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Inspection carried out on 13 December 2017

During a routine inspection

Lillibet House is a care home registered to provide accommodation with personal care for up to 30 people. Some people may have dementia.

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

Inspection carried out on 15 September 2015

During an inspection to make sure that the improvements required had been made

This inspection took place on 15 September 2015 and was unannounced The inspection was carried out in response to information of concern which had been received.

At this inspection we looked at these specific areas to check if the provider was meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Lillibet House provides care and support for up to 30 older people who are physically and mentally frail, some of whom may be living with dementia.

The registered manager at the service had recently resigned from the service. Therefore, the service did not have a registered manager. 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.

During this inspection we found that risk assessments for people whose behaviour could challenge others required more detail on the actions staff should take to reduce the potential risk of harm. We also found that one person’s mobility had become impaired; however, their risk assessment had not been updated to reflect the changes.

There was insufficient guidance for staff to follow on the circumstances when staff should administer ‘when required’ medicines (PRN) to a person who use the service.

We found the staffing numbers were sufficient to meet the needs of the people who lived at the service.

Staff ensured the principles of the Mental Capacity Act (MCA) 2005 were being followed when supporting people to make decisions.

We found people were provided with adequate amounts of food, drinks and snacks.

Inspection carried out on 12 March 2015

During a routine inspection

Lillibet House is a care home registered to provide accommodation with personal care for up to 30 people. Some people may have dementia.

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

Inspection carried out on 11 November 2013

During a routine inspection

When we visited Lillibet House on 11 November 2013, people told us they were happy with the home environment, the support they were offered and the food they were given. One person said, “I really like being here.” Another told us, “The staff are very nice and always look after me.”

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.

Inspection carried out on 15 November 2012

During a routine inspection

On our visit of the 15 November 2012 we observed the interactions between staff and people using the service. The interactions were positive and people were consulted about the things they wanted to do.

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."

Inspection carried out on 6 December 2011

During a routine inspection

People who spoke with us told us that they made their own decisions about issues such as what time they got up, went to bed and where they had their meals. They also said that they could choose whether to take part in the activities that were available. One of the people living in Lillibet House told us that their needs were met there and that the staff were helpful.

We observed staff speaking to people in a kind and respectful way. We heard people being offered choices and also heard staff taking time to explain things to people who had difficulty in understanding the first time.

Reports under our old system of regulation (including those from before CQC was created)