This inspection was unannounced and took place on the 21 March 2016. A second day of the inspection took place on 29 March 2016 in order to gather additional information.Lilford Court was last inspected in August 2013. Six breaches of legal requirements relating to: consent to care and treatment; care and welfare of people using the service; staffing; supporting workers; assessing and monitoring the quality of service provision and records were identified. We undertook a follow-up inspection in March 2014 and found that improvements had been made to address the breaches.
Lilford Court offers accommodation and personal care for up to eight adults who have an autistic spectrum disorder and / or a learning disability. The registered provider is Autism Initiatives UK. At the time of our inspection the service was accommodating six people.
People using the service are supported by staff on a twenty-four hour basis. Each person has their own bedroom upstairs and people share a communal bathroom. A kitchen, lounge and dining room are also located on the ground floor. There are gardens at the front and back of the houses and parking outside.
At the time of the inspection there was a registered manager at Lilford Court. 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.
It became apparent during the inspection that there was a lack of managerial presence and direction in the service as a range of issues were highlighted throughout the inspection as detailed within the report.
During this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take as the back of the full version of the report.
We found that the registered person had not taken appropriate steps to keep the properties clean and appropriately maintained.
We also found that the registered person was not operating effective systems or processes to assess, monitor and improve the quality and safety of the services provided.
A number of records essential to the management of the service or to the evaluation of people’s care and treatment were either unavailable or out of date.
During our inspection we used a number of different methods to help us understand the experiences of people who lived at Lilford Court. This was because the people who lived at Lilford Court communicated in different ways and we were not always able to directly ask them their views about their experiences. Our observations showed people appeared relaxed and at ease with the staff.
We found there was a warm atmosphere and people appeared content, relaxed and happy in their home environment. People using the service were seen to follow their preferred routines and lifestyle and interactions between staff and people were positive, responsive to need and caring.
The care provided at Lilford Court was personalised and enabled people to live as independently as possible. People who used the service were supported and encouraged to follow their preferred routines and to make decisions about aspects of their daily lives such as their meals and daily activities.
Staff knew how to protect people from abuse and to keep them safe. The registered provider had policies in place to safeguard people from abuse and staff had completed training in this key area.
Medicines were ordered, stored, administered and disposed of safely. People had contact with their GP and health professionals as required.
Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. Staff were only able to start work at Lilford Court once the provider had received satisfactory pre-employment checks. We saw there were enough staff on duty to support people as needed in the home.
CQC is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. DoLS are a code of practice to supplement the main Mental Capacity Act 2005. These safeguards protect the rights of adults by ensuring if there are restrictions on their freedom and liberty these are assessed by the supervisory body. The assistant manager and majority of support staff spoken with had a good understanding about this and when it should be applied.
People who lived at Lilford Court were supported to plan their meals and make their own drinks and snacks, with staff support. Staff had good knowledge of people’s likes, dislikes and routines in respect of food, drinks and meal times.
People using the service took part in a variety of activities. Some people attended a day centre and others enjoyed activities both in the home and in their local community. Individual weekly timetables were completed as a way of helping people to understand what they were doing at different times of the day.
A complaints procedure had been developed by the provider and systems were in place to respond to complaints. We found that any complaints had been managed in accordance with the home’s complaints procedure.