We carried out an unannounced inspection of The Lilacs Residential Home on 8 May 2017. The Lilacs Residential Home provides care and accommodation for up to 29 people who required accommodation and personal care. Nursing care can be provided through the local community nursing services if appropriate. At the time of the inspection 25 people were living at The Lilacs Residential Home and a further three people were receiving temporary respite care. The manager was currently going through our application process to register as a registered manager with the Care Quality Commission (CQC). They were supported by a deputy manager. Both had worked at the service for many years. 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. The provider, Lilacs Care Ltd, is part of Stonehaven Care Group which is a family run company providing care in seven homes throughout the South West. Each home was supported by a central support office and a director visited each home at least once a month to monitor quality standards. This is the first inspection since the new provider, Lilacs Care Ltd, registered with CQC on 16 December 2015.
At this inspection we found the service was meeting all regulatory requirements and we did not identify any concerns with the care provided to people living at the home. One relative said, "I come regularly and I can always leave knowing [person’s name] is happy. The staff communicate well and the manager will ring and reassure me everything is ok.”
On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a friendly and respectful way. People were able to choose what they wanted to do and enjoyed spending time with the staff who were visible and attentive. There was a lot of staff interaction and engagement with people, most of whom were living with dementia and unable to tell us directly about their experiences. They looked comfortable and happy to spend time in the large conservatory. People were encouraged and supported to maintain their independence. There was a sense of purpose as people engaged with staff, watched what was going on, played games and pottered around the home or went out into the garden with relatives. The majority of people were living with dementia and were independently mobile or required some assistance from one care worker. Staff engaged with them in ways which reflected people's individual needs and understanding, ensuring people mobilised safely from a discreet distance.
People were provided with good opportunities for activities, engagement and trips out. These were well thought out in an individual way and the manager had previously been the activity co-ordinator. They had identified that the service could improve activities by providing smaller items to touch and interact with when there was not an organised activity planned. They had resourced activity kits from a specialist dementia service and planned to add these into the day to day programme. For example, appropriate dementia focussed games, art and visual stimulation. People could choose to take part if they wished and when some people preferred to stay in their rooms, staff checked them regularly spending one to one time with them.
People and relatives said the home was a safe place for them to live. One person was able to tell us, “The girls are all top hole! I’m a people person and I like it here.” Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns. Staff were confident that any allegations made would be fully investigated to ensure people were protected. Any safeguarding concerns had been managed well with provider involvement and the service worked with the local authority safeguarding team. Relatives said they would speak with staff if they had any concerns and issues would be addressed and people seemed happy to go over to staff and indicate if they needed any assistance. Staff were vigilant about protecting each person from possible negative interactions with other people living at the home, recognising frustrations and misunderstandings between people due to them living with dementia. They used chatting and distraction techniques as they knew people well, showing patience and understanding. People and relatives knew how to make a formal complaint if they needed to but felt that issues would usually be resolved informally. One relative said staff had discussed meal time arrangements with them to ensure their loved one sat with people who also required assistance with meal times. This had helped to encourage their loved one to eat more readily.
People were well cared for and relatives were involved in planning and reviewing their care as most people were not able to be involved due to living with dementia. Care plans showed that people were enabled to make smaller day to day choices such as what drink they would like or what clothes to choose. Where people had short term memory loss staff were patient in repeating choices each time and explaining what was going on and listening to people’s repeated stories.
There were regular reviews of people's health, and staff responded promptly to changes in need. For example, care records showed many examples of staff identifying changes in need and appropriate and timely referrals to health professionals. One person had been referred to a community psychiatric nurse and staff had worked together resulting in the person becoming more settled and calmer around the home. Staff said, “It’s been really nice as they had behaviour that was challenging and distressing before and now they can still be active, which they like, but they are not so anxious. That’s good because we don’t want anyone sedated.” People were assisted to attend appointments with appropriate health and social care professionals to ensure they received treatment and support for their specific needs. For example, one person had a sore area which had healed quickly with district nurse input and monitoring by staff.
Medicines were well managed and stored in line with national guidance. Records were completed with no gaps and there were regular audits of medication records and administration and to ensure the correct medication stock levels were in place.
Staff had good knowledge of people, including their needs and preferences. Care plans were individualised and comprehensive ensuring staff had up to date information in order to meet people's individual needs effectively. The service was in the process of transferring information to a new computer system. At the time of the inspection the previous care plan records were cumbersome with repetitive and unnecessary forms so the new system would enable staff to write less in a more meaningful way. For example, incident forms were used which could have been used with the daily record forms to bring information together in a more organised way. However, all the information about people was available, although not easy to access and there was a very stable staff team who knew people really well to be able to meet their needs. Following this inspection the deputy manager was starting to devise ‘wardrobe summaries’ to put discreetly in people’s rooms showing important information ‘at a glance’. Handover and communication between staff shifts was good so there was consistent care. The service rarely used agency staff but were able to fill vacancies if they could not cover shifts within the staff team.
Staff were well trained and there were good opportunities for on-going training and obtaining additional qualifications. The staff team was very stable and many care staff had worked at the home for some years. They said they enjoyed the homely feel and felt they had never been so supported since the new provider took over the service. Staff clearly had good knowledge in identifying people’s changing needs and providing appropriate care. Relatives said, “All the staff are pleasant and patient. They listen to any ideas I have. They are very thorough.”
People's privacy was respected. Staff ensured people kept in touch with family and friends, inviting friends and family to outings and events regularly. Two relatives told us they were always made welcome and were able to visit at any time, use the quieter lounges and make hot drinks. They had particularly enjoyed a trip out on the train. People were able to see their visitors in communal areas or in private.
The manager and deputy manager showed great enthusiasm in wanting to provide the best level of care possible and valued their staff team. For example, organising staff days out raising money for a dementia charity and working together to ensure people’s needs were met as well as facilitating fun opportunities for people. Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people in individualised ways. During the inspection staff held a sing along with people using a printed folder of song words so they all joined in. Staff were very positive about working at the home. They had enjoyed bringing fish and chip suppers to the home, wrapping the meal in paper like a takeaway, which people had enjoyed. Staff said they saw The Lilacs as their second home and one staff member had begun their wedding celebrations at the home to ensure people living there were included.
Observations of meal times showed these to be a positive experience, with people being supported to eat a meal of their choice where they chose to eat it. Staff engaged in conversation with people and encouraged them throughout the meal, noting who liked to sit with whom. Nutritional a