Archived: Lilly House

Updated 17 February 2021

The inspection

This was a focused inspection to check whether the provider had met the requirements of the Warning Notice in relation to Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In addition, as part of CQC’s response to care homes with outbreaks of coronavirus, we are conducting reviews to ensure that the Infection Prevention and Control practice was safe and the service was compliant with IPC measures.

Inspection team

The inspection was carried out by one inspector.

Service and service type

Lilly 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.

A new manager had recently started in the service and their CQC registration was in progress. This meant the service did not have a registered manager in the service at the time of inspection. In this case, the provider is legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was announced by telephone shortly before we entered the building. This allowed us to discuss risk factors related to COVID-19 before the inspection commenced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority.

During the inspection

We spoke with three relatives of people who used the service. We spoke with the provider and five members of staff including the manager and care staff. 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 verbally explain their views to us.

We reviewed a range of records. This included two people’s care records and two staff files in relation to recruitment and staff supervision. We looked at medication records and recording of incidents and physical intervention. A variety of records relating to the management of the service, including quality assurance processes, were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data, the staff rota and a selection of audits, policies and procedures.

Updated 17 February 2021

About the service

Lilly House is a residential care home providing personal care and support to four younger adults with learning disabilities and autism. The service can support up to four people in one adapted building.

Lilly House is a family sized property in a residential area which looks similar to other houses on the street. It is located conveniently, a short drive from community resources, a large park and the town.

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

Systems and processes for staff to record incidents, particularly of behaviours that may challenge, needed to be strengthened and embedded. Safeguarding incidents were not always reported properly by staff. Positive behaviour support plans required further development. We have made a recommendation about reporting, recording, follow up and monitoring of safeguarding incidents and behaviours that challenge. Improvements had been made to staff training and deployment. There were sufficient staff on shift who had received training in safe physical intervention.

Some areas of infection prevention and control (IPC)needed improvement, including the effectiveness of checklists to monitor IPC. Staff did not always correctly use and dispose of personal protective equipment (PPE). The manager undertook an immediate review of PPE in order to reach compliance with government guidance. A programme of regular testing for COVID-19 was in place to help keep people and staff safe. Improvements had been made to the monitoring of environmental risk factors. Previously identified risks of scalding had been rectified.

Improvements had been made to some quality assurance and audit processes. Further improvements were required to ensure the manager and provider had effective oversight of all aspects of the service. There was a lack of effective audits in areas including incidents, people's behaviour charts, daily notes and cleaning tasks. The new manager had identified these issues and was implementing improvements. We have made a recommendation about quality assurance processes.

Robust recruitment practises were in place to ensure staff had the right skills and characteristics for their roles. Processes to store, administer and record medicines safely were in place. Staff had received training in safeguarding and knew how to raise concerns if they needed to.

A new manager had recently started who was open and honest about the improvements required. They had already identified the issues we found and had started to implement improvements. Positive feedback was received from staff and relatives about the manager.

Staff and relatives had opportunities to discuss and provide feedback about the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, 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 providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

The manager and care staff promoted a positive culture in the service. People had experienced significant change to their usual routines during the pandemic period and people could not pursue many of the activities and learning opportunities they usually enjoyed. Staff were proactive in supporting people with alternative activities and this had led to people’s behaviour being calmer and more settled. Staff had supported some people to reduce their prescribed medicines with GP support. Relatives were supported to stay up to date with how their loved ones were getting on, and visits were facilitated as and when this was possible. This helped promote people’s choices and independence even during the pandemic period when normal routines were disrupted. Improvements were required to ensure all aspects of people's care was person centred.

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 requires improvement (published 6 October 2020) and there were two breaches of regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

The overall rating for the service has not changed following this inspection and remains requires improvement.

Why we inspected

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. In addition, as part of CQC’s response to care homes with outbreaks of coronavirus, we are conducting reviews to ensure that the Infection Prevention and Control practice was safe and the service was compliant with IPC measures.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection priorities.