Lilybank Hamlet Care Home

Lilybank Hamlet Care Home is a residential care home providing personal care to up to 63 people. The service provides support to people with dementia, older people and people with a learning disability. At the time of our inspection there were 32 people using the service.

The home is set over 3 floors with a lounge, dining room and conservatory on the ground floor and further communal spaces to the second floor. There was a mixture of ensuite and shared bathroom facilities and there was access to outdoor space.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Care: Identified risks to people's safety were not always mitigated to keep people safe from avoidable harm. Governance systems were not effective in monitoring risks to the health, safety and welfare of people using the service.

Systems and processes were not effective in maintaining and inspecting equipment accessories used to lift people. Medicines were not always managed safely; medicine protocols were not always in place for the administration of when required medicines. Fire safety actions were not completed, fire procedures were not updated, evacuations were not reviewed with actions to improve, and staff had not been trained in the use of fire equipment.

People received kind and compassionate care. Staff protected and respected people's privacy and dignity. Family members felt that their relatives were safe at the service. Appropriate checks were carried out when recruiting new staff to support people. People could take part in activities and were supported to access their community.

Right Culture: The service had recently gone through several changes, including a change of leadership. More time will be required to assess whether the leadership in place ensures people have inclusive and empowered lives. People felt able to raise concerns and felt that the management team were approachable.

Right Support: Staff had received training to support people with a learning disability. The provider recently closed a small home at the location and supported peoples transition into other placements or into the main home. The provider had worked with other agencies to coordinate and plan the transitions for people.

People were supported to have maximum possible choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service did not always demonstrate how they were meeting the principles of right support, right care, right culture.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 17 March 2023).

At our last inspection we found breaches of the regulations in relation to safe care and treatment and governance. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve.

At this inspection, we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 06 June 2023. Breaches of legal requirements were found in relation to safe care and treatment and good governance.

We undertook this focused inspection to check if the provider had made improvements and if they were now meeting the legal requirements. This report only covers our findings in relation to the key questions Safe and Well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has not changed following this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lilybank Hamlet Care Home on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We have identified continued breaches in relation to health and safety, fire safety, governance and medicines management.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Lilybank Hamlet Care Home is a residential care home providing personal care for up to 63 people. The service provides support to people with dementia, older people and people with a learning disability. At the time of our inspection there were 31 older people living at the main house and a second home provided personal care and support for 4 people with a learning disability.

The main home is set over 3 floors with a lounge, dining room and conservatory on the ground floor and further communal spaces to the second floor. The smaller home was adjacent to the main house and had 2 communal areas and shared bathroom facilities. Both homes had access to outdoor space.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People’s experience of using this service and what we found

Medicines were not always safely managed. Systems were not used effectively to monitor stock levels and medicine storage was not secure and monitored. Routine safety checks were not in place putting people at risk of avoidable harm. Governance systems were not effective in monitoring and mitigating risks to the health, safety and welfare of people using the service.

Right Support: Improvements were required from the provider to ensure staff received the training they needed to meet people’s needs, not all staff had received training in supporting people with a learning disability or autism.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service also did not support people to have choice and control over their own lives.

Right Care: Care plans did not always reflect the care that people received from the staff team and did not always demonstrate the underpinning principles of Right support, right care, right culture. People were not supported by staff who knew them well as some of the staff team were scheduled to work between the 2 homes. People had access to health care professionals. Family members felt that their relatives were safe at the service. Appropriate checks were carried out when recruiting new staff to support people.

Right Culture: People's accommodation and care was focused on keeping people safe and was not focused on effectively listening to them and the promotion of people having control over their lives and living an ordinary lifestyle. For example, people were not supported to access and participate in their local community. People felt able to raise concerns and felt that the management team were approachable. Staff also felt supported in their role and felt able to raise concerns if necessary.

The provider acknowledged at the beginning of the inspection that they were exploring renovation options, although there was no schedule in place.

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

Rating at last inspection and update

The last rating for this service was Good (published 24 February 2020)

Why we inspected

We received concerns relating to staffing, activities and maintenance of the environment. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. We are assured the home manager has taken action following the inspection to address our concerns.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lilybank Hamlet Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Lilybank Hamlet Care Home is a residential care home providing personal care and support for up to 42 older people in the main house, some of whom are living with dementia. A second smaller home adjacent to the main house provides personal care and support for up to five people with a learning disability. At the time of our inspection there were 36 older people living in the main house and the second smaller home was fully occupied. The main house is set over three floors, with a variety of different room sizes and features. All rooms have wash basins and some are fitted with en-suite bathrooms. There is a lift available to access the upper floors in the building. There are numerous lounges, a conservatory, a formal dining room and hairdressing salon on the ground floor.

As it relates to the small home setting, the service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

People felt safe using the service and were protected from abuse and the risk of abuse. The staff team understood how to identify and report safeguarding concerns. Safe recruitment practices were in place. Risks to people were assessed and managed. Medicines were safely administered, stored and recorded. Infection control measures were in place to protect people from the risk of infection and regular checks of the safety of equipment and the premises took place.

People had personalised assessments of their care needs in place. Care plans were developed with people and their families and included their preferences and routines. People had a choice of nutritious food, drinks and snacks. Options were available at each meal time and people’s dietary needs were met. People were supported in the least restrictive way possible and were supported to have maximum choice and control of their lives.

People felt the staff were kind, helpful and caring. People were treated with dignity and respect and their privacy was respected. People were supported to maintain relationships with friends and family. People were encouraged to remain as independent as possible. Advocacy services were made available to anyone who needed them.

People’s care was responsive to their individual needs. People’s communication needs were included in care plans, this meant staff were able to communicate with them in a meaningful way. A variety of group or individual activities were available. People and their relatives were aware of how to raise a complaint which were acted upon promptly by the management team.

The registered manager was committed to providing a good standard of care. Staff felt supported by the management team and team morale was positive. The registered manager was aware of their regulatory responsibilities. Regular audits and checks ensuring the service was safe and of a good quality were conducted. People, their families and other professionals were encouraged to provide feedback and suggestions. The management team worked with other professionals from health and social care in a multi-agency approach to ensure good outcomes for people.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

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

Rating at last inspection

The last rating for this service was Good (4 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The inspection visits took place on 9 and 12 June 2017 and the first day was unannounced. The service was last inspected on 16 and 17 June 2015 and was rated 'Good' overall. At this inspection we found the service remained 'Good' in all five key questions and overall.

There was a registered manager in post at the service; there was also a new manager who had commenced the process of registering to become the 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.

Systems in place in relation to medicines were safe and managed in a manner which met with current guidance. Procedures were in place to deal with unexpected incidents and emergencies. Pre-employment checks were carried out before staff began working at the service. Policies and procedures were in place for safeguarding and protecting people from abuse

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.

Staff were provided with training which gave them the skills and confidence to carry out their job roles and responsibilities. People were provided with choice around meals and special diets were catered for. People were supported to access appropriate healthcare professionals.

People and relatives felt staff continued to be kind, caring and compassionate; people were supported to remain as independent as possible. People told us they chose how to spend their spare time.

Staff undertook assessment of people’s needs prior to them using the service. The provider had an easy read pictorial and written complaints procedure which was clearly displayed at the service. A number of audits were carried out to monitor the quality of service was maintained; where improvements had been identified as necessary, they were addressed promptly. The service was managed in an open and transparent manner.

As part of our inspection we spoke with eleven people receiving care and five of their relatives. We spoke with managers and staff working at the home, examined records and observed people receiving care.

Below is a summary of what we found.

Is the service safe?

We observed people were treated with respect and dignity by the staff. One person living at the home told us, "They do their best for me here." Another person's relative said, 'The care is generally good. The staff are caring and respectful.' Systems were in place to monitor the quality of care people received and record any incidents and accidents. This helped reduced risks to people and helped the service to continually improve. We found special equipment was provided for people and checks were completed to ensure it was safe. A plan was in place for dealing with emergencies so that people were not put at risk. The community house we inspected was not adequately maintained to ensure it was fully safe for people receiving care. Some aspects of people's care was not ensuring their welfare and safety. Risks and changes in people's care needs were not always identified promptly and appropriate action taken. Enough staff were usually provided to meet people's care needs but there were some needs that were not being adequately met because suitable or sufficient staff were not available. A plan was in place for responding to unexpected events that could affect the running of the service, for example fire or loss of the power or water supply. Some areas of the community house we visited were not adequately maintained to ensure it was fully safe for people receiving care to use.

Is the service effective?

We found people's needs were assessed and care files included information about any diagnosed health conditions or disabilities. Some risks that could affect people had not been adequately assessed and managed as part of the care planning process. This meant that care had not fully protected people's welfare and safety. Consent was obtained for people's care and appropriate arrangements made if people could not consent for themselves, for example due to dementia.

Is the service caring?

People told us they were happy with the care they received at the service. One person's relative said, "You can see [my relative] is happy with staff. That's what matters to me." We observed that staff communicated well with people and were keen to involve them in activities if they chose to do this. Care planning took account of people's wishes, preferences and background which helped ensure staff could provide personalised care that met their needs.

Is the service responsive?

Systems were in place for obtaining people's views about the service provided. People told us they knew how to make a complaint if they were unhappy. They also told us staff responded well if they had any concerns. One person said, "I think if I were unhappy. The staff would help me.' We saw the provider assessed the quality of care people received and that action was taken where improvements were needed. Some aspects of people's care was not fully safe because care plans had not been updated to include information to protect them from risks.

Is the service well-led?

Checks and audits of medication, infection control systems and other aspects of safety and practice were in place at the home. People using the service, their relatives and other people involved with the service completed an annual satisfaction survey and records showed action was taken where any improvements were required . Meetings were held with people living at the home and also relatives and friends to discuss what was going well and any concerns. As a result, the managers were able to plan any improvements that were needed to the way people's care was delivered and the service was provided.

People we spoke with were, on the whole, satisfied with the care provided at Lilybank Hamlet. They told us, 'I am alright here. I am independent, I can look after myself. The carers are good and they speak to me with respect.' and, 'I feel safe and I'm happy with the care.'

We found that the provider had taken action following our last inspection. This had resulted in changes and improvements to how care was planned and delivered. Medication was given safely and recorded correctly and there were systems to monitor this. People's personal records were regularly reviewed so that information about their needs was up to date. Staff were receiving regular supervision to support them to meet the needs of people using the service.

We found that staffing levels and staff training were sufficient to meet the needs of people using the service. However, the staffing level in the service for people with learning disabilities was not always flexible to allow for individual choice.

The provider had taken some action to ensure that people were asked for their consent before they received care or treatment. However, we found that assessments made of people's capacity to make decisions about their care were not always in line with relevant legislation.

People we spoke with were mostly positive about the service. They told us, 'They look after me.', and, 'The staff are nice.' A relative told us that the staff were 'Very good, they understand her, they know what she likes to do.' One person told us they felt staff were sometimes 'Too sharp' and this did not help when the person was upset.

We found that people were not always asked for their consent before they received care or treatment. If people lacked the capacity to consent, there were no suitable arrangements for acting in their best interests.

People's needs were assessed, but their care and treatment was not always planned and delivered to meet their needs. This meant that people were at risk of receiving unsafe or inappropriate care or treatment.

We found that medicines were not always safely and correctly administered and recorded.

We found that people were cared for by staff who had received appropriate training. However, staff supervision did not always ensure that staff were delivering care safely and to an appropriate standard.

People's personal records were not always accurate or up to date.