Lillington House

Lillington House provides nursing and rehabilitative support to a maximum of 57 people suffering from a neurological disability. Most people also have highly complex medical conditions requiring continuous care and support or highly specialised nursing. The home is divided into three units over two floors. On the lower ground floor there is a therapy unit with a hydrotherapy pool, physiotherapy room and an occupational therapy assessment room. A range of on-site therapists provide rehabilitative input. There are large communal areas and extensive grounds which are accessible to the people living in the home.

People’s experience of using this service:

People had confidence in the service to keep them safe and were protected from avoidable harm by staff trained to recognise and report any concerns. Potential risks to people were assessed and minimised. Staff monitored signs and symptoms to keep people safe and well. Medicines were received, stored, administered and disposed of safely.

The registered manager ensured there were enough staff available with the appropriate knowledge and skills to meet people’s needs. People received effective care from staff who were well trained and well supported. There was a thorough approach to planning and co-ordinating people's care. Staff and therapy teams worked well together and with external care professionals to ensure people received the care and support they needed. People's nutrition and hydration needs were met. People were offered a choice of meals which promoted a healthy and balanced diet.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. Information was presented to people in way that enabled them to be involved in their care.

People received compassionate care from staff who prioritised their needs and worked as a team to ensure people achieved good outcomes. Staff were responsive to people’s physical, emotional and mental health needs. People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints received.

There was a clear quality assurance system in place and the provider took learning from situations to improve outcomes for people.

The service met the characteristics for a rating of “good” in all the key questions we inspected. Therefore, our overall rating for the service after this inspection was “good”.

Rating at last inspection: At the last inspection the service was rated ‘Good’ overall, but some improvements were required in the leadership of the service. At this inspection the improvements had been made. (Last report published 20 December 2016).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor all information we receive about the service and schedule the next inspection accordingly.

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

Castel Froma provides nursing and rehabilitative support to a maximum of 57 people suffering from a neurological disability. Most people also have highly complex medical conditions requiring continuous care and support or highly specialised nursing. The home is divided into three units over two floors. On the lower ground floor there is a therapy unit with a hydrotherapy pool, physiotherapy room and an occupational therapy assessment room. A range of on-site therapists provide rehabilitative input. There are large communal areas and extensive grounds which are accessible to the people living in the home.

We last inspected the home in October 2015. After that inspection we asked the provider to take action to make improvements in management of medicines in the home. The provider sent us an action plan to tell us the improvements they were going to make. At this inspection we found improvements had been made.

A registered manager was in post. 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.

Staff were proud of the service they provided and committed to providing high quality, compassionate care. Staff were friendly and thoughtful and took time to understand the needs of people with no or limited verbal communication. Staff treated people with dignity and respect and understood the importance of making them feel valued.

Friends and family were welcomed into the home and able to visit when they wished. Staff showed an awareness of how families and friends needed their support to manage their emotional needs and understand people’s conditions.

There were enough skilled and experienced staff on duty to meet people’s care and support needs safely and effectively. Staff had the necessary knowledge and information to ensure people were kept safe from abuse or harm. The provider’s recruitment process was thorough and ensured, as far as possible, staff were of a suitable character to work with people who lived at Castel Froma.

Staff had clear guidance on how to mitigate identified risks associated with people's health and well-being. Risk assessments were an essential part of keeping people safe, and some risk assessments were for ‘positive risk taking’ which promoted people's independence. The provider had procedures and policies to ensure the safety of the environment and equipment in the home. People's medicines were managed, stored and administered safely.

People received care from a multi-disciplinary staff team who were qualified and trained to meet their needs effectively. Staff were encouraged to undertake additional training and qualifications relevant to their roles. Nurses were offered reflective practice sessions where they could discuss any issues with their work.

The rights of people who were unable to make important decisions about their health or well-being were protected. Staff followed the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People were assessed on an on-going basis by dieticians and speech and language therapists (SALT) who visited the home every week to ensure people’s nutrition plans met their medical and health needs.

People's medical and personal needs were assessed and care and support was planned and delivered in line with their individual care plans. Each person had a named nurse who co-ordinated their care and regularly evaluated care plans to ensure they continued to meet the person's health and medical needs. Staff knew and understood people’s needs and how to support them. Staff worked closely with a range of external healthcare professionals to monitor and maintain people's health.

People were supported to achieve personal goals through rehabilitative input from physiotherapists and occupational therapists. Staff celebrated and were proud of people’s achievements in attaining their goals.

Whilst some staff felt included, valued and supported within the home, others did not. Care staff told us they felt the demands on their time were not always understood and there was inconsistency when senior managers gave instructions and directions outside their own areas of responsibility. They were not confident their concerns were always listened to.

There was a clear management structure in place to support the management and governance of the home. The provider completed various audits and checks to ensure the service people received was safe, effective and responsive to people’s needs. The provider's quality assurance system involved asking people and their relatives about their experience of the service.

During our visit we spoke with the clinical manager and eight care and nursing staff. We spoke with three people who lived at Castel Froma and six visiting relatives. We also had the opportunity to speak to a GP who attended the home on the afternoon of our visit. We spent time in the communal areas of the home and observed the care and support provided to people. We looked at care records, staff records and quality assurance records. We used all the information we gathered during our visit to answer five key questions. Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. If you would like to see the evidence supporting our summary please read the full report.

Is the service safe?

We looked at the care records for three people living at Castel Froma. Care plans provided staff with the information required to meet people’s individual care and nursing needs.

The service was safe, clean and hygienic. Housekeeping staff demonstrated a good understanding of their responsibilities in providing a clean environment for people receiving support. Staff understood the importance of infection control although training in that area was not up to date.

There were appropriate emergency evacuation plans in place and an up to date critical incident plan to ensure the needs of people could continue to be met during or following an emergency.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS) which applies to care homes and hospitals. Whilst nobody had a DOLS in place, the clinical manager was aware of their responsibilities under the legislation to ensure people’s rights were protected.

Is the service effective?

People’s health and care needs were assessed before people moved to the home. Relatives confirmed they were involved in planning the care their loved one received. We saw people’s care needs were regularly reviewed and discussed with them or their relatives.

One relative told us they had an annual review with the nurse, physiotherapy and occupational therapy. They told us, “They listen intently to what I say because I am very proactive and they like my feedback as much as I like theirs. We cover everything.”

A visiting healthcare professional told us, "For the level of care and nursing support people need here, the staff do a really good job as there is a high level of need for some patients."

One person told us, “They have done me well. They have got me back on my feet.”

We found there were areas of record keeping that needed improvement to evidence care was being delivered as set out in people’s care plans.

Is the service caring?

People were supported by kind and attentive staff. People who used the service and their relatives spoke positively about the staff who provided care and support.

Comments included:

“They are all friendly and they all speak.”

“They are very good. I have a good laugh with them. They try and make it as homely as possible. When I need somebody they will always come to me.”

Interactions between staff and the people living at the home appeared relaxed and not rushed. We found staff were compassionate and caring when supporting people.

Is the service responsive?

Care records we looked at confirmed people were referred to other healthcare professionals when a need was identified.

Most people told us they would feel confident in raising any concerns about the service provided. One person said, “If I’m not happy, I will say. I find the powers to be here are very approachable.”

Is the service well-led?

We found staff employed at the home did not have regular supervision with members of the management team. We saw where staff had raised concerns about their workloads these had not been addressed and staff had not received the support they required to carry out their role. A lack of supervision and support was impacting negatively on staff morale.

There was a system of audits both internally and by the provider to identify areas of concern and actions the manager and staff needed to take to address concerns.

People and their relatives were asked their views of the home through regular quality assurance questionnaires.

We found that systems were in place to allow people choice and independence. We found that people's individual needs had been met and care identified to support those needs. The people we spoke with identified satisfaction with their diet and told us they had been given food choices at each meal time. We saw during our lunch time observational exercise that people's nutrition and hydration needs were being met.

We spoke with eleven staff and two relatives about staffing levels at the home. People's relatives told us that there were sufficient staffing levels and there were always staff available to talk with. The staff we spoke with told us that staffing at the home was satisfactory and that any shortfalls in staffing were replaced. We looked to see whether staff were sufficiently skilled within their roles and saw evidence of on-going training in place to maintain staff skills and knowledge.

We found an effective complaints process in place. This meant that people’s concerns had been listened to and acted on effectively.