Lilybank Hamlet is registered with CQC to provide personal care and support in a number of residential settings. The main house provided residential care for up to 42 older people, some of whom may have dementia. On our visit, 36 people were living in the main house. There was also a smaller home for five people with learning disabilities which was fully occupied.

The inspection visits took place on 9 and 12 June 2017 and the first day was unannounced. The service was last inspected on 16 and 17 June 2015 and was rated 'Good' overall. At this inspection we found the service remained 'Good' in all five key questions and overall.

There was a registered manager in post at the service; there was also a new manager who had commenced the process of registering to become the 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.

Systems in place in relation to medicines were safe and managed in a manner which met with current guidance. Procedures were in place to deal with unexpected incidents and emergencies. Pre-employment checks were carried out before staff began working at the service. Policies and procedures were in place for safeguarding and protecting people from abuse

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were provided with training which gave them the skills and confidence to carry out their job roles and responsibilities. People were provided with choice around meals and special diets were catered for. People were supported to access appropriate healthcare professionals.

People and relatives felt staff continued to be kind, caring and compassionate; people were supported to remain as independent as possible. People told us they chose how to spend their spare time.

Staff undertook assessment of people’s needs prior to them using the service. The provider had an easy read pictorial and written complaints procedure which was clearly displayed at the service. A number of audits were carried out to monitor the quality of service was maintained; where improvements had been identified as necessary, they were addressed promptly. The service was managed in an open and transparent manner.

The service at Lilybank Hamlet Care Home consists of two community houses for people with a learning disability and a separate care home for 42 older people. A manager was appointed in September 2013 for the community houses, and had applied for registration with the CQC. The care home is managed by another manager registered with the CQC.

As part of our inspection we spoke with eleven people receiving care and five of their relatives. We spoke with managers and staff working at the home, examined records and observed people receiving care.

Below is a summary of what we found.

Is the service safe?

We observed people were treated with respect and dignity by the staff. One person living at the home told us, "They do their best for me here." Another person’s relative said, “The care is generally good. The staff are caring and respectful.” Systems were in place to monitor the quality of care people received and record any incidents and accidents. This helped reduced risks to people and helped the service to continually improve. We found special equipment was provided for people and checks were completed to ensure it was safe. A plan was in place for dealing with emergencies so that people were not put at risk. The community house we inspected was not adequately maintained to ensure it was fully safe for people receiving care. Some aspects of people's care was not ensuring their welfare and safety. Risks and changes in people's care needs were not always identified promptly and appropriate action taken. Enough staff were usually provided to meet people's care needs but there were some needs that were not being adequately met because suitable or sufficient staff were not available. A plan was in place for responding to unexpected events that could affect the running of the service, for example fire or loss of the power or water supply. Some areas of the community house we visited were not adequately maintained to ensure it was fully safe for people receiving care to use.

Is the service effective?

We found people's needs were assessed and care files included information about any diagnosed health conditions or disabilities. Some risks that could affect people had not been adequately assessed and managed as part of the care planning process. This meant that care had not fully protected people's welfare and safety. Consent was obtained for people's care and appropriate arrangements made if people could not consent for themselves, for example due to dementia.

Is the service caring?

People told us they were happy with the care they received at the service. One person's relative said, "You can see [my relative] is happy with staff. That’s what matters to me." We observed that staff communicated well with people and were keen to involve them in activities if they chose to do this. Care planning took account of people’s wishes, preferences and background which helped ensure staff could provide personalised care that met their needs.

Is the service responsive?

Systems were in place for obtaining people’s views about the service provided. People told us they knew how to make a complaint if they were unhappy. They also told us staff responded well if they had any concerns. One person said, "I think if I were unhappy. The staff would help me.” We saw the provider assessed the quality of care people received and that action was taken where improvements were needed. Some aspects of people's care was not fully safe because care plans had not been updated to include information to protect them from risks.

Is the service well-led?

Checks and audits of medication, infection control systems and other aspects of safety and practice were in place at the home. People using the service, their relatives and other people involved with the service completed an annual satisfaction survey and records showed action was taken where any improvements were required . Meetings were held with people living at the home and also relatives and friends to discuss what was going well and any concerns. As a result, the managers were able to plan any improvements that were needed to the way people’s care was delivered and the service was provided.

There were 34 people in the main care home and 10 people using the learning disability service at the time of our visit. We spoke with ten people, two visiting relatives, four staff and the manager.

People we spoke with were, on the whole, satisfied with the care provided at Lilybank Hamlet. They told us, “I am alright here. I am independent, I can look after myself. The carers are good and they speak to me with respect.” and, “I feel safe and I’m happy with the care.”

We found that the provider had taken action following our last inspection. This had resulted in changes and improvements to how care was planned and delivered. Medication was given safely and recorded correctly and there were systems to monitor this. People’s personal records were regularly reviewed so that information about their needs was up to date. Staff were receiving regular supervision to support them to meet the needs of people using the service.

We found that staffing levels and staff training were sufficient to meet the needs of people using the service. However, the staffing level in the service for people with learning disabilities was not always flexible to allow for individual choice.

The provider had taken some action to ensure that people were asked for their consent before they received care or treatment. However, we found that assessments made of people's capacity to make decisions about their care were not always in line with relevant legislation.

There were 35 people in the main care home and eight people using the learning disability service at the time of our visit. We spoke with six people and three relatives in the main care home and two people using the learning disability service.

People we spoke with were mostly positive about the service. They told us, “They look after me.”, and, “The staff are nice.” A relative told us that the staff were “Very good, they understand her, they know what she likes to do.” One person told us they felt staff were sometimes “Too sharp” and this did not help when the person was upset.

We found that people were not always asked for their consent before they received care or treatment. If people lacked the capacity to consent, there were no suitable arrangements for acting in their best interests.

People’s needs were assessed, but their care and treatment was not always planned and delivered to meet their needs. This meant that people were at risk of receiving unsafe or inappropriate care or treatment.

We found that medicines were not always safely and correctly administered and recorded.

We found that people were cared for by staff who had received appropriate training. However, staff supervision did not always ensure that staff were delivering care safely and to an appropriate standard.

People’s personal records were not always accurate or up to date.

There were 46 people using the service at the time of our visit. We spoke with eight people to gain their views of the service. Some people were not able to give their views, but we were able to observe their mood, behaviour and how they interacted with staff. We also spoke with two visitors.

People told us they were involved in making decisions about their care and treatment. For example, two people in the learning disabilities service said they had been involved in their care plans - "we helped to make them". People in the care home, or their relatives, had signed their care plans to indicate their involvement and agreement.

People told us they had care and support that met their needs. One person in the care home told us "we're well looked after here". People using the learning disabilities service told us "I like living here a lot" and "we get lots of support in things like having a bath or shower".

People said they, or their relative, were safe living in the service. People knew who to talk to if they were unhappy about anything.

The inspection visits at Lilybank Hamlet took place on 16 and 17 June 2015 and the first day was unannounced.

At our last inspection on 30 April 2014, we found the provider was not meeting three regulations. These were in relation to care and welfare, safety and suitability of premises and suitability of staff. These breaches were of regulations 9, 15 and 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2010. Following that inspection the provider sent us an action plan to tell us the improvements they were going to make. At this inspection we found that the actions we required had been completed and these regulations were now met.

Lilybank Hamlet is registered with CQC to provide personal care and support in a number of residential facilities. The main house provided residential care for up to 42 older people, some of whom may have dementia. On our visit, 22 people were living in the main house.

There was also a smaller home for five people with learning disabilities which was fully occupied.

There are two other houses and 7 apartments for people with learning disabilities, which were empty at the time of our inspection.

There is a registered manager at the service. 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 and their relatives were happy with the care and support provided and everyone felt individual needs were being met. People were treated with compassion and respect and told us they felt safe. Relatives we spoke with confirmed this.

We saw that people were well supported by a staff team who were knowledgeable about the needs of people and understood their individual needs. We observed that staff were kind and friendly and respectful of people’s individual needs.

People received care and support from staff who had received training for their job roles. Staff received support, supervision and appraisal to carry out their jobs.

People were supported to make their own decisions and where they could not do this staff had recorded how a decision was made in people’s best interests. Records we looked at showed that staff had assessed people’s capacity to make key decisions although assessments were not always completed correctly.

Staff recruitment procedures were followed and pre-employment checks were carried out to ensure new staff were safe to work with vulnerable people.

Medicines were managed safely and in line with current legislation and guidance. Staff who administered medicines received training to ensure their practice was safe. There were systems in place to ensure medicines were safely stored, administered and disposed of.

People were offered drinks throughout the day, however in the main house people were unable to access drinks for themselves at other times. People’s nutritional needs were assessed and records were adequately maintained. Where potential risks were identified, people were monitored and referred to relevant professionals.

There were effective systems in place to monitor and assess the quality of the service.