Liam House

Updated 9 September 2022

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 Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Two inspectors, a member of the CQC medicines team and an Expert by Experience carried out the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

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

Notice of inspection

This inspection was unannounced.

What we did before inspection

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We sought feedback from a local authority that commissions care from the service. We used all of this information to plan our inspection.

During the inspection

We spoke with five people who used the service and three relatives about their experience of the care provided. We observed a staff member using signing to communicate with a person who did not communicate with words.

We spoke with four members of staff including the provider, accounts manager, a senior support worker, and a support worker.

We spent time observing the mood and engagement of people at Liam House and the quality of staff interactions. These observations were conducted throughout the inspection.

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

After the inspection

We continued to seek clarification from the provider to validate evidence found. We liaised with the provider to discuss actions they had taken in response to the issues identified during our inspection. We received feedback from two professionals who regularly visit the service.

Updated 9 September 2022

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.

About the service

Liam House is a residential care service that provides 24-hour care and support to people with a learning disability and autistic people. Eight people were living at the service at the time of the inspection. The service can support up to 10 people.

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

The service was not always able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support

People’s rights were not always protected as there was a lack of understanding of the MCA from the provider and staff and, where restrictions were in place, we did not see evidence of best interest decisions to support this.

People received care and support in an environment that was not always safe, clean, stimulating and well-maintained.

People had a choice about their living environment and were able to personalise their rooms. Two people proudly showed us their rooms which they had decorated to reflect their tastes and hobbies.

Right care

The service did not have enough appropriately trained staff to meet all people’s needs and keep them safe.

Some people were at risk of harm as care plans and risk assessments were not always complete and up to date.

Staff had attended safeguarding training and when we spoke with them demonstrated they knew how to apply it. However, we did find referrals for one person were not always made by the provider to the local authority safeguarding team.

Staff worked well with other services and professionals to prevent people needing admission to hospital.

Right culture

There had been changes in management with the home now overseen by the provider who worked remotely at the time of the inspection. This had affected the quality of auditing and oversight of the service.

Although the provider promoted the importance of person-centred care people were not consistently involved with planning and reviewing their care.

The provider demonstrated a good understanding of their legal responsibilities for sharing information with CQC.

The provider had reached out to leaders in the health and social care sector to express their concern and that, as a small provider, they were struggling during the pandemic.

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 27 September 2018).

Why we inspected

We received concerns in relation to record keeping, governance and oversight. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings at this inspection.

We have found evidence that 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.

The provider is being supported by the local authority and management support has been offered and accepted. Management support has been provided to support the service to further assess and mitigate known risks with an aim to drive improvements.

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

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 have identified breaches in relation to the safe care and treatment of people, need for consent, safeguarding, staffing and governance of the service at this inspection. We have made a recommendation around staff training.

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 from 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. If we receive any concerning information we may inspect sooner.