Archived: Lilly House

Lilly House is a residential care home providing personal care and support to four younger adults with learning disabilities and autism. The service can support up to four people in one adapted building.

Lilly House is a family sized property in a residential area which looks similar to other houses on the street. It is located conveniently, a short drive from community resources, a large park and the town.

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

Systems and processes for staff to record incidents, particularly of behaviours that may challenge, needed to be strengthened and embedded. Safeguarding incidents were not always reported properly by staff. Positive behaviour support plans required further development. We have made a recommendation about reporting, recording, follow up and monitoring of safeguarding incidents and behaviours that challenge. Improvements had been made to staff training and deployment. There were sufficient staff on shift who had received training in safe physical intervention.

Some areas of infection prevention and control (IPC)needed improvement, including the effectiveness of checklists to monitor IPC. Staff did not always correctly use and dispose of personal protective equipment (PPE). The manager undertook an immediate review of PPE in order to reach compliance with government guidance. A programme of regular testing for COVID-19 was in place to help keep people and staff safe. Improvements had been made to the monitoring of environmental risk factors. Previously identified risks of scalding had been rectified.

Improvements had been made to some quality assurance and audit processes. Further improvements were required to ensure the manager and provider had effective oversight of all aspects of the service. There was a lack of effective audits in areas including incidents, people's behaviour charts, daily notes and cleaning tasks. The new manager had identified these issues and was implementing improvements. We have made a recommendation about quality assurance processes.

Robust recruitment practises were in place to ensure staff had the right skills and characteristics for their roles. Processes to store, administer and record medicines safely were in place. Staff had received training in safeguarding and knew how to raise concerns if they needed to.

A new manager had recently started who was open and honest about the improvements required. They had already identified the issues we found and had started to implement improvements. Positive feedback was received from staff and relatives about the manager.

Staff and relatives had opportunities to discuss and provide feedback about the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, 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 providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

The manager and care staff promoted a positive culture in the service. People had experienced significant change to their usual routines during the pandemic period and people could not pursue many of the activities and learning opportunities they usually enjoyed. Staff were proactive in supporting people with alternative activities and this had led to people’s behaviour being calmer and more settled. Staff had supported some people to reduce their prescribed medicines with GP support. Relatives were supported to stay up to date with how their loved ones were getting on, and visits were facilitated as and when this was possible. This helped promote people’s choices and independence even during the pandemic period when normal routines were disrupted. Improvements were required to ensure all aspects of people's care was person centred.

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 requires improvement (published 6 October 2020) and there were two breaches of regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

The overall rating for the service has not changed following this inspection and remains requires improvement.

Why we inspected

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. In addition, as part of CQC’s response to care homes with outbreaks of coronavirus, we are conducting reviews to ensure that the Infection Prevention and Control practice was safe and the service was compliant with IPC measures.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection priorities.

Lilly House is a residential care home providing personal care to 4 younger adults with learning disability and autism at the time of the inspection. The service can support up to 4 people in one adapted building.

Lilly House is a family sized house in a residential area, similar in appearance to the other houses in the street. It is close to local amenities and affords easy access to the community.

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

The service was not always safe. There were not always enough staff with the right skills and training deployed across the service.

The risk of scalding was not managed effectively. Staff had failed to identify issues with monthly water temperature checks and mechanisms to keep water at an appropriate temperature were not serviced or maintained as required.

Infection prevention and control practices required improvement. Personal Protective Equipment (PPE) was being disposed of in a communal bin and specific cleaning schedules were not in place.

The provider failed to have adequate systems in place to monitor the quality of care provided. Several audits were not taking place and there were not always effective action plans to mitigate risk.

Whilst it was evident that the provider had some quality control systems in place, we observed that they did not always identify issues or result in improvements and were therefore not always effective.

Improvements were required to end of life care planning to meet best practice guidance such as that provided by the Gold Standards Framework.

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 at Lilly House did not support this practice.

Medicines administration was safely managed. However, the audit systems in place to monitor the stock of high risk medicines was not sufficiently robust.

People’s individual risks were managed in a safe way and staff knew how to protect people from the risk of harm and abuse. Risk assessments were completed appropriately, for example around personal care, nutrition and emotional wellbeing.

Care records were person centred and contained sufficient information about people’s preferences, specific routines, their life history and interests.

Staff and the management team were kind, caring and compassionate. People’s relatives told us that the staff were kind to them and this was confirmed during our observations.

People were supported to maintain a healthy diet by a staff team who knew their individual preferences. People had options regarding their meals and were able to help themselves to food and drink.

People and their representatives were involved in the planning of their care and given opportunities to feedback on the service they received. People’s views were acted upon.

The provider had systems in place to encourage and respond to any complaints or compliments. The provider and management team had good links with the local communities within which people lived.

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

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

Rating at last inspection

This service was registered with us on 9 April 2019 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about staffing and staff training. A decision was made for us to inspect and examine those risks. As the service was registered with us on 9 April 2019 and was yet to be inspected, a decision was taken to undertake a comprehensive inspection.

We have found evidence the provider needs to make improvements. Please see the Safe, Effective and Well-Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to staffing, staff training, medicines, environment, infection prevention and control 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 work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.