Lilac Cottage

Updated 24 January 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by two inspectors on 13 December 2019 and one inspector on 27 December 2019.

Service and service type

Lilac Cottage is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with three people who used the service and five people close to them , including family members, to ask about their experience of the care provided. We spoke with five members of staff including the provider’s operations manager, the registered manager, senior care workers and a care worker. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records. This included people’s care records and medication records. We looked at staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including reports, safety and quality checks and procedures were reviewed.

Updated 24 January 2020

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 looked after. At home they never settled, but we get to see a different side to them now.”

Team meetings established a clear vision and expectation by the registered manager for all staff to be accountable and take responsibility for the quality of people’s care. Between the two days of our visit, the registered manager had already acted to improve records and rectify issues. The provider had introduced additional checks to ensure more robust oversight going forward and management arrangements had been reviewed to promote greater stability.

Although at this visit we did not check this particular aspect of the service, at the last inspection we found that people were overall 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. We found that since the last inspection the service had made improvements to their recording and reflections following incidents.

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 29 March 2019).

Why we inspected

We received concerns in relation to the safety, staffing and governance of the service. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

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.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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

Enforcement

We have identified a breach of registration regulations at this inspection, as CQC had not always been notified of specific events and related risks for people.

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

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. To check on progress made or if we receive any concerning information we may inspect sooner.