Lyngate Care Home

Lyngate Care Home is a care home which is registered to provide accommodation for up to 41 adults requiring personal care. The home is situated on the main road in the Deane area of Bolton. At the time of the inspection there were 29 people using the service.

People’s experience of using this service and what we found

Improvements had been made within the service and medicines systems were now safe. Medicines records were now complete and up to date.

Records of personal care had improved and were now complete and accurate. Documentation of risks was now more comprehensive and included information about how to mitigate risks effectively. Required health and safety records were complete and up to date.

People’s dignity was respected and people were well-presented and looked warm and comfortable. People told us they were well looked after and staff spoke to people in a kind and friendly manner. People and, where appropriate, their friends and family were involved in all aspects of their care and support.

Systems were in place to help safeguard people from the risk of abuse. Staff were recruited safely and there were enough staff to meet people’s needs effectively. Measures were in place to help prevent and control the spread of infection.

People were given choices and their opinions listened to. There was a range of activities on offer and people were encouraged to pursue their particular interests.

Individual methods of communication were documented clearly within the care files. People were supported to maintain contact with people who were important to them. People’s wishes for when they were nearing the end of life were clearly documented.

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

Complaints were responded to appropriately and the service had received a number of compliments. Audits were completed and any issues addressed with actions. The service took learning from these to facilitate improvement to service provision.

Staff were well supported and given information to help them do their jobs effectively.

The service worked well with partner agencies, including the local authority teams district nurses and mental health services.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 26 February 2020) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Caring, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lyngate Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

Staff followed cleaning schedules to ensure all areas of the home were regularly cleaned, including high touch areas such as door handles and light switches.

Staff had received recent training in infection prevention and control, including how to put on and take off their personal protective equipment (PPE) in a safe way.

We saw staff wore PPE as appropriate, and regularly washed and sanitised their hands.

Tests for COVID-19 were being carried out in line with good practice guidance, where possible.

Visits to the home were restricted at the time of this inspection, in accordance with local infection control guidance. During this time staff were supporting people to stay in contact with their relatives and friends via telephone calls, or via on-line calls.

Lyngate Care Home is a care home which is registered to provide accommodation for up to 41 adults requiring personal care. The home is situated on the main road in the Deane area of Bolton. At the time of the inspection there were 30 people using the service.

People’s experience of using this service and what we found

Some medicines were not stored securely and people did not always receive their medicines safely. Medicines records were incomplete and medicines audits had failed to pick up and address issues.

Daily personal care records were incomplete, and it was unclear whether some people had received the assistance they required.

Individual risks were assessed but there was no information about how these had been addressed and the risk mitigated. It was unclear whether people’s oral health needs were being supported.

The upper floor of the home was quite cold. The water in one of the bathrooms was very hot and could scald people, other taps did not work. The registered manager agreed to address the hot water issue immediately to ensure people’s safety.

Some corridors and rooms were cluttered and could pose a risk to people’s health and well-being. The new dementia unit had poor lighting and was not decorated or furnished in a way that was considered good practice with regard to caring for people living with dementia. Information, such as signage and menus, needed to be produced in a more accessible way to make them more understandable for people living with dementia.

Some people were not presented well and their dignity was not always respected. There were no activities taking place due to the activities coordinator being on annual leave. However, there was evidence that activities and outings did occur quite frequently.

Health and safety certificates were in place as required and equipment was tested regularly. Staff were recruited safely and there were sufficient staff on duty to meet people’s needs.

Staff completed training in safeguarding and were aware of whistle blowing to report poor practice witnessed. Staff wore appropriate personal protective equipment to help prevent the spread of infection.

People’s nutritional needs and choices were recorded within their care files. People told us the food was good and they were given choices. People’s communication methods were documented and staff were aware of how to communicate with each individual.

Care plans included relevant background and support information and the service worked with other professionals and agencies. We saw evidence of people’s involvement in their care and support. People’s spiritual, emotional and psychological needs were documented and choices were recorded.

The service provided a thorough induction and good on-going training opportunities for staff. Staff told us the manager was supportive and approachable. Regular staff meetings and staff supervisions were held.

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

There was a policy in place around equality and diversity and training was completed by staff. People we spoke with found the home satisfactory and said staff were kind and caring.

The complaints procedure was displayed, there had been no recent complaints but systems were in place to deal with any complaints appropriately. Where people had been willing to share, their wishes for when they were nearing the end of their life were recorded. Some staff at the home were completing training in end of life care.

The provider sent in notifications to CQC of significant incidents, such as deaths, serious injuries and suspected abuse as required. Satisfaction surveys were issued regularly and the feedback from people who used the service and relatives was positive.

The home welcomed visits from various local religious representatives and there were visits from local schools and nurseries to entertain the people living at the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 23 May 2017).

At this inspection the rating has deteriorated to requires improvement. We have identified three breaches in relation safe care and treatment, dignity and privacy and the leadership and management of the home.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The last inspection was undertaken in August 2016. During that inspection we found multiple breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 with regard to staffing, safe care and treatment, meeting nutritional and hydration needs, need for consent, dignity and respect, person centred care and good governance.

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. There was a registered manager in place, but they were currently on sick leave and had given their notice. The service were planning to advertise the post internally. In the meantime the operations manager and care manager were undertaking all management duties.

People we spoke with said they felt safe at the home. Staffing levels were sufficient to meet the needs of the people who used the service and they were now using a dependency tool to calculate staffing levels based on need. There were medication systems in place to ensure that people who used the service received their medicines as prescribed and medicines were ordered, stored and disposed of safely.

The service had a robust recruitment system which helped ensure people employed were suitable to work with vulnerable people. Safeguarding procedures were in place and staff had undertaken training in this area and were able to demonstrate a good understanding of the issues.

The latest infection control audit had highlighted areas which were below standard and required improvement. The service was working on an improvement plan to help raise standards.

The induction programme was appropriate and staff received training and shadowing experience. Staff spoken with confirmed they had opportunities for training and development and we saw an on-going programme of training. A new supervision schedule had been implemented and supervision sessions were being completed on a regular basis.

People’s nutritional needs were recorded and met appropriately. There was a good choice of food and drink and we observed friendly, respectful interactions when meals were being served.

The service were working within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS).

We saw that staff were kind and courteous with people who used the service. Staff were clear about their roles and demonstrated a good understanding of the people they cared for.

People’s dignity and privacy was respected and they were encouraged to be involved in care planning and reviews. Residents and relatives meetings were held and this gave people further opportunities to be involved in aspects of the service delivery, such as menu choice and activities.

Care plans were person-centred and included a range of information around people’s health and personal preferences, background and interests.

There were a range of activities on offer and the service were considering suggestions from people who used the service for future outings.

The complaints procedure was clearly displayed and concerns and complaints dealt with appropriately. The service had received a number of compliment cards from relatives of people who used the service.

The management team were described as approachable and supportive by staff. However, the operations manager was a new addition to the staff team and a new registered manager had not yet been appointed. Therefore, although there were clear improvements in leadership, there was not yet evidence to show sustainment in this area. Staff were supported by regular supervision sessions and team meetings.

Surveys were sent out to seek opinions of people who used the service, relatives and staff. The results were used to continually improve the service.

A number of audits were undertaken to help ensure quality of service delivery. The provider and the operations manager were involved in a number of local groups to enable them to keep up to date with best practice and current guidance.

Lyngate Care Home is registered to provide accommodation for up to 41 adults requiring personal care. The home is situated on a busy main road in the Deane area of Bolton. There are car parking facilities to the rear of the building and there is good access to local amenities. On the day of the inspection there were 34 people using the service.

There was 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.

During this inspection we found multiple breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 with regard to staffing, safe care and treatment, meeting nutritional and hydration needs, need for consent, dignity and respect, person centred care and good governance.

Staffing levels were inadequate to meet the needs of the people currently using the service. There were some safety hazards, such as a long trailing buzzer cord and a call buzzer which was out of reach of people who used the service. Individual risk assessments were not always meaningful in terms of actions required to minimise the risk and the information in people’s care files was not always completed.

The staff recruitment and induction processes were satisfactory and staff training was not up to date but there were plans in place to rectify this. Supervisions and appraisals were not carried out on a regular basis.

There was a safeguarding policy in place and staff were able to explain how they would recognise and report any concerns. Safeguarding issues raised had been followed up appropriately.

All health and safety processes, such as electrical and gas safety, fire equipment maintenance and checks and environmental maintenance and checks were in place at the service. There were systems in place to help ensure medicines were ordered, stored, administered and disposed of safely.

There was a lack of choice with regard to meals and food and fluid charts were not always completed. People’s preferences, choices, likes and dislikes were not consistently recorded and people were often unable to have their choices respected due to the low staffing numbers.

Some people who used the service were poorly presented and records indicated they were not being supported to have baths and showers on a regular basis. The building was over three floors and was difficult for people to navigate around without support.

Staff had a basic understanding of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) but information in care files was not robust in regard to these issues. There was a complaints policy in place and no complaints had been received recently. No staff meetings where staff could voice their opinions or raise concerns were taking place.

The registered manager was not visible around the home and staff said they would raise any concerns or issues with the deputy managers. We saw medication audits but there was no evidence of other quality audits. Regular surveys were completed with people who used the service and their relatives. Many of the policies at the service required updating.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

Lyngate Care Home was safe, clean and hygienic. Equipment was serviced and maintained regularly which helped ensure people who used the service were not put at any unnecessary risk.

We checked the staffing rotas and saw the required numbers of staff were on duty. One staff member accompanied a person to hospital and another staff member covered for them until they returned. This helped ensure the safety of people who used the service.

Deprivation of Liberty Safeguards (DoLS) become important when a person is judged to lack the capacity to make an informed decision related to their care and treatment. The provider told us no applications for DoLS had been made but knew the procedure to be followed if an application needed to be made.

Is the service effective?

We were told by the manager that before any person was admitted to the care home, they had undergone a pre-admission assessment. We saw care plans had been signed by the person or their representative which showed they had been involved in the creation of their care plans.

People who used the service and their families had been involved in regular surveys. The last one was completed in February 2014. We saw an action plan had been put together and any shortfalls had been addressed.

Is the service caring?

We saw there was a good interaction between staff members and people who used the service. Staff were patient with people and took their time to understand their needs.

We spoke with two people who used the service and one told us, "It`s home from home here. Really champion." A family member told us, "This is such a homely place and the staff are so approachable."

Is the service responsive?

We spoke with the activities co-ordinator who confirmed people completed a range of social activities both inside and outside the care home. The home had its own minibus which helped ensure people were kept involved around the local community.

People who used the service had their spiritual and religious needs met by the provider. Monthly services were held at the care home for all denominations. People who chose to could attend.

Is the service well-led?

We saw evidence in care plans and were told by the manager that the care home had a good relationship with other agencies. This helped ensure people received care and support when they needed it.

The provider had quality assurance procedures in place. Internal and external audits had been completed and we saw any shortfalls had been addressed. This helped ensure the quality of care and support people received continued to improve.

Information of concern regarded the care and welfare of people who used the service in relation to staff getting people out of bed very early and the recruitment procedure when employing new staff.

We spoke with all the night staff on duty and some of the day staff and the manager.

We looked at the daily monitoring records of four people who used the service.

We sampled staff files of the last two members of staff to be recruited.

We spoke with four people who used the service they told us; "I had a look around the home first and was involved with my care plan when I entered the home". "I am very happy here' 'I can't complain' 'Absolutely smashing here' 'Staff are all very kind' 'I recommend to anybody' 'They listen to you' 'The staff notice if anything is bothering me' 'I've never heard anyone be cross with anyone'.

We found there was appropriate management of the nutritional needs of the people who used the service. When we sampled six care files we noted nutritional assessments had been undertaken. Weights were recorded on a monthly basis.

We found care was provided in an environment that was clean and well organised. Bedrooms and communal areas were free from any malodours. We saw staff had access to appropriate infection control and prevention guidance.

We found that Lyngate care home had a robust recruitment process and all required checks on new staff were completed.

Lyngate care home had appropriate systems in place to monitor the quality of the service provided. We found audits were undertaken by the registered manger and senior staff.