Lister House

Updated 27 November 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This comprehensive inspection took place on 20, 26 and 27 September 2018. The first day of the inspection was unannounced.

The inspection was undertaken by an adult social care inspector, an assistant inspector, a specialist advisor for medicines, and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert by experience who supported this inspection had experience of supporting a person living with dementia.

We were given a tour of the environment which provided an opportunity to observe staff interactions with one another and with the people supported by the service. With permission, we also looked in people’s rooms.

We used information the provider sent us in the Provider Information Return. This is information providers are required to send us at least once annually to give some key information about the service, what the service does well and any improvements they plan to make. This contributed to our understanding of the service.

Before our inspection, we reviewed information we held about the service, which included information shared with the CQC and notifications sent to us since our last inspection. The provider is legally required to send notifications about events, incidents or changes that occur and which affect their service or the people who use it. We also contacted the local authority commissioning group and the local Healthwatch, a consumer group who aim to share the views and experiences of people using health and social care services in England. We used this information in planning our inspection.

During the inspection, we spoke with seven people supported by the service and five relatives. We spoke with thirteen members of staff including the peripatetic manager, operations manager, personal development facilitator, nurse, head of catering, unit manager, senior carers and care assistants.

We reviewed documentation relating to six people which included risk assessments, care plans and reviews. We looked at three staff files and an overview of staff training, supervisions and appraisals. We reviewed information relating to the running of the service including staff rotas, compliments and complaints and a series of policies and procedures.

Updated 27 November 2018

This inspection took place on 20, 26 and 27 September 2018. The first day of our inspection was unannounced.

Lister House is a ‘care home’ situated in Ripon. 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. The service supports older people, some of whom may be living with dementia, and can accommodate up to 76 people. People who live at Lister House have an association with the Armed Forces.

The service can accommodate up to 60 people within their main building and 16 people within the Colsterdale Unit, which specialises in supporting people living with dementia. There were communal spaces for people to enjoy including a chapel and gymnasium, and there was lots of outdoor space.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager in post who had managed the service since 2013. 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 was absent at the time of our inspection and a peripatetic manager was managing the service with input from the provider.

Quality assurance checks completed did not identify some of the issues we highlighted during our inspection. For example, some statutory notifications had not been submitted, there was lack of specialist training for staff and agency profiles missing for two staff. There were also outstanding actions following the provider's most recent audit. The management team were responsive to the issues we raised and took actions to address these. The provider was in the process of developing their quality assurance tools to ensure the safety of the people who used the service and demonstrated they wanted the service to continually improve

Staffing levels were safe and the provider took appropriate actions when they considered staffing levels to be insufficient. People received their medicines as required. We found two instances where people prescribed ‘as and when needed’ medicines did not have protocols in place to ensure staff understood when to administer these medicines. For one person a choking risk assessment had not been completed but for all other identified risks, risk assessments were completed and staff understood what actions to respond to risks. The provider had safeguarding policy in place and staff understood potential signs of abuse and who to report their concerns to. Accidents, incidents and near misses were recorded by staff and reviewed by the management team to ensure appropriate follow-up actions had been taken.

Staff completed training the provider considered mandatory, but had not completed training specific to the needs of the people who used the service. We have made a recommendation about the provider ensuring staff received the specialist training required.

Staff received supervisions and annual appraisals and told us they felt supported in their role. People were positive about the quality and choice of food. Staff weighed people on a regular basis, however for two people that required weekly weights these had not been taken. People had access to healthcare professionals. The needs of the people were considered in the design and decoration of the building. 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.

We received positive feedback about the caring nature of the staff who worked at Lister House. People who used the service and their relatives told us staff were kind and polite. We observed staff were patient with people and made effort to reassure people. Staff promoted people’s dignity and privacy through their interactions and were mindful to promote their independence. People’s relatives told us they felt welcome to visit and had built a rapport with staff. Information was available about advocacy services and the management team understood when people may require their support.

People received person-centred support. Care plans were in place and provided information about people’s needs, abilities and background. For those who required end of life care, this was available, and information was recorded about people’s wishes. A variety of activities were available and were in the process of being further developed. The provider had a complaints policy and responded to complaints appropriately. We highlighted the need to ensure complaints were responded to in writing, in accordance with their policy. People had confidence that any issues would be addressed.

People who used the service and their relatives felt the service was well managed. The management team wanted people to receive person-centred and high quality care. Meetings were held for residents and relatives to gain their feedback about the running of the service. Staff meetings were held to deliver important information about the running of the service and to discuss the needs of the people who used the service.

Further information is in the detailed findings below.