Lilford Court

Lilford Court is a residential care home providing personal care to up to 8 people. The service provides support to autistic people and people with a learning disability. At the time of our inspection there were 8 people using the service.

Lilford Court comprises of 2 semi-detached houses, each with its own large garden.

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

Right Support: Lilford Court is located in a residential area, within easy reach of local shops and amenities. There were enough staff to meet people’s care and support needs and support people to take part in activities of their choice. Staff were safely recruited and completed the training required to carry out their roles.

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 supported this practice. Staff knew how people communicated their needs and choices.

Right Care: People’s needs were assessed before moving to the service. Person-centred care records identified people’s preferences, support needs and potential risks. Guidance was provided to manage these risks. People were supported to maintain their health and wellbeing. People received their medicines as prescribed. Some areas of the home were not always clean. The registered manager said they would address this.

Relatives were positive about the care and support provided. People received kind and compassionate care. Staff respected people’s privacy and dignity. They understood and responded to people’s individual needs.

Right Culture: People and their relatives were positive about living at Lilford Court. They were involved in agreeing and reviewing their care. Relatives said there was good communication with the home. Staff enjoyed working at Lilford Court and felt listened to by the registered manager. A quality assurance system was in place. Actions were completed where any issues had been identified.

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 26 April 2018).

Why we inspected

The inspection was prompted in part due to concerns received about restrictions in place for 1 person and staff knowledge for supporting autistic people. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see all sections of this full report.

Follow up

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

We found the following examples of good practice.

The provider demonstrated a robust process to prevent visitors from catching and spreading infections.

During the previous inspection of the service in 2016 we found breaches of the regulations Regulation 15 and 17 HSCA RA Regulations 2014 in relation to risks associated with the premises and equipment because of inadequate maintenance and the lack of good governance. Recommendations were also made to update training records and care plans. Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key question in safe, effective, responsive and well led to at least good.

During this visit we found that the service had fully complied with the action plan and were no longer in breach of any regulations.

Lilford Court offers accommodation and personal care for up to eight adults who have an autistic spectrum disorder and / or a learning disability. The registered provider is Autism Initiatives UK. At the time of our inspection the service was accommodating six people.

People living at the service are supported by staff on a 24-hour basis. The accommodation comprises of a pair of four bedroomed semi-detached houses. Each person has their own bedroom in one of the properties with a communal bathroom being provided in both houses. Each property has a kitchen, lounge and dining room located on the ground floor. There are gardens at the front and back of the houses and parking outside.

At the time of the inspection there was a registered manager at Lilford Court. 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.

We found there was a warm atmosphere and people appeared content, relaxed and happy in their home environment. People using the service were seen to follow their preferred routines and lifestyle and interactions between staff and people were positive, responsive to need and caring.

The premises were clean and well-maintained.

Without exception all the relatives we spoke with expressed their delight at the way the service was provided. They said the staff and services provided were “second to none”.

The care provided at Lilford Court was personalised and enabled people to live as independently as possible. We saw that people’s care plans were person-centred. This meant they contained information about people’s individual needs, their support requirements and their preferences with regards to how their support was provided. It was clear that people using the service and their representatives had been actively involved in discussing and planning their own support package.

Staff knew how to protect people from abuse and to keep them safe. The registered provider had policies in place to safeguard people from abuse and staff had completed training in this key area. Staff training records clearly identified that they had received all mandatory training and additional training of their choice.

Medicines were ordered, stored, administered and disposed of safely. People had contact with their GP and health professionals as required.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. Staff were only able to start work at Lilford Court once the provider had received satisfactory pre-employment checks. We saw there were enough staff on duty to support people as needed in the home. However we saw that the service utilised a lot of agency staff because they were not able to fully recruit permanent staff and this was a potential risk to continuity of care.

People who lived at Lilford Court were supported to plan their meals and make their own drinks and snacks, with staff support. Staff had good knowledge of people's likes, dislikes and routines in respect of food, drinks and meal times.

People using the service took part in a variety of activities. Some people attended a day centre and others enjoyed activities both in the home and in their local community. Individual weekly timetables were completed as a way of helping people to understand what they were doing at different times of the day.

A complaints procedure had been developed by the provider and systems were in place to respond to complaints. We found that any complaints had been managed in accordance with the home's complaints procedure.

Systems were in place to check the quality and safety of the service. The registered manager also sought feedback from people informally on a regular basis and on a formal basis annually. All the feedback we viewed was positive. Spot checks and observations were carried out with staff to ensure that the standards of care were maintained.

People told us that the service was well-managed. Records showed that effective systems were in place to ensure good governance.

Lilford Court was last inspected in August 2013. Six breaches of legal requirements relating to: consent to care and treatment; care and welfare of people using the service; staffing; supporting workers; assessing and monitoring the quality of service provision and records were identified. We undertook a follow-up inspection in March 2014 and found that improvements had been made to address the breaches.

Lilford Court offers accommodation and personal care for up to eight adults who have an autistic spectrum disorder and / or a learning disability. The registered provider is Autism Initiatives UK. At the time of our inspection the service was accommodating six people.

People using the service are supported by staff on a twenty-four hour basis. Each person has their own bedroom upstairs and people share a communal bathroom. A kitchen, lounge and dining room are also located on the ground floor. There are gardens at the front and back of the houses and parking outside.

At the time of the inspection there was a registered manager at Lilford Court. 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.

It became apparent during the inspection that there was a lack of managerial presence and direction in the service as a range of issues were highlighted throughout the inspection as detailed within the report.

During this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take as the back of the full version of the report.

We found that the registered person had not taken appropriate steps to keep the properties clean and appropriately maintained.

We also found that the registered person was not operating effective systems or processes to assess, monitor and improve the quality and safety of the services provided.

A number of records essential to the management of the service or to the evaluation of people’s care and treatment were either unavailable or out of date.

During our inspection we used a number of different methods to help us understand the experiences of people who lived at Lilford Court. This was because the people who lived at Lilford Court communicated in different ways and we were not always able to directly ask them their views about their experiences. Our observations showed people appeared relaxed and at ease with the staff.

We found there was a warm atmosphere and people appeared content, relaxed and happy in their home environment. People using the service were seen to follow their preferred routines and lifestyle and interactions between staff and people were positive, responsive to need and caring.

The care provided at Lilford Court was personalised and enabled people to live as independently as possible. People who used the service were supported and encouraged to follow their preferred routines and to make decisions about aspects of their daily lives such as their meals and daily activities.

Staff knew how to protect people from abuse and to keep them safe. The registered provider had policies in place to safeguard people from abuse and staff had completed training in this key area.

Medicines were ordered, stored, administered and disposed of safely. People had contact with their GP and health professionals as required.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. Staff were only able to start work at Lilford Court once the provider had received satisfactory pre-employment checks. We saw there were enough staff on duty to support people as needed in the home.

CQC is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. DoLS are a code of practice to supplement the main Mental Capacity Act 2005. These safeguards protect the rights of adults by ensuring if there are restrictions on their freedom and liberty these are assessed by the supervisory body. The assistant manager and majority of support staff spoken with had a good understanding about this and when it should be applied.

People who lived at Lilford Court were supported to plan their meals and make their own drinks and snacks, with staff support. Staff had good knowledge of people’s likes, dislikes and routines in respect of food, drinks and meal times.

People using the service took part in a variety of activities. Some people attended a day centre and others enjoyed activities both in the home and in their local community. Individual weekly timetables were completed as a way of helping people to understand what they were doing at different times of the day.

A complaints procedure had been developed by the provider and systems were in place to respond to complaints. We found that any complaints had been managed in accordance with the home’s complaints procedure.

At this visit we looked at support plans and found that they had been fully updated. They now contained more information to enable staff to consult and guide people to make choices as to how they would like to spend their time and give more structure to their day. This was done in a way that was intended to ensure people's safety and welfare.

We looked at the duty rotas and had no concerns with regard to the numbers and skill mix of staff working at the home. A recruitment drive had taken place and new permanent staff had been employed at Lilford Court.

We looked at recent audits that had been completed and any actions raised had been fully addressed and recorded.

Staff spoken with said that the training was up to date and following training discussions were held to ensure that they could put what they had learned in to practice at the home.

They said that they were receiving regular formal supervisions and that they felt the service was much improved.

Staff told us that staff meetings were taking place, communication was much improved and they felt part of a team and felt listened to.

A new manager had been employed by the service and had commenced work in Lilford Court.

On this visit we found that record keeping had much improved

Staff on duty did appear to know how to support the people in their care and had warm relationships with them. They spoke about how to support people as individuals and gave examples of each person's daily routines and care.

Comments from staff included; " we have not been told when training sessions are being held' "we get no supervision,"we do not have clear rotas as they are always being changed at the last minute." Staff felt that they had been let down by the management of Autism Initiatives.

Relatives spoken with said " I have no problems with the way the home looks after my relative." " I am more than satisfied with the care my relative receives" and " my relative looks on Lilford Court as home"

One relative spoken with said " I am made fully aware of any incidents that affect my relative, staff keep me informed".and " the staff are very good, it does take a long time to get to know the people living at the hom" and staff here are very caring and genuine"

We spoke with the relatives of people living at Lilford Court and they said 'This is a very positive service. Support plans are discussed with me and any thing they do at Lilford is done in the same way at home so that all care and support is consistent, '

They spoke very highly of the staff team and said ' The progress has been brilliant. They have worked hard to enable him to go on public transport and to overcome his fear of attending the doctors surgery. He is a happy young man. The home focuses on the positive not the negative.'

Staff spoken with said 'I love my job, it is a good company and I like the way the people are supported. It is lovely to see how they get something out of the activities . ' another said ' this is the best place I have ever worked we get lots of support and the induction plan was detailed.' Staff said they felt supported by the manager and senior staff.