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Inspection carried out on 3 May 2018

During a routine inspection

Lyles House provides accommodation and personal care for up to eighteen people. This comprehensive inspection took place on 3 May 2018 and was unannounced. There were eighteen people living in the home when we inspected.

The last inspection at this service was on1 March 2017. In 2017 the service was rated requires improvement in the key question of safe and well led with a breach of regulation 12 Safe care and treatment. This means that the service was rated ‘Requires Improvement’ overall. At that inspection, we assessed the care as being safe but identified risks associated with the environment, which could have affected people’s safety. The registered provider/manager took immediate actions and submitted an action plan to tell us what they had done.

At this inspection on the 3 May 2018, we found the service offered safe care and have rated it good against all key questions we inspect against. There were certain aspects of the service which were very good but other areas of the service which could be strengthened to enhance people’s experiences

Lyles House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 had a registered manager who was also the registered provider. 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.

At this inspection, on the 3 May 2018 we found Lyles House was a well- planned, well- managed service. People said they felt safe and in the main risks were well documented in relation to people’s individual’s needs. Adequate steps were taken to mitigate risk as far as reasonably possible. The service had a low number of incidents, accidents and falls. We attributed this to the steps the service had taken reduce risk. However, we identified a couple of potential risks, which had not been adequately responded to. This was fed-back to the registered provider/manager to address.

People received their medicines as intended by staff who were sufficiently trained and competent. Medicines were audited to ensure they were available and administered as required. Medicines were only prescribed when necessary and reviewed to ensure they remained appropriate to the needs of the individual.

Staffing levels were sufficient and staff worked cohesively to ensure people’s needs were met in a timely manner. The hours specifically allocated to activities were limited and if increased would further enhance people’s well -being.

Staff understood how to keep people safe and who to report concerns to if they suspected a person was at risk or harm or actual abuse. Staff were confident in their role and felt able to report issues internally and externally if necessary.

The service recorded accidents, incidents or any event affecting the well- being and safety of people using the service. The service was open and transparent and lessons were learnt.

The registered provider/manager had adequate staff recruitment processes to help ensure only suitable staff were employed. Once employed staff were supported to work independently and as part of the team. Staff received support, supervision and training to help them fulfil their role. Staff kept up to date with best practice through training updates and a detailed induction to care.

People were supported to stay adequately hydrated and receive sufficient nutrition. This was monitored to help ensure people did not have unintentional weight loss and if this happened, steps were taken to reverse it. People had their health care needs met. Their needs were carefully monitored and steps taken to ens

Inspection carried out on 1 March 2017

During a routine inspection

This inspection took place on 1 March 2017.

Lyles House is a care home that provides accommodation and personal care for up to 20 people. There were 20 people living in the home on the day of the inspection, some of whom were living with dementia.

The home did not require a registered manager as the provider is an individual.

During this inspection, we found one breach of the Health and Social Care Act 2008 (Regulated Activities) 2014. This breach occurred because the provider had not always assessed and managed risks to people’s safety appropriately. These risks were in relation to adequate protection from burns or scalds, being safe to leave the home unaccompanied and fire safety at night. You can see what action we have told the provider to take at the back of this report. Immediately after the inspection visit, the provider took some action to reduce the identified risks to protect people from the risk of harm.

Systems were in place to protect people from the risk of abuse, and the staff had received sufficient training and supervision to provide people with good effective care. People received their medicines when they needed them and there were enough staff on the day of the inspection visit to support them when required and to meet people’s individual needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Consent was sought from people before a task was undertaken. Where people lacked capacity to make their own decisions about their care, consent had been obtained in line with the relevant legislation.

People received enough food and drink to meet their individual needs and they were supported to maintain their health.

The staff were kind, caring and compassionate and knew the people they supported well. They listened to people, quickly dealt with any concerns they raised and treated them with dignity and respect.

People’s individual wants and needs had been assessed and the staff were meeting these. People were treated as individuals and were encouraged to be as independent as they could be and to participate in activities that were meaningful to them. This enhanced their well-being.

The provider had instilled an open culture within the home where people, their relatives and staff were listened to and their opinions respected. The staff received good direction and leadership and understood their individual roles and responsibilities. The provider was passionate about providing people with care that enhanced their wellbeing and this passion was also demonstrated by the staff team.

People and staff were involved in the running of the home. Their suggestions for improvement were listened to and where possible, implemented. Some systems that were in place were effective at monitoring and improving the quality of care people received. However, not all systems were effective at identifying and managing risks to people’s safety.

Inspection carried out on 21 October 2014

During a routine inspection

This inspection was unannounced and took place on 21 October 2014. At the last inspection in October 2013, we found that the provider was meeting all of the standards that we checked.

Lyles House is a service that provides accommodation and care to older people and is registered to care for up to 20 people. On the day of our inspection, there were 18 people living at the service.

There was a registered manager working 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 and associated Regulations about how the service is run.

People told us they felt safe and that they were not discriminated against. Staff knew how to reduce the risk of harm to people and there were enough of them to keep people safe.

People received their medicines when they needed them. The provider had made sure that the premises were well maintained and that the required safety checks had been carried out. Equipment used to assist people to move had been regularly serviced to ensure that it was safe to use.

People told us that staff asked for their consent. Staff had received training in a number of subjects to give them the skills needed to provide people with safe care. However, some staff and the provider did not understand the principles of the Mental Capacity Act 2005 (MCA) or the Deprivation of Liberty Safeguards (DoLS). The MCA and DoLS is legislation that must be followed by providers to protect the rights of people who lack capacity to make their own decisions. Therefore, we could not be sure that people who lacked capacity to make their own decisions consistently had their rights protected.

People told us that the staff were kind and caring. Our observations confirmed this. We saw that staff treated people with respect and were kind and compassionate towards them. People told us they felt happy to raise any concerns they had with staff and were confident that these would be dealt with.

People received sufficient food and drink to meet their needs and had access to healthcare professionals when they became unwell or required specialist help with an existing medical condition.

Staff were responsive to people’s needs and they had access to activities they found interesting. The service had not received any complaints.

All of the staff spoken with felt supported by the provider and deputy manager. Staff were encouraged to pursue further qualifications within the Health and Social Care sector to improve their skills. The provider regularly monitored the quality of the service to make sure that the care and support being given was of good quality.

We recommend that the provider considers guidance in relation to the recent Supreme Court judgement regarding the Mental Capacity Act 2005 Deprivation of Liberty Safeguards and the implications this has for care home providers, staff and people living in the home.

Inspection carried out on 3 October 2013

During a routine inspection

We spoke with 11 people living in Lyles House and they all said that they were very happy there. One person said, “I love it here, this is my home”. Another person said, “This is the best home I could have chosen to stay in, it’s wonderful”.

Care plans were person-centred and demonstrated that people had been involved in making decisions about how they wished to be supported. We noted that people had signed their care records and consented to their plan of care. We observed care staff interacting with people in a kind and compassionate manner. The staff demonstrated that they knew the people living in the home, and their needs, very well.

We saw that the premises were safe and clean. There was detailed information regarding hygiene and infection control and we found evidence that this was followed in practice.

There were enough staff on duty to meet people’s needs in a timely manner. The people we spoke with all stated that they were well cared for. One person said, “The carers are wonderful and the manager is fantastic. All of them are very kind and take their time. They don’t rush you”. We noted that there were effective recruitment and selection processes in place and that staff received regular supervisions and appraisals.

We looked at the records held by the service and noted that they were accurate and fit for purpose. We saw evidence that records containing confidential information were stored securely.

Inspection carried out on 5 October 2012

During a routine inspection

We spoke to 11 people receiving care and accommodation in this home. They reported that they were satisfied with the care, attention and kindness shown by staff. They confirmed that they were well looked after and that their independence was promoted wherever possible. For example one person told us that, “Nothing is too much trouble for the staff”. Another person told us “Since l have been here, I am much more confident in doing things for myself”.

They also told us that they felt respected and involved by staff and that if they had any questions or concerns staff would be willing to address these. For example one person told us “The staff are very approachable”. Another person told us that the staff were always, “Happy to help”.

Inspection carried out on 27 October 2011

During a routine inspection

We were welcomed by people living in the home who were happy to speak to us about their experiences. Staff fully included people in any discussions and made certain people were informed about the inspection and why we were in the home.

People told us that staff are available when needed to assist them or to chat about any worries or concerns they may have. They felt that staff worked hard to make certain their needs are met and every person we spoke to said they were happy at Lyles House.

One person explained how staff had given support and enabled the person to now walk across their room. We were also told how staff make certain people are safe at all times when walking around the home.