Archived: Lisieux Hall Residential Nursing Home

Lisieux Hall is run by Brothers of Charity and is part of a wider service, which also provides day care, supported employment, and domiciliary services to people with learning disabilities in the Chorley and South Ribble areas. Lisieux Hall is registered to provide nursing and personal care for up to 16 people with a learning disability.

The service provides accommodation in two single storey bungalows (Meadows and Woodlands). There is a third property on the site (St Edwin’s), however, as this property has been determined as not fit for purpose by the service provider, it is no longer in use. At the time of our inspection there were 10 people living at Lisieux Hall.

At the last inspection on 27 September and 4 October 2016 we found that the service was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe care and treatment, as the management and administration of people’s medicines did not demonstrate that people received their prescribed medicines safely by staff who were competent.

In 2016, we also found a breach in Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Good Governance, as without clear and accurate records, people’s current and changing needs could not be easily monitored and acted upon in order to ensure their health and well-being was maintained. As a result, the service was given the rating: Requires Improvement.

At this inspection, we found that the service was no longer in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and that no further breaches were found. The service has been given the rating: Good.

A registered manager was now in post 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.

The registered manager and staff team were passionate about ensuring people at the service had a good quality of life and were supported safely. They worked well with outside professionals and took on board advice and guidance to make a positive difference to the care and support people received. They used information from complaints, mistakes and incidents to learn lessons and improve safety.

Relatives and visiting professionals told us the registered manager and staff were approachable and visible. There was an open culture at the service which meant staff felt able to raise concerns freely and know that something would be done as a result.

Staff were trained in infection control. Accidents and incidents were monitored and we noted that these had lessened in this service. Good risk assessments and emergency planning were in place.

Staff had received training on ensuring people were kept free from harm and abuse. They were confident in management dealing with any issues appropriately.

Staff recruitment was thorough with all checks completed before new staff worked with vulnerable people. Staffing levels were suitable to meet the assessed needs of people in the service. The organisation had robust disciplinary procedures in place.

People had their medicines reviewed by their GP and specialist health care providers. Medicines were well managed.

Staff we spoke with to displayed a caring attitude. They understood how to support people and help them maintain their dignity and privacy.

There were regular internal and external audits of all aspects of the service. Changes were put into place after evaluation of the service. Good recording systems were in place and these covered all the support needs of the people in the service.

Lisieux Hall is run by Brothers of Charity and is part of a wider service, which also provides day care, supported employment, and domiciliary services to people with learning disabilities in the Chorley and South Ribble areas. Lisieux Hall is registered to provide nursing and personal care for up to 12 people with a learning disability. The service provides accommodation in two single storey bungalows (St Edwin’s and Moorlands) with a third property providing short stay respite support for up to four people (Meadows). At the time of our inspection there were 11 people living at Lisieux Hall.

The service had not had a registered manager since August 2016. Interim arrangements had been put in place and a new manager appointment had been made. The provider was aware that the new manager would need to make application to register with the Care Quality Commission (CQC). 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.

During this inspection we identified two breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

The management and administration of people’s medicines did not demonstrate people received their prescribed medicines safely and by staff competent to do so.

People’s monitoring records, such as repositioning charts and food and fluid charts were not kept up to date and complete so that their current and changing needs could be easily monitored and acted upon ensuring their health and well-being was maintained.

People’s relatives spoke positively about the care and support offered by staff. Interactions were seen to be polite and respectful. Social and recreational opportunities were provided to enable people to maintain their independence. Advocacy support was also provided to encourage people’s involvement.

Where possible people were clearly involved in making decisions about their support. Where people lacked the mental capacity to make certain decisions appropriate arrangements had been made to ensure their rights were protected.

Information about people was person centred and focused on their individual needs and wishes. Support plans and risk assessments were reviewed regularly with the involvement of people and their relatives.

Staff had completed training in how to safeguard people from abuse. Those staff spoken with knew what action they should take if they had any concerns.

We found that safe systems were in place with regards to the recruitment of staff, infection control and health and safety. These helped to protect people’s health and well-being.

Staff received a programme of induction, supervision and on-going training to help ensure they were able to deliver safe and effective care. Staff spoken with confirmed they were supported in carrying out their role.

People were encouraged to have a balanced and nutritional diet. Where people received their nutrition through feeding tubes, appropriate assessments and training had been provided.

Systems were in place to monitor and review the quality of service provided. These were being enhanced so that a more robust system was in place. There was a commitment from the management team to improve the service so that outcomes for people were positive. Both staff and people who used the service were involved and could make comment on the service provided.

Effective systems were in place for the recording of complaints and concerns to show that people were listened to and where necessary action had been taken. Peoples’ relatives said they would have no hesitation in speaking with a staff member if they needed to.

People's needs were assessed and care and support was planned and delivered in line with their individual care needs. From speaking to staff it was clear that they were able to act appropriately in the event of an emergency such as a fire or a medical issue.

We found evidence that there was an effective recruitment process in place and found policies to back the process up.

The provider had an effective system in place to identify, assess and manage risks to the health and safety of people using the service and others.

People's personal records were accurate, fit for purpose and securely maintained. Other records required to be kept were maintained and held securely.

Care plans showed that people's care was delivered in a person centred way and that their likes and dislikes were noted and recognised by staff. Staff were observed to be patient, calm and treated people with dignity at all times. One relative described the service as follows, "Some of the staff have been here since _____ came which was a number of years ago, the amount of love shown by people is amazing". Another said, "I haven't seen anything that has given me concern. If they (the staff) are worried about issues or they are outside of their comfort zone they get someone in".

From speaking to staff, looking at their personnel files and staff training files it was apparent that staff felt supported and had the opportunity to develop. At all times during our visit, across both units, staff were seen to be treating people with dignity and in a person centred way that ensured users of the service were happy with the care and support received.