Archived: Lilas House

Lilas House is a residential care home providing accommodation and personal care to up to six people. The service is in a Victorian building with shared communal areas and a courtyard garden. The service provides support to people who are living with a learning disability or autistic spectrum disorder. At the time of our inspection there were five people using the service, and one person was in hospital.

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

People were supported to have maximum 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 did not always support this practice as it was not clearly documented why decisions were being made in people’s best interests and how their independence could be maximised. However observations and feedback showed staff understood how to promote people to have choice and control.

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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of key questions of safe, effective and well-led the service was not able to demonstrate they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support

People were supported to have choice and control over their lives, as well as pursue their interests. However, there was a lack of guidance around where people required decisions being made in their best interests. Despite the lack of written guidance, people were supported by staff who knew them well and who understood their care and support needs, and what was important to them.

Right care

Risks were not always identified and therefore not adequately managed. People’s care records lacked detail about how people communicated their wants and wishes, however, this was mitigated because of how well staff knew people.

Right culture

Whilst the service promoted an inclusive culture, there still remained a lack of effective governance systems to monitor and assess the quality of service people received.

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 inadequate (published 13 October 2021) and there were breaches of regulation. We imposed conditions on the provider’s registration, and they sent us action plans each month. At this inspection we found some improvements had been made, but the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

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

Please see the action we have told the provider to take at the end of this report.

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 continue to monitor information we receive about the service, which will help inform when we next inspect. 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.

Lilas House is a residential care home providing personal care to six people with a learning disability and autism.

Lilas House is accommodation for six people across three floors. People have their own bedrooms with shared bathrooms. The ground floor has a kitchen, dining room and living area.

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

People were at risk of harm due to the lack of effective systems in place to identify when people were at risk. Staff lacked knowledge and did not follow key care plans and risk assessments, which identified fundamental information to ensure people were supported in a safe way.

Infection prevention control measures were not effective, and practices meant that people were at risk of infections. Staff did not use safe practices when using personal protective equipment. There were widespread concerns with the environment people were living in, living conditions were not acceptable and posed a risk to people’s safety and comfort.

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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe, effective and well-led. The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

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 did not support this practice.

People were not always shown respect and dignity when being supported by staff and there was a lack of meaningful things that people enjoyed doing.

The registered manager and provider did not promote the principles of right support, right care, right culture which meant staff were not knowledgeable in how to truly support people to have an empowered life.

Quality assurance systems were not effective and did not identify the issues we found. We were not confident the provider had an open and honest culture and used language that was respectful to people.

Professionals were involved in people support and felt the registered manager engaged when required. People and relatives felt happy with the staff that supported them.

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 (published 17 October 2017).

Why we inspected

We received concerns in relation to the provider and their locations. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. 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 people’s safety whilst eating and drinking, infection control and environmental repairs. People having support that is not truly person centred and the overall management oversight of the service.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Lilas House is a residential care home for six people with learning difficulties. At the time of our inspection there were six people living in the home.

There was a registered manager in the home. 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 last inspection, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good

People were cared for in a safe way by staff who knew how to protect people from abuse. Individual risks to people and within the environment were identified and steps were taken to manage known risks.

There was consistently enough staff to support people and safe recruitment practices ensured that only suitable staff were employed. Staff received training relevant to their role and were supported through regular supervisions with the registered manager.

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

People were supported to maintain a healthy nutritional intake and prompt referrals were made to relevant healthcare professional when concerns were raised about a person’s health.

Staff were caring and treated people with respect. People’s privacy and dignity were constantly upheld. Staff understood what was important to people and knew their care needs well. People felt listened to and were supported to be as independent as possible.

People’s care plans were detailed and people were involved in the planning of their care.

There was clear and visible leadership in place and staff understood what was expected of them. Regular quality monitoring of the service was carried out to ensure that people received a good level of care.

Further information is in the detailed findings below

This person also told us, 'I go through my care folders every month with my keyworker. I know what's in them and I know what's written in 'My Health' book. We have a full review of my care every year with me, my family, the manager, my keyworker and social services'.

Another person told us, 'I love it here, I really do! I used to get lonely when I lived on my own but living here is just right'.

When we asked who chose the meals for the coming week, one person replied, 'We all do. We have a group discussion and we have a menu book to help us choose what we want'

One person we spoke with told us, 'I have a locking box in my room for my medicine; I prefer the staff to look after it and they usually give it to me on time'.

A member of staff we spoke with told us that they were very well supported by the manager and the organisation as a whole. This person told us that they received one-to-one supervisions every two months and also received an annual appraisal with their manager.

When we asked people whether they knew how to make a complaint if they needed to, they made comments such as: 'Yes; I needed to complain once and everything was answered and sorted out' And, 'The staff know me; I always say what I think'

When we asked who they would speak to if they had a problem or complaint, one person replied, 'Usually the manager but any of the staff'