Lister House

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.

The five questions we ask about services and what we found