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Lilac Cottage Requires improvement

Reports


Inspection carried out on 13 December 2019

During an inspection looking at part of the service

About the service

Lilac Cottage is a residential care home providing personal care to five people at the time of inspection. The service can support up to seven people with different health and care needs, including learning disabilities and/ or autism, in one adapted building.

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. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. There was some mixed feedback about the consistent implementation of the principles and the adaptation of the service to meet individual needs.

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

People and staff told us that the service had gone through a period of unsettlement but was stabilising again. People and staff were pleased that the registered manager was back at Lilac Cottage full-time. The provider had seconded the registered manager elsewhere and made alternative management arrangements for the service. However, in the absence of the registered manager, there had been some inconsistencies in management arrangements and effective provider oversight had not always been ensured. This had led to a deterioration in some areas, including the safety and quality of people’s care, but this was now improving. Staff comments included, “When I first came here, things were up the wall. With [registered manager] back, we are progressing a lot.” The provider had identified these gaps; however, it was clear their lessons learned from events included the need to ensure more timely, robust oversight and prevent recurrence of issues.

The report highlights issues experienced by the service during an unsettled time and issues we identified at the start of our visit. We found a breach of regulations, as the Care Quality Commission (CQC) had not always been notified of specific events. However, we also took into consideration progress made and the reintroduction of stability with the presence of a dedicated registered manager. This provided mitigation to potential further breaches of regulation. We therefore made recommendations regarding safeguarding oversight, risk management and record-keeping, staffing and governance.

Record-keeping and quality processes had needed to be more effective, particularly to ensure safety and risk management information were up to date. We received some concerns regarding staffing. People felt that there were not always enough staff and that many had left. The registered manager was addressing this through recruitment. Staff felt that colleague numbers and reliability were stabilising again.

The service applied the principles the principles and values of Registering the Right Support and other best practice guidance, but some improvements were needed to the consistency of this. The principles 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. It was noted that an aspect of service adaptation did not always meet the individual needs of a person. We considered that partnership working with people, families and stakeholders at times needed to be more robust. This was to ensure there was an agreement on how individual needs would be met appropriately and establish a shared vision of support and expectations.

However, following their recent full-time return the registered manager had brought back with them their passion to drive up the quality of people’s care. Overall, people told us they felt safe living at Lilac Cottage and thought, “[Registered manager] is sound” or showed us in their own ways how much they liked them. Positive feedback from some relatives told us, “I generally think it is a great service, the staff are very supportive of [name] and their family” and “[Name] is safe and well

Inspection carried out on 14 March 2019

During a routine inspection

About the service:

Lilac Cottage is a residential care home that was providing accommodation and personal care to seven people with different health and care needs at the time of the inspection. The service specialises in the care for people with learning disabilities and/or autism, as well as people with mental health conditions or multiple and complex needs. Lilac Cottage is one of the provider’s several homes on the New Hall campus in Fazakerley, a short walk away from local shops and public transport.

People’s experience of using this service:

• People felt safe living at the service and were actively involved in the design and delivery of care.

• Although Lilac Cottage is part of a campus-style setup, staff supported people living at the service to get involved in the community.

• Care was person-centred to promote independence. People had individual “Our journey to independence” pathways and good outcomes were achieved with a view to people moving into their own tenancies.

• We observed a warm, caring atmosphere and people told us in their own words or ways that they were happy with their care and support.

• The culture of the service embraced and actively promoted the diversity and equality of people.

• This was led by a passionate registered manager, who was well respected by people living at the service and their staff team.

• There were enough staff to meet people’s needs and their support was flexible around people’s wishes.

• Staff felt well supported and were involved in the development of the service.

• The service continued to meet the characteristics of Good in most of the areas we looked at.

• We found some particularly good and creative elements of care in which people were involved, for example in promoting health and wellbeing.

• However, some governance aspects and record-keeping needed to be more robust to underpin safe and consistent service delivery.

• We made a recommendation regarding the service’s governance and record-keeping.

• We therefore rated Well-Led as Requires Improvement on this inspection, however the overall rating for the service did not change.

Rating at last inspection:

At the last inspection the service was rated overall as Good.

Why we inspected:

This was a planned inspection that was scheduled based on the previous rating. We inspected to check whether the service had sustained its Good rating.

Follow up:

We will follow up on this inspection through ongoing monitoring of the service, through conversations and notifications.

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

Inspection carried out on 22 August 2016

During a routine inspection

This inspection took place on 22 August 2016 and was unannounced.

Lilac Cottage is a residential service which provides accommodation and personal care for a maximum of six people with complex health and care needs. At the time of the inspection six people were living at the home. The accommodation consists of six self-contained flats and a shared kitchen and lounge.

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.

At the previous inspection we were unable to provide a rating. The home had only recently started to provide services and we were unable to gather sufficient evidence.

Risk to people living at the home was appropriately assessed and recorded in care records. We saw risk assessments relating to a range of situations, for example, health conditions, medicines and accessing the community.

Staff understood different types of abuse and neglect and what signs to look out for. Staff also knew what action to take if they suspected that abuse was taking place.

Accidents and incidents were recorded in appropriate detail and assessed by the registered manager. The registered manager was required to submit a copy of the information to the provider. The information was then analysed to identify patterns and triggers.

The home had sufficient staff to meet the needs of the people living there. People received different levels of support based on their needs and the activities that they were involved in. None of the people that we spoke with reported that staffing levels had been an issue.

The home had a robust approach to safety monitoring and employed external contractors to service and check; gas safety, electrical safety and fire equipment. We saw that checks had been completed in each area within the previous 12 months.

People’s medicines were stored and administered in accordance with good practice. We spot-checked Medicine Administration Record (MAR) sheets and stock levels. Each of the MAR sheets had been completed, however, stock levels for one medicine did not tally with the figures recorded on the MAR sheets. We spoke with the registered manager about this. They completed an immediate investigation and identified that the error was in the figure recorded on the MAR sheet and not in the stock levels.

Staff had the skills and knowledge to meet the needs of the people living at the home. Staff told us that they were well-supported by the provider. They were given regular formal supervision which was recorded on their staff file.

Applications to deprive people of their liberty had been submitted appropriately and in accordance with the Mental Capacity Act 2005 and had been made in people’s best-interests.

People were supported to maintain good health by accessing a range of community services. We saw evidence in care records that people had a GP, optician and dentist and had regular check-ups. People were also supported to engage with specialist services and were accompanied on appointments to help with assessment and communication. We also saw evidence of health action plans which detailed a range of healthcare needs and other important information.

Throughout the inspection we observed staff interacting with people living at the home in a manner which was kind, compassionate and caring. We saw that staff involved people in discussions and decisions about their own care and in general conversation.

We saw that people had choice and control over their life and that staff responded to them expressing choice in a positive and supportive manner.

Privacy and dignity were protected and promoted by staff. Staff spoke with respect about the people living at the home and promoted their dignity in prac

Inspection carried out on 5 and 7 October 2015

During a routine inspection

This unannounced inspection took place on 5 and 7 of October 2015. Lilac Cottage is registered to provide personal care and a transitional service to young people aged 16 – 24 who are moving on from children’s services, foster care, hostels and youth offender institutions. They may also have a learning disability, mental health need, behaviour that challenges or a combination of these.

One person was living at Lilac Cottage at the time of the inspection. This person had only been living at the property for a week during the time of our inspection. Due to this we have not been able to rate the service as it is too early to tell if the provider is providing a service which is safe, effective, caring responsive and well led. However we have produced this report based on our findings at the time of the inspection.

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 knew what actions to take if they thought that anyone had been harmed in any way. Records showed the person was happy with the care they were receiving at Lilac Cottage

Staff we spoke with and rotas confirmed that there were enough staff available to meet the needs of the person living at the home.

They knew the person well and were aware of their history, preferences and dislikes. Staff monitored the person’s health and welfare needs and acted on issues identified. The Person had been referred to healthcare professionals when needed.

We observed there were enough suitably trained staff to meet their individual care needs. Staff were only appointed after a thorough recruitment process. Staff were available to support the person to go on trips or visits within the local and wider community.

The Person who lived at the home were not applicable to be assessed under the Mental Capacity Act 2005 legislation as they were under eighteen years of age, however the manager did demonstrate a good understanding of the Mental Capacity Act 2005.This is legislation to protect and empower people who may not be able to make their own decisions.

Deprivation of Liberty Safeguards (DoLS). DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. At the time of this inspection, there was no one living in Lilac Cottage who was over 18 years of age, so this safeguard did not apply.

The Person’s bedroom was individually decorated to their own tastes. The person was encouraged to express their views and these were communicated to staff verbally.

The person who lived at the home, their relatives and other professionals had been involved in the assessment and planning of their care. Care records were in place, however these did not fully explain the complexity of the person who lived at the home or how they should be supported.

There was a complaints procedure in place and we could see from the persons file the procedure had been discussed with them.