Lynton Terrace

Lynton Terrace is a care home for up to 10 adults with mental health needs. At the time of our inspection, 10 people were living at the service.

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

The environment and equipment were not always safely maintained or clean.

People received their medicines in a safe way. However, some of the systems for managing medicines were not safe. For example, the way in which they were stored.

The provider's systems for monitoring and mitigating risks were not always effectively operated.

People were happy at the service. They received personalised care. They liked the staff and they felt safe and well cared for. People had access to healthcare professionals who worked closely with the staff. There were organised activities and people could learn new skills and develop their independence.

The staff felt well supported. There were staff vacancies and the provider relied on temporary staff to help make sure they had enough staff on duty. They tried to arrange for familiar temporary staff and gave these staff support and guidance to help them work well alongside permanent workers. There were systems to help ensure only suitable staff were recruited. The staff undertook a range of training and had opportunities to meet with their line manager to discuss their work.

There were systems for monitoring quality and dealing with complaints, accidents, and incidents. The registered manager also managed another care service. They supported an interim manager who worked at Lynton Terrace full time. People using the service and staff told us they felt the interim manager was approachable and had helped develop the service.

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.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 21 October 2017).

Why we inspected

We undertook this inspection based on the date of the previous inspection.

Enforcement

We have identified breaches in relation to safe care and treatment, premises and equipment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Although there were systems in place for infection control and prevention including a cleaning regime, supply of personal protective equipment (PPE) for staff, and regular audits, we found some issues in the kitchen around cleanliness and the storage of food.

The provider worked closely with healthcare professionals and the local authority to learn and develop best practice. Staff received training and understood their roles and responsibilities in keeping people safe from infection. Staff wore PPE such as masks, gloves and aprons.

The provider supported people to stay in touch with family and friends in a safe way. Visitors were required to take COVID-19 tests and wear PPE.

People and staff were reminded to social distance where possible, and information about this was displayed. There were appropriate systems in relation to laundry and the disposal of clinical waste. People who used the service had access to outdoor space including a shelter where they could meet and smoke if they wished to.

Each person using the service had a COVID-19 care plan and risk assessment in place. These outlined how to support the person according to their individual needs, and how to minimise risks to their safety and wellbeing. There were also risk assessments in place for staff taking into account any healthcare needs and their ethnicity.

At the last inspection on 17 November 2015, the service was rated Good. At this inspection we found the service remained Good.

Lynton Terrace is part of Hestia, a large charitable organisation that provides support for a range of people, such as older people, young people, people with disabilities and mental health needs.

There was a registered manager in post at the service at the time of our inspection. 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 were systems and processes in place to protect people from the risk of harm. Checks were carried out during the recruitment process to ensure only suitable staff were employed. There were enough staff on duty to meet people’s needs.

There were arrangements in place for the safe management of people’s medicines and daily checks were undertaken.

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.

People were supported by staff who were suitably trained, supervised and appraised. People’s nutritional needs were met, and they were involved in devising their menus.

Staff were caring and treated people with dignity and respect. Care plans addressed each person’s individual needs, including what was important to them, and how they wanted to be supported.

People were fully involved in undertaking activities of their choice, both in the home and the community. People were cared for in a way that took account of their diversity, values and human rights.

People living at the home, their relatives, staff and other stakeholders told us that the registered manager was approachable and supportive. People and their relatives were supported to raise concerns and make suggestions about where improvements could be made.

The provider had effective systems in place to monitor the quality of the service and ensure that areas of improvement were identified and addressed. The registered manager kept themselves informed of developments within the social care sector and cascaded important information to the rest of the team.

Lynton Terrace provides residential care for up to ten adults with mental health needs. There were ten people living at the service at the time of our inspection.

There was a registered manager in post at the service at the time of our inspection. 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.

Staff told us they felt safe and we saw there were systems and processes in place to protect people from the risk of harm. There were sufficient staff on duty to meet people's needs and bank staff were available to cover in the event of staff shortage to ensure people's safety.

Staff had undertaken training on the Mental Capacity Act 2005 (MCA) and were aware of their responsibilities in relation to the Deprivation of Liberty Safeguards (DoLS). They ensured people were given choices and opportunities to make their own decisions.

There were arrangements in place for the management of people's medicines and staff had received training in administration of medicines.

People's nutritional needs were met, and people were involved in weekly meetings with staff to choose what they wanted to eat and drink.

Staff received effective training, supervision and appraisal. The registered manager sought guidance and support from other healthcare professionals and attended workshops and conferences in order to cascade important information to staff, thus ensuring that the staff team were well informed and trained to deliver effective support to people.

Staff were caring and treated people with dignity and respect. Care plans were clear and comprehensive and written in a way to address each person's individual needs, including what was important to them, and how they wanted their care to be provided.

A range of activities were provided both in the home and in the community. We saw that people were cared for in a way that took account of their diversity, values and human rights.

People, staff, relatives and healthcare professionals told us that the management team were approachable and supportive. There was a clear management structure, and they encouraged an open and transparent culture within the service. People and staff were supported to raise concerns and make suggestions about where improvements could be made.

The provider had effective systems in place to monitor the quality of the service to ensure that areas for improvement were identified and addressed.

Our inspection team was made up of a single inspector. As part of this inspection we spoke with three people who used the service. We spoke with the registered manager and three members of staff. We reviewed care records for people who used the service and records relating to the management of the home, which included staff files. We also observed people being cared for by staff.

Below is a summary of what we found. The summary describes what people who used the service and the staff told us and the records we looked at.

Is the service safe?

There were effective recruitment processes in place for staff, which included obtaining references. Staff had undergone criminal record checks. All staff had been trained in emergency first aid and there was an on-call system for dealing with emergencies out of hours. There was a policy in place to deal with adverse incidents such as adverse weather.

We found people were not protected against the risk of unsafe or inadequately maintained premises. The carpet in two of the bedrooms looked worn and toilets in the communal areas were in need of re-decoration and repair.

Is the service effective?

There were up to date care plans in place for each person, which enabled staff to provide safe and effective care. Care plans were being reviewed and included details about the care and support required as well as details of the next of kin. We observed people being asked their permission to do things during our visit.

Is the service caring?

The people we spoke with told us they felt safe. People who used the service were involved in decisions about their care and support. A member of staff told us, "We always ask [people who used the service] what they want and give them choice." They went on to say they never forced people to do anything.

Is the service responsive?

The service liaised with health professionals such as the doctor and psychiatrist to meet the needs of people who used the service. The staff we spoke with were aware of the needs of people who used the service.

Is the service well-led?

We saw evidence there were processes in place to monitor and improve the quality of service delivery. Daily care records were also being completed. The people who used the service were provided with information about how to make a complaint and people we spoke with were aware of the complaints procedure.

We looked at the support plans for four people. The plans included clear objectives, were regularly reviewed and people were involved in updating their own plans. Daily records showed that care and support were delivered in line with each person's plan.

When we last inspected the home we noted that risk assessments were not available for people who smoked. We saw during this inspection that the risk assessments had been completed.

The home provided a good standard of accommodation. People's bedrooms were individual and there were sufficient communal areas for people to spend time in small groups, if they chose. A separate communal room was also provided for people who wished to smoke.

Staff told us they had access to good quality training that enabled them to support people safely. The provider had made arrangements for new staff to complete a thorough induction training programme.

People told us they would tell staff if they had any complaints and they trusted staff to deal with any issues they raised. Complaints were recorded with details of the actions taken by staff and the outcome for the person who made the complaint.

We saw that the home had systems for assessing and reviewing the care needs of people using the service. People using the service were involved in writing their own care plans and these plans were regularly reviewed to reflect people's changing needs. Appropriate risk assessments were completed and where possible risks were identified, staff were given clear guidance on how these should be managed.

We also saw that staff working in the home had up to date guidance and training on how to support people safely.

Although people using the service told us they were well supported, we found that failure to maintain a safe environment may have put them and other people, such as staff and visitors, at risk.