We carried out an unannounced inspection of The Lilacs Residential Home on 8 May 2017. The Lilacs Residential Home provides care and accommodation for up to 29 people who required accommodation and personal care. Nursing care can be provided through the local community nursing services if appropriate. At the time of the inspection 25 people were living at The Lilacs Residential Home and a further three people were receiving temporary respite care.

The manager was currently going through our application process to register as a registered manager with the Care Quality Commission (CQC). They were supported by a deputy manager. Both had worked at the service for many years. 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. The provider, Lilacs Care Ltd, is part of Stonehaven Care Group which is a family run company providing care in seven homes throughout the South West. Each home was supported by a central support office and a director visited each home at least once a month to monitor quality standards. This is the first inspection since the new provider, Lilacs Care Ltd, registered with CQC on 16 December 2015.

At this inspection we found the service was meeting all regulatory requirements and we did not identify any concerns with the care provided to people living at the home. One relative said, "I come regularly and I can always leave knowing [person’s name] is happy. The staff communicate well and the manager will ring and reassure me everything is ok.”

On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a friendly and respectful way. People were able to choose what they wanted to do and enjoyed spending time with the staff who were visible and attentive. There was a lot of staff interaction and engagement with people, most of whom were living with dementia and unable to tell us directly about their experiences. They looked comfortable and happy to spend time in the large conservatory. People were encouraged and supported to maintain their independence. There was a sense of purpose as people engaged with staff, watched what was going on, played games and pottered around the home or went out into the garden with relatives. The majority of people were living with dementia and were independently mobile or required some assistance from one care worker. Staff engaged with them in ways which reflected people's individual needs and understanding, ensuring people mobilised safely from a discreet distance.

People were provided with good opportunities for activities, engagement and trips out. These were well thought out in an individual way and the manager had previously been the activity co-ordinator. They had identified that the service could improve activities by providing smaller items to touch and interact with when there was not an organised activity planned. They had resourced activity kits from a specialist dementia service and planned to add these into the day to day programme. For example, appropriate dementia focussed games, art and visual stimulation. People could choose to take part if they wished and when some people preferred to stay in their rooms, staff checked them regularly spending one to one time with them.

People and relatives said the home was a safe place for them to live. One person was able to tell us, “The girls are all top hole! I’m a people person and I like it here.” Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns. Staff were confident that any allegations made would be fully investigated to ensure people were protected. Any safeguarding concerns had been managed well with prov

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

On the day of our inspection there were 25 people using the service. The summary is based on conversations with five people using the service, six staff supporting them and two health care professionals. We looked at records, toured the building and observed what happened at the home throughout our visit.

This is a summary of what we found.

Is the service safe?

The service was not safe because risks to people’s health and safety were not always assessed or plans in place to reduce those risks. For example, where a person was at risk from falling or skin pressure damage. This might lead to inconsistency in care provided or inadequate arrangements to reduce risk to an agreed minimum.

The service was not safe from infection or cross contamination. Suitable policies and procedures in infection control were not available for staff reference. Areas of the home were not adequately clean and some care workers did not follow good hygiene practices, which posed a risk to people using the service and staff.

The service was not safe because some areas of risk had not been assessed, such as freestanding wardrobes which could fall if pulled upon. Some fire safety checks had been missed and fire doors wedged open.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no applications have been submitted, we heard from the manager how she had ensured that decisions were made in people’s best interest where they lacked capacity to make those decisions. However, no staff had received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and so people were at risk from unauthorised deprivation of their liberty through lack of staff understanding.

Is the service caring?

We saw many examples of staff providing care and support to people using the service. Staff supported people to work at their own pace and they involved them in how they spent their day. For example, where to sit and what food and drink they preferred. We observed a care worker worrying that a person was cold. They returned to the person more than once trying to persuade them to let them fetch their cardigan to keep them warm. We saw the housekeeper encourage one person to have their room cleaned when they had been reluctant to let them into the room. Eventually they agreed what could be cleaned and what was to be left untouched.

Where there was adequate assessment of people’s needs this included their likes and dislikes and people were cared for as individuals and with respect.

Is the service effective?

Staff were able to show a good understanding of people's needs and preferred routines. Our observations of how care and support was being delivered supported this.

People appeared to be relaxed and comfortable and one person told us how they liked the home because they could talk to other people there. We saw that friendships had been made and staff were attentive to individual’s needs and wishes.

A GP told us “There are high needs patients and (the staff) have done a good job.”

Is the service responsive?

The service was responsive because advice was sought from external health care professionals. However, there was inadequate assessment of people’s needs and some people’s support plans did not reflect their current situation and so the information was not available to staff to respond to those changes. An example was a person found in the garden on two occasions but the home had no plan in place to either help them achieve what they may have wanted or protect them from hazards within the garden area.

We saw there had been a positive response to people’s request for changes to the menu and one person said how much they preferred a new room provided. We saw staff responding quickly to people’s need for physical and emotional support.

Is the service well led?

The service was well led because people knew who was in charge and we saw they were relaxed in staff company.

The service was well led when the registered manager was available but not well led when that responsibility was delegated to other staff. This had led to unsafe situations, such as fire safety checks not completed. We only looked at one policy but this was not suitable for the needs of the home and did not inform staff what was expected of them.

The service was well led in that staff received time with their line manager to discuss their role and they received training suitable for their work role. One told us there was a very low turn-over of staff at the home and “things seem to work quite well”.

The Lilacs residential home provides care and support for older people. There were 23 people living in the home at the time of our inspection. We talked with four people who lived at the home, seven staff including the provider, three health professionals and four relatives. We saw people were able to move freely about the home where able and were comfortable in the company of the staff who supported them. We saw they responded positively to people who came into the home and to the activities provided by the care workers.

We heard from the people we spoke with and their visitors about how they were involved in deciding about their care and support; and saw how people’s care and welfare was provided with dignity and respect in line with their care plan. One person told us “They look after me very well and are kind and caring”.

The home was clean and tidy and we saw how the manager worked with other professionals to ensure people received appropriate support and that their safety and welfare was protected.

Staff recruitment was carried out in line with current guidance. The provider routinely checked and monitored the services they provided and used the information from those checks to improve their services.

The Lilacs mainly provides care and support for older people with dementia. We talked with twelve people who lived at the home, eight staff and three relatives. Some people had communication difficulties; this meant they could not specifically tell us what it was like to live at the Lilacs. We used the Short Observational Framework for Inspection (SOFI) to understand people's views.

People’s privacy, dignity and independence were respected by staff who supported them.

People we spoke with expressed their views and were involved in making decisions about their care and treatment; they said staff sought their verbal agreement before providing care and treatment. We saw evidence of written consent to care and treatment in people’s files we checked.

People told us that it was 'a nice place to live’, one person said ‘the staff are very kind'. We saw relatives visiting their family member; they were greeted cheerfully by the staff. People told us they felt safe in the home and knew how to raise concerns.

Medication administration was managed well with good checks in place to ensure that people were given the right medication.

There were effective staff support processes in place with appropriate training provided.

People were not always protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not always maintained

People had access to a comments and complaints system which responded to their concerns

The inspection took place on 9 and 13 January 2015 and was unannounced. The service was previously inspected on 9 June 2014 when we found the service was not meeting people’s needs in respect of their care and welfare. There were also concerns about the cleanliness of the home and the systems they had in place to prevent infection. The service did not have adequate systems in place to assess and monitor the quality of the services provided. During this inspection we found improvements which meant that these concerns had been addressed

The Lilacs is a care home which is registered to provide care for up to 29 older people. The home specialises in the care of older people but does not provide nursing care which is provided by community nurses. Some people living at The Lilacs had a dementia type illness. There were 26 people living at The Lilacs at the time of this inspection.

There is a registered manager who is responsible for the home. 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 and associated Regulations about how the service is run.

There was a friendly and relaxed atmosphere in the home. Staff offered people support in a kind, understanding and respectful manner. People were given friendly encouragement to make choices about their day and support them to retain as much independence as possible. People and their relatives and visitors said they were happy living there. Comments included “The care seems very good – definitely,” and “Very good. They are all lovely. It’s fun. There’s plenty to do.”

People were consulted and involved in daily routines in the home. Resident’s meetings were held regularly and their views and suggestions were listened to and acted upon. There was a wide range of activities provided twice a day to suit most people’s interests.

Since the last inspection a number of changes and improvements had been made. The management structure had been strengthened by ensuring all senior staff understood their roles and responsibilities. A range of monitoring systems had been put in place to make sure essential tasks were carried out. A key worker system had been put in place and all staff were given the task of reviewing and updating care plans and risk assessments.

Care plans had been improved and provided more detailed and thorough risk assessments. Risks such as weight loss or pressure sores had been assessed and reviewed regularly and actions had been taken to reduce those risks where possible, for example through the use of pressure relieving equipment. There were clear explanations showing how people wanted to be assisted with personal care tasks. Relatives told us they were confident staff spotted any changes in health needs promptly. Medical professionals we spoke with told us the staff were competent, sought their advice appropriately, and people’s needs were being met.

There was a stable staff team, many of whom had worked in the home for several years. Staff said there was good teamwork and a happy working atmosphere. The staff knew each person well and took a pride in making sure every person received a good standard of care. They told us it was a good place to work. People said there were enough staff on duty at all times of the day and night to meet their needs.

Care was taken when recruiting new staff to make sure applicants were entirely suitable for the job before they began working in the home. New staff received thorough induction training and all staff received training and updates on relevant topics. The level of staff holding a relevant qualification was very high, with almost every member of staff having gained, or in the process of gaining a National Vocational Qualification or equivalent.

There were systems in place to ensure the home was clean and hygienic. We looked around the home and saw that the building had been well maintained. All areas were warm, comfortable and homely.

A member of staff administered the midday medicines safely using the home systems. Medicines were stored and administered safely.

People said they felt safe. The staff understood how to recognise the signs of abuse and were confident the registered manager or provider would listen and act on any concerns appropriately. They had received training from the local authority safeguarding team and knew how to contact them if they suspected any persons were at risk of abuse.