Lilac Cottage

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.

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

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 practical ways. Each person had their own private space in the form of a self-contained flat with a bathroom.

We saw from our observations that the people living at the home were involved in discussions about care and support on a day to day basis. The majority of people were also actively involved in assessment and review processes.

Assessments and care records were sufficiently detailed to instruct staff on how best to support people. The language used was person-centred and gave the staff a good understanding of peoples goals, aspirations and needs.

Staff were deployed flexibly so that people had a degree of choice in who provided care and support. Where practical, keyworkers and other staff were matched to people so that they had shared interests.

The home had a complaints procedure and a complaints book available to people living at the home and visitors. Each of the care records that we saw also contained a copy of the complaints procedure. The records that we saw indicated that two formal complaints had been received in the previous 12 months. In each case the complaint had been resolved.

We spoke with the manager about responsibilities in relation to reporting to the Care Quality Commission (CQC) and the regulatory standards that applied to the home. The registered manager was able to explain their responsibilities in appropriate detail. We saw that reference was made to the relevant regulations in key documents and important information about the home’s registration was clearly displayed.

Communication between staff, relatives and the registered manager was open and regular. We saw evidence that staff meetings had taken place throughout 2016. Information relating to people living at the home and developments had been shard at the meetings.

Staff were clearly motivated to do their jobs and enjoyed working at the home. Staff understood their roles and demonstrated that they knew what was expected of them.

The registered manager had a clear understanding of the need to monitor quality and safety through regular audits. They undertook regular monitoring of; care records, medicines and the physical environment and addressed issues as they arose. They were required to complete quality assurance checks which were analysed by the provider’s quality team. The quality team also completed regular checks on the home.