Liam House

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.

Liam House is registered to accommodate up to ten people. At the time of our inspection there were nine people living at the home in one adapted building in a residential area of Bournemouth.

People had lived at Liam House for a number of years. They were all supported to maintain regular contact with their families if they wished to. The service reflects the values that underpin the Registering the Right Support and other best practice guidance, except that it is larger than this guidance recommends. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Liam House had a registered manager. 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.

People told us they enjoyed living at Liam House and liked everyone who lived and worked there. We received positive feedback from relatives and health professionals who visited the home regularly.

People were supported by appropriate numbers of trained, experienced staff who knew the people who lived at Liam House very well. Staff understood how to identify and report abuse and were well supported in their roles. Staff received up to date training on all core subjects as well as ad hoc training for subjects that interested them such as dementia care and specialist medicine training.

People made their own choices about how they spent their day. Staff had a good knowledge and understanding of the Mental Capacity Act 2005 (MCA) and promoted people's independence and choice in their day to day living. Where people might lack capacity to make a specific decision staff acted in accordance with the MCA.

People were supported to take their medicines safely by staff who had received the appropriate levels of training.

People's health care needs were met and staff supported people to see healthcare professionals when appropriate.

People were encouraged and supported to take part in a wide range of activities, hobbies and voluntary work. People told us they really enjoyed their activities which promoted their independence and maintained their sense of wellbeing.

People and relatives knew how to make a complaint if the needed to and felt any concerns would be taken seriously and action straight away.

There were quality assurance systems in place to drive continuous improvement and ensure the home offered a safe, effective, caring and responsive service.