Archived: Lilycross Care Centre

A new manager had been appointed since our inspection in February.

The home has been under an embargo [not allowed to admit new residents] from the local authorities who place there since February and regular meetings have been held with the provider and all agencies involved, including the Care Quality Commission to try and address this. Workers from both councils, with particular input from Halton's care homes and contract monitoring teams have been supporting the home throughout this process and they are currently in the process of providing training for staff members.

Given the above and since this inspection took place a decision to lift the embargo has been made. A phased admission plan has been devised that will restrict the home to one new admission every two weeks. The council's will continue to monitor the home for improvements before this restriction will be lifted. All parties involved believe that it is crucial that the improvements made are sustained in order to ensure a similar situation does not occur in the future.

Notwithstanding the above we considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations, including SOFI during the inspection, speaking with people using the service, their relatives; the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The home was well maintained in order to ensure the home was pleasant and safe for people living and working there.

The manager advised us that appropriate procedures, including review were in place should anyone need to be subject to a Deprivation of Liberty Safeguard (DoLS). DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests.

Training records highlighted that the new manager, with support from the local authorities who place there was working on improving the staff training within the home.

Is the service effective?

We found that the people living at Lilycross looked well cared for and were dressed appropriately for the weather on the day. We spoke to fourteen people living at Lilycross, one family member and a visiting specialist nurse during our visit. The people using the service who were able to tell us said that they were happy living in the home. Comments included; 'we are looked after, it's very good, there are never any problems', 'everyone is very friendly', 'never any trouble' and we 'all get on together'.

The staff members we spoke with could show that they had a good understanding of the people they were supporting and they were able to meet their various needs.

Is the service caring?

We observed that staff interacted well with residents. Before carrying out interventions with the people using the service they explained what they needed or intended to do and asked if that was alright rather than assume consent. They also spoke to people informally and acknowledged with a smile as they passed through the home and went about their daily tasks. The relationships we saw were warm, respectful, dignified and with plenty of smiles and laughter.

We asked the people living at Lilycross about the staff working there, comments included; 'staff are fine', 'X is very nice, they are kind'. A visiting family member said, 'the new staff seem keen. The new carer 'X' seems to do more with them'.

Is the service responsive?

A new manager had been appointed since our inspection in February and they have addressed the two compliance actions regarding staffing and records made following that visit. They still need to apply for registration with the Care Quality Commission.

New unit managers on Lily and Rose suites have also been appointed and a recruitment drive to appoint new care staff members has taken place.

During this inspection we found that the provider with input from Halton and St Helens councils had, with the exception of some concerns regarding weight monitoring on Rose suite, addressed the recording issues and the care plans were up to date and reflected the needs of the people they belonged to.

Is the service well-led?

The staff members we spoke to said that the home was being well managed and they enjoyed working there. They spoke positively about the improvement in staff morale within the home and that there was less use of agency staff. Comments from the staff members we spoke with included; 'things are better, you can approach 'the new manager', very easy to get on with', 'much calmer since the new manager has been here, very approachable, will act on things', 'it is a lot happier now' and 'lots of people are more content. Before it was really poor, it got to the stage of really dreading coming into work but not anymore'.

The manager had implemented systems to gather information about the safety and quality of service provided. This had included the sending of a letter to the people using the service and their families introducing themselves and the fact they had now taken over the management of the home. They had held two resident and relatives meetings and two staff meetings since their appointment in March and has just sent out questionnaires to residents and relatives asking for their views about the home.

They had also implemented a new audit system; this included monthly checks on the care plans, kitchen and dining room and a record of any issues raised.

The main concerns identified are the care and welfare of the people living in the home and the quality of any documents, including the auditing used to support this. The management and staffing of the home, including, staff qualifications, the use of agency staff members and the numbers of staff working on each shift. There have also been concerns about financial matters including the alleged poor quality of the food provided and the method of payment of staff wages, effecting staff morale.

We did not have any concerns with any of the staff members we observed during this inspection visit. We saw that they were interacting well with people in order to deliver care.

We did not find any evidence that people were not being provided with a choice of suitable and nutritious food.

We have identified concerns with the home not having enough suitably qualified, trained and experienced staff members to meet people's needs.

We have also identified issues with the homes care records and the systems in place to audit them.

At this inspection we did not identify any issues regarding the care and welfare of people living in the home and we did not have any concerns with the staff members we observed during this inspection visit.

The Commission are now being notified of any safeguarding issues that have arisen. This has also been confirmed in discussions with officers from Halton Borough Council's safeguarding team.

During this inspection we found that care plans and risk assessments had been updated or re-written and the issues identified previously had been addressed.

The people using the service who were able to tell us said that they were happy living in the home.

We have identified some concerns regarding care and welfare. These were discussed fully with the manager and proprietor at the time of the visit and are being dealt with as a separate issue.

The people we spoke with during our inspection all said that the food was good. One person said, 'Very good food.'

There have been recent incidents that have occurred that have not been dealt with appropriately and have also not been reported to the Care Quality Commission.

We looked at three staff files to check that effective recruitment procedures had been completed. In all files we found that the appropriate checks had been made.

The people we spoke with had no complaints about the service. They said that they felt able to express their views about the service they received.

We found that people were not fully protected from the risk of unsafe or inappropriate treatment because some care plans and risk assessments had not been updated to reflect the person's current circumstances and records did not always contain sufficient details to confirm the care that people had received.