Lillibet House

Lillibet House is a residential care home providing accommodation and personal care to up to 30 people, most of whom were living with different types of dementia. At the time of our inspection there were 25 people using the service.

The home is built over three floors. All bedrooms have a wash hand basin, shared toilets and bathrooms are located on each floor. In addition, there are shared living areas on the ground floor and first floor of the home. The care home has a private garden with a summer house available to people, their relatives and friends.

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

Since the last inspection the provider had engaged with a care consultant to support with addressing shortfalls within the service. Protecting people from potential harm and abuse had improved. However, further work was required to ensure information within risk assessments provided guidance and direction to staff to reduce risk.

We received mixed feedback from relatives regarding the staffing levels in the service. Following the last inspection, the provider had reviewed the staffing levels and made amendments to the deployment of staff in the home. In addition, a recruitment drive was ongoing, and several new staff had joined the staff team. People appeared to be comfortable and relaxed with the staff in the service. Staff treated people with dignity and respect. Social engagement had improved since the last inspection and staff were observed encouraging people to participate in activities of their choice.

Staff received an induction which prepared them for their role. Staff told us they had completed additional specialist dementia training which had enhanced their understanding. One staff member told us, “The training provided a real insight into how a person living with dementia feels. It has made me think more about how I support people as well as refreshing my understanding of dementia.” Staff felt supported by the registered manager, who they found to be approachable and visible in the service.

Cleaning schedules had been reviewed within the service. The service was visibly clean with no mal odour. A system was in place to reduce the risk of transmission of communicable disease. Staff and visitors had access to face masks, gloves and aprons.

Following the last inspection, the quality assurance system had been reviewed and additional checks had been implemented to identify and address shortfalls within the service. This required further time to evidence that processes were embedded within the service to sustain improvements.

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 support this practice.

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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 26 January 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of some regulations. However, not enough improvements had been made in other areas and the provider was still in breach of the associated regulation.

This service has been in Special Measures since 19 January 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

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

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 risk assessments at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. 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.

Lillibet House is a residential care home providing accommodation and personal care to 28 people in one adapted building. Most of whom were living with different types of dementia. The home can support up to 30 people.

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

The home supported people living with dementia who had complex needs who could become distressed and inadvertently can cause harm to others. We found the management of the home did not always have the right processes and systems to manage this risk effectively. There were also shortfalls with how the registered manager, management team and provider assessed the quality of their service.

We saw examples of potentially abusive care with how people were treated and supported in the home. We raised two safeguarding referrals with the local authority about what we saw. Staff needed more support to care for people in a safe and thoughtful way. Following situations when people living with dementia became distressed and who inadvertently harmed others, the registered manager and provider had not considered if there was enough staff or if these staff were in the right places at the right times, in order to support people, and to defuse situations when some people became distressed.

There was a lack of a social, fun and happy atmosphere in the home. People were waiting around in the lounge and hallway all day with nothing to do. Staff were often not present in the lounges and, when they were, they did not chat or try and do something interesting or fun with people.

We found issues with how the registered manager and provider were managing the risk of COVID-19. There were unvaccinated staff in the home. Relaxed processes for supporting visitors and professionals into the home. Staff did not always maintain social distance amongst themselves.

There were shortfalls with how the registered manager, provider and management team assessed and checked how other risks which people faced were being managed. Processes, risk assessments, care plans, and reviews of safety checks were not effective in supporting the management of these risks. This put people at potential risk of harm.

When we could communicate with people, they spoke fondly of the registered manager. Relatives and professionals also spoke well of the registered manager. They felt there was good communication and the home was doing everything they could to support their relatives and the people in the home, in very challenging situations.

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 13 December 2017).

Why we inspected

We received concerns in relation to the management of COVID-19. As a result, we undertook a focused inspection to review the key questions of safe, caring and well led.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We issued a warning notice to the provider in response to a breach of regulation 12 (safe care and treatment) and we have imposed a timescale for the required improvements to be completed. Please see the action we have told the provider to take at the end of this report.

We have identified breaches in relation to keeping people safe, promoting people’s dignity, and how effective the leadership of the service was. 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

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

• Families and people were encouraged and supported to use the electronic care planning system in place to post photographs and exchange messages with each other where they were unable to complete face to face visits. The provider advised us they were awaiting the installation of a log cabin in the back garden to accommodate face to face visits between people and their family and friends in inclement weather.

• The provider had sourced a taxi service to enable staff to travel to work safely and reduce use of public transport.

Further information is in the detailed findings below.

Lillibet House is a large three storey Victorian building in the tree-lined avenue close to both Bedford Park and within walking distance of Bedford town centre.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

People using the service felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and felt confident in how to report them.

People had risk assessments in place to enable them to be as independent as they could be in a safe manner. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks and remain independent.

There were sufficient staff, with the correct skill mix, on duty to support people with their needs. Effective recruitment processes were in place and followed by the service. Staff were not offered employment until satisfactory checks had been completed.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service.

Effective infection control measures were in place to protect people.

People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people. Staff gained consent before supporting people.

Staff received an induction process and on-going training. They had attended a variety of training to ensure they were able to provide care based on current practice when supporting people. They were also supported with regular supervisions.

People were able to make choices about the food and drink they had, and staff gave support when required to enable people to access a balanced diet. There was access to drinks and snacks throughout the day.

People were supported to access a variety of health professionals when required, including opticians and doctors, to make sure they received additional healthcare to meet their needs.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support.

People’s privacy and dignity was maintained at all times.

Care plans were written in a person centred way and were responsive to people’s needs.

People were supported to follow their interests and join in activities.

People knew how to complain. There was a complaints procedure in place and accessible to all. Complaints had been responded to appropriately.

Quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.

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

Further information is in the detailed findings below

We found that people were given food that was presented nicely and based upon their nutritional requirements. Staff were aware of each person's dietary needs and understood the importance of maintaining an adequate fluid intake, making sure that regular drinks were given to people with snacks as required.

We saw from records that the provider ensured people were referred to appropriate professionals and attended relevant appointments. On the day of our inspection, we observed a doctor and district nurse visiting and were aware of staff ensuring they were updated with relevant information.

We spoke with staff about their understanding of safeguarding and found that they had a good working knowledge of the different types of abuse and neglect and were aware of the processes for reporting any concerns. People told us they were well cared for by staff. One person said, "I do feel very safe here.' Another told us, 'I have no problems in being here.'

The premises were well maintained and safe for the people who lived there. We found that the equipment used within the home for people was fit for use and that staff had access to on call maintenance for repairs should this be required.

The care plan process was robust and agreed with relatives or the individual where appropriate. Plans were person centred and peoples' health and welfare was appropriately managed. One person said "I don't want to be here but they look after me well. The food is good." Another said "It's good here."

There was a record kept of all administration of medication. Medication was administered by senior staff who had received training to do this.

There were six staff on duty each morning and again each evening with three staff on a waking shift overnight. Each shift had a senior member of care staff on duty to manage the shift and direct care staff.

There was a complaints process in place and one person told us "I know how to complain. I would speak straight to the manager." The compliments recorded said "We could not have asked for a better home. You have been wonderful."