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Inspection carried out on 20 September 2018

During a routine inspection

This inspection took place on 20, 26 and 27 September 2018. The first day of our inspection was unannounced.

Lister House is a ‘care home’ situated in Ripon. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service supports older people, some of whom may be living with dementia, and can accommodate up to 76 people. People who live at Lister House have an association with the Armed Forces.

The service can accommodate up to 60 people within their main building and 16 people within the Colsterdale Unit, which specialises in supporting people living with dementia. There were communal spaces for people to enjoy including a chapel and gymnasium, and there was lots of outdoor space.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager in post who had managed the service since 2013. 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 registered manager was absent at the time of our inspection and a peripatetic manager was managing the service with input from the provider.

Quality assurance checks completed did not identify some of the issues we highlighted during our inspection. For example, some statutory notifications had not been submitted, there was lack of specialist training for staff and agency profiles missing for two staff. There were also outstanding actions following the provider's most recent audit. The management team were responsive to the issues we raised and took actions to address these. The provider was in the process of developing their quality assurance tools to ensure the safety of the people who used the service and demonstrated they wanted the service to continually improve

Staffing levels were safe and the provider took appropriate actions when they considered staffing levels to be insufficient. People received their medicines as required. We found two instances where people prescribed ‘as and when needed’ medicines did not have protocols in place to ensure staff understood when to administer these medicines. For one person a choking risk assessment had not been completed but for all other identified risks, risk assessments were completed and staff understood what actions to respond to risks. The provider had safeguarding policy in place and staff understood potential signs of abuse and who to report their concerns to. Accidents, incidents and near misses were recorded by staff and reviewed by the management team to ensure appropriate follow-up actions had been taken.

Staff completed training the provider considered mandatory, but had not completed training specific to the needs of the people who used the service. We have made a recommendation about the provider ensuring staff received the specialist training required.

Staff received supervisions and annual appraisals and told us they felt supported in their role. People were positive about the quality and choice of food. Staff weighed people on a regular basis, however for two people that required weekly weights these had not been taken. People had access to healthcare professionals. The needs of the people were considered in the design and decoration of the building. People were supported to have maximum choice an

Inspection carried out on 18 January 2016

During a routine inspection

This inspection was unannounced and was carried out on 18 January 2015. Lister House is owned and managed by The Royal British Legion, and has been since 1988. Admission is normally limited to those people who have served in the Armed Forces or their dependants. The home has sixty rooms in the main building and sixteen beds in the Colsterdale Unit, a purpose built dementia care unit. The home is registered for people who require nursing or personal care; they can also accommodate people with dementia and younger adults. There were 61 people living at Lister House on the day we inspected.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Care staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people.

People’s safety was promoted because risks that may cause them harm had been identified and managed. People were supported by care staff who encouraged them to remain independent. Appropriate risk assessments were in place to keep people safe. People we spoke with said they felt safe and they spoke positively about the care and support they received.

Staff recruitment processes included carrying out appropriate checks to reduce the risk of employing unsuitable people.

The home had safe systems in place to ensure people received their medication as prescribed; this included regular auditing by the home and the dispensing pharmacist. Staff were assessed for competency prior to administering medication and this was reassessed regularly.

Staff received a range of training which supported them to understand and meet people’s needs. Staff received supervision of their work and felt well supported by more experienced staff and the registered manager.

The assessment and the planning of people’s care was thorough and ensured staff had good information of people’s individual needs and preferences. People had a variety of activities available to them and the staffing arrangements helped to provide a flexible approach, such as supporting people to go out into the community.

Staff followed the principles of the Mental Capacity Act 2005 to ensure that people’s rights were protected where they were unable to make decisions.

People received a varied and nutritious diet which they enjoyed. People’s diet was closely monitored to ensure they received food and fluids necessary for their welfare. People who required special diets were catered for.

People had good access to health care services and the service was committed to working in partnership with healthcare professionals.

People told us that they were well cared for and happy with the support they received. We found staff approached people in a caring manner and people’s privacy and dignity was respected.

People looked well cared for and appeared at ease with staff. The home had a relaxed and

comfortable atmosphere.

People were involved in activities they liked and were linked to previous life experience, interests and hobbies. Visitors were made welcome to the home and people were supported to maintain relationships with their friends and relatives.

People knew how to make a complaint if they were unhappy and all the people we spoke with told us that they felt that they could talk with any of the staff if they had a concern or were worried about anything.

People completed an annual survey about the quality of the service. The provider reviewed this feedback used it to address any shortfalls and improve the service.

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The registered manager and care staff promoted a culture which focused on providing individual person centred care. People were assisted by care staff who were en

Inspection carried out on 17 April 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People were asked for their consent before they received any care or treatment and the service worked with other agencies and services to make sure the right people were involved in any decision making. This meant that the provider acted in accordance with legal requirements to safeguard people.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, and complaints, concerns and whistleblowing. This helped the service to continually improve.

The service had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff understood when an application should be made, and how to submit one. This meant that people would be safeguarded as needed.

The service was well maintained and it was comfortable and clean. This meant that people were not put at unnecessary risk.

The management team took people�s care needs into account in the recruitment process and systems were in place to make sure staff had received updated training in a timely way. This made sure there were enough qualified, skilled and experienced staff to meet people�s needs.

Is the service effective?

Information was available in the service to explain advocacy and ensure that people were aware of what independent support could be provided.

People�s health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist support and equipment had been identified in care plans as needed.

People�s care needs had been taken into account with signage and the layout of the service. This allowed people to move around freely and safely both inside the service and outside in the secure courtyard garden area. The premises were suitable to meet the needs of people with a physical disability.

In written feedback one person reported that people were always treated with dignity and respect, and every effort was made to identify the individual's needs and interests, and give a good quality of life. They said the care in the dementia unit was skilled and allowed their relative�s �former outgoing personality to shine through the frustration of dementia�

Is the service caring?

People spoke positively about the care they received. Comments included, �They (the staff) look after us very well. We all hail from different parts of the country with different needs and expectations it�s quite remarkable what a good job they do,� �They always have time for us,� and, �It is a really excellent standard here, they look after us wonderfully well.�

Is the service responsive?

People were supported to follow their own interests and pursuits. One person said, �The food is really excellent and we can all choose what we want to eat and how we want to spend our days.�

People using the service, their relatives and other professionals involved with the service completed an annual survey. This enabled the manager to address any shortfalls or concerns.

People knew how to make a complaint if they had any worries or concerns. We looked at how these complaints had been dealt with and found that the responses had been open, thorough and timely. People therefore can be confident that complaints would be investigated and action taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure that people received the right care.

Quality assurance systems were being developed to drive improvements based on feedback from people who used the service and stakeholder feedback and compliance auditing. These policies were intended to deliver services of a high standard and to ensure improvements.

Staff understood the aims and ethos of the service and they were clear about their roles and responsibilities to safeguard and promote people's and safety.

Inspection carried out on 9 July 2013

During a routine inspection

People who used the service, and their representatives, told us they were well looked after. One person said, �The care here is first rate.� We found people were able to choose where and how to spend their time and there were quieter areas for people who preferred a more restful environment. We observed staff were kind and respectful and spoke with people using their preferred names.

We found people�s care and welfare needs were identified and they were given the support they needed to meet these needs. People had access to a range of NHS services including community psychiatric nurses and district nurses.

We observed the meal service at lunchtime, in one communal area and saw people were offered a choice of food. People who needed help or encouragement to eat were given appropriate support.

We found people who used the service were safe and staff were aware of how to recognise and report any concerns about people�s safety and well being.

People we spoke with described the staff as �first class and lovely.� We saw staff were supported to maintain and develop their knowledge, abilities and skills.

There were systems in place to assess the quality of the service people received.

Inspection carried out on 11 May 2012

During a routine inspection

We spoke with over 17 people. Three people told us that they had been involved in planning their care. People understood the care and treatment choices available to them. One person told us that staff had spent time talking with them to write a life history, which included likes and dislikes, significant relationships and what was important to them. Another person told us that staff asked about their daily living decisions, for example, menu and activity choices.

People told us that they enjoyed their life at Lister House and that they were enabled to have freedom in their daily routines according to their wishes. This included regular trips out of the home during group events or to take part in individual interests and keep in contact with friends and relatives. Some people said they knew about their care plans and had been involved in developing them. One person was very positive about the care provided and told us, their 'health' had 'improved immensely since arriving here, in fact it improves every day.' They went on to say that the "Physio is very kind." One person said that when they used the nurse call staff remark 'what's up' which made them feel as if they 'shouldn't have rung the bell. Other people said they had no problems with summoning attention, although one person did say they had once had to wait half an hour to be attended to, but it had not been an 'emergency.'

One of the people using the service told us, "The nurses give me my tablets and that's the best way, I would probably forget if I had to do it myself." Another person said, "The nurse sorts out the medicines, no problem, I get my painkillers when I need them."

People told us that they found staff to be 'kind, appropriately trained and competent.' One person said; "The carers are alright, nice lasses with smiles on their faces, it makes all the difference."

Inspection carried out on 5 May 2011

During a routine inspection

The people who used the service told us that they were happy with the care and support that they received. One person said �It�s better than I thought here, I feel healthier since arriving. The care is very good, well excellent, they look after people well�. People receiving care and support were seen to be treated with dignity and respect by the staff. Another person said �Staff always come, I am happy they come when I need them�.

We observed that mealtimes were relaxed and seemed to be a social experience. People said �The food is good. Another said �I have put weight on�.

People told us �Staff are patient and kind. I feel safe with the staff, who always listen and act on what I want. I feel secure here. Staff told us that they knew how to report suspected abuse to help protect people.

People said that staff were there when they needed them. One person said �They recruit some pleasant staff who seem to know what they are doing�.

People we spoke to said they felt comfortable to raise any issues they may have and felt they would be dealt with appropriately. One person said �I feel I could talk to the manager if I had a complaint, I know her very well, and things would be sorted out�. Another person said �Fortunately since I have been here I have not had a reason to complain�.

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