

Staff felt supported by the manager and provider to enable them to carry out their role sufficiently. Staff had received training relevant to their role, however we found new staff with no previous experience in mental health services had not received the required training prior to supporting people alone.

People’s nutritional needs were met and monitored. People were able to freely choose what they ate and people’s weights and dietary records had been maintained. People we spoke with told us they had access to a range of health professionals, and records demonstrated they were referred quickly when their needs changed, which was confirmed by visiting professionals.

Staff spoke to people in a kind, patient and friendly way and people were treated in a dignified manner. Staff consistently ensured people’s social needs were met, however people did not always receive care that was responsive to their needs.

Libury Hall promoted a culture that was open and honest, staff morale was high and people felt the provider was approachable. However people also felt the registered manager was not visible within the home. People did not receive high quality care that was well led and regularly monitored. People’s personal care records were not regularly reviewed, completed or updated when required.