Lyndale

Lyndale is a residential care home providing care and support for up to nine people. The service specialises in providing support to people who have mental health needs. At the time of our inspection there was one person receiving a regulated activity, this was support with their personal care.

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

Improvements had been made to the service and the systems and processes put into place following the last inspection had been sustained and embedded. Staff knew people well; this included any risks to their wellbeing and safety which had been assessed. The person told us they were happy living at Lyndale and was not restricted in their life.

There was a relaxed, calm and friendly atmosphere in the home, it was clean, tidy and well maintained. All necessary utility and building checks had been carried out. People were supported by staff who were safely recruited and trained to ensure they had the skills necessary. Staff felt supported and were well trained. There were enough staff on duty. People had enough to eat and drink and were involved in creating shopping lists.

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. People had access to healthcare services as they needed.

Medicines were managed safely. Infection control risks were mitigated, and clear guidance was in place and followed, in particular in relation to COVID-19. Care plans were detailed, and person centred, support with socialisation activities were in place.

Lyndale was well-led, robust monitoring systems meant people were protected from avoidable harm. The service learnt from events that occurred and used the outcomes to make further improvements. People, their relatives, staff and professionals were asked for their feedback on the care and support provided at the service and this was used to make improvements.

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 11 April 2019) and there was a breach 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

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service:

Following the last inspection, we met with the provider to confirm what they would do and by when to improve the rating of all the key questions to at least Good. At this inspection we found that improvements had been made. Improvements continued to be necessary in some areas to achieve a rating of Good.

People told us they felt safe. Risk management had improved but continued to require improvement to ensure clear decision-making processes resulted in support to mitigate risk that did not overly restrict people. An assurance related to the oversight of one person’s care made to professionals following a safeguarding concern had not been implemented. This was a continued breach of the regulations.

At our last inspection we made a recommendation about the review of restrictive practices. This recommendation remains in place following this inspection.

Systems to ensure people received their medicines as prescribed had also improved but continued to need improvement.

The manager had a visual presence and staff felt supported by them. Staff had received training to support their role. Supervision records were not always available to reflect individual staff members support and development needs.

People had access to health care support from professionals. When people were unwell, staff had raised the concern and taken action with health professionals to address their health care needs.

People were comfortable with the staff that supported them. Staff offered support and reassurance to people. People made decisions about their day to day lives such as when they got up and if they went out. We have made a recommendation about involving people in decision making about their care.

Information had been gathered and recorded about social activities that people enjoyed and wanted in their lives. This information had not been acted on sufficiently.

The manager had begun to implement oversight systems in the home and these were leading to actions to improve people’s experience of care and support. At this inspection we had not been able to assess whether the improvements made had been fully embedded and sustained.

More information is in the detailed findings below: We identified a continued breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 related to safe care and treatment. Details of action we have asked the provider to take can be found at the end of this report.

Rating at last inspection: At the last inspection the service was rated Inadequate. (Published November 2018)

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Why we inspected:

We inspected the service to understand the experience of people since the oversight of the home had changed.

Follow up: We will continue to monitor information received about the service and ensure the next planned inspection is scheduled accordingly.

The people living in Lyndale have care and support needs associated with their physical and mental health.

The inspection visit took place on the 11 October 2018. The visit was unannounced. We continued to gather evidence from the home and professionals until 17 October 2018.

The service did not have registered manager. The previous registered manager had deregistered in May 2018. They remained involved with the home. 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.

We carried out this inspection in response to information of concern we received alleging that people were receiving unsafe and poor care in an environment that was in poor condition. During our inspection we gathered evidence that reflected these concerns.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At this inspection, we found that risk management was not sufficient to ensure people received safe care and treatment. Risks related to people’s skin damage and mental health were not being managed effectively and staff did not always have accurate information about these risks. Risks related to the environment had not been picked up and fire safety checks had not been carried out. This was a breach of the regulations.

Staff did not follow safe procedures and this meant people were at risk of not receiving their medicines as prescribed. Staff competency had not been adequately assessed to make sure they were able to administer medicines safely. Other staff training was not current including fire training and infection control. This was a breach of regulations.

People were supported to have choice and control of their lives. However, restrictive practices were not reviewed to determine if they were still appropriate. We have made a recommendation about this.

Notifications had not been made to the Care Quality Commission where required. This was a breach of the regulations.

Staff were able to respond to people when they wanted help. We also saw that the risk management related to staff recruitment was not robust.

People told us the food was adequate.

Care staff were kind throughout. Privacy was not always respected and failures to address environmental concerns did not reflect that people were respected or valued by a caring provider.

People told us they had access to GP’s and dentists when they needed them.

People knew how to raise concerns but were not confident they would always be heard. Verbal complaints were not being managed in line with the organisational policy.

Oversight and governance in the home had not been effective in identifying shortfalls and unsafe practices. This was a breach of regulation.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Lyndale is a care home for up to nine adults who require support with their mental health. There were eight people living there when we visited. Bedrooms are situated on the ground and first floors of the building. The first floor is accessed by stairs.

The service had a registered manager, which is a condition of its registration with the Care Quality Commission (CQC). A registered manager is a person who has registered with CQC 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 deputy manager was also involved with managing the service and provided information for us during the inspection.

People were treated with dignity and respect. They received individualised care and support from staff who knew them and understood their needs and preferences. They were involved in planning and reviewing their care and support. They received the support they needed to manage their health and to eat well, including managing special dietary needs.

People’s consent had been sought for their care. The management team had a working understanding of the Mental Capacity Act 2005 and when authorisation under the Deprivation of Liberty Safeguards would be necessary.

People were protected from the risk of abuse and avoidable harm. Staff understood their responsibilities in relation to safeguarding adults, and information about safeguarding was also available for people and was discussed with them. People’s individual risks were assessed and managed in a way that respected people’s choices.

People and staff were meaningfully involved and consulted in the running of the service. There were meetings for residents and for staff. The registered manager and deputy worked closely with people and staff and regularly spoke with people informally about what was happening.

The management team had close oversight of how the service was operating. They had commissioned outside audits of its performance and had an action plan to address areas for improvement.

Complaints and concerns were viewed as an opportunity to improve the service. Information about how to make a complaint was displayed in the hallway. However, the complaints policy was dated 2010 and referred people to CQC if they were unhappy with the way their complaint had been addressed. This was incorrect, as CQC has no powers to investigate individual complaints, although it is glad to hear about people’s experiences of the services it regulates. We have made a recommendation about updating the complaints policy.

Key property maintenance and testing, such as gas, electrical, water and fire safety was undertaken by specialist contractors. There was a property refurbishment programme under way. A new kitchen had recently been installed and people told us this was a great improvement. The outside of the building and some communal areas had also been redecorated. There were outstanding maintenance issues with two people's bedrooms that had not yet been refurbished. The management team confirmed these were programmed for refurbishment and were seeking to arrange this that minimised disruption and anxiety for the people concerned.

Medicines were stored and managed safety. The management team had close oversight of medicines and checked that staff who handled medicines were trained and competent to do so. However, they did not clearly record their competency checks. We have made a recommendation about recording competency checks.

There were sufficient staff on duty to provide the support people needed. Recruitment procedures were robust to ensure staff were suitable to work in a care setting. They had the training, skills and support they needed to be able to perform their roles effectively.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found :-

Is the service safe?

The home had systems in place to monitor the quality of service provided to people. There was a low incidence of accidents at the home but these were monitored so that remedial action could be taken to prevent further occurrences. People who lived at the home we spoke with told us that they felt safe at the home. Their care was assessed and care plans in place to support the staff. All of the staff were found to have had training in adult protection and policies and procedures for safeguarding vulnerable adults were in place.

CQC monitors the operation of the Deprivation of Liberty Safeguards which apply to care homes. No applications had been submitted, however the provider had a policy and relevant staff understood how an application should be made.

Is the service effective?

People's care and support achieved good outcomes. People we spoke with were happy with the way they were looked after and reported no concerns. Action had been taken to achieve compliance with the improvements identified at the last inspection in October 2013.

Is the service caring?

We spoke with people living at the home and they told us that they got on well with the staff team and they were happy with the service being provided. People were able to identify and set their own goals and to make decisions about their lifestyle choices.

Is the service responsive?

Services provided to people were organised so that they met people's needs. People had care plans in place so that staff knew how to be responsive to people's care and support needs. Residents' meetings had been re-instated so that people could feedback about the service they received.

Is the service well-led?

The registered manager has been in post for many years and has years of experience in running a home. We found there were well developed systems for monitoring the quality of service provided to people. Accident and incident monitoring systems were in place. Action had been taken by the provider to carry out work on the premises agreed at the last inspection in October 2013. Records we saw were accurate and up to date.

People's care and support was assessed and up to date. Care plans were in place to inform staff of how to look after people. People we spoke with told us that their care and support needs were met.

Generally the premises provided a safe and well maintained environment for people who lived at the home. The provider agreed some actions to the maintenance of the exterior of the premises, although we have not been able to confirm that compliance has been maintained.

Systems were in place to monitor the quality of service provided to people. However, the provider could be more responsive in responding to maintenance issues brought to their attention.

The home had a well-publicised complaints procedure and maintained a log of any complaints received from people who lived at Lyndale or their representatives. Complaints received from people who lived at the home were responded to appropriately.

People told us that they were well cared for and that they were settled at the home. Their care needs had been assessed and care plans put in place to inform staff of how to meet people's needs. There was also evidence within people's files that their consent had been obtained about how they were cared for.

Assessments had been carried out concerning people's ability to manage their own medication. Where people had medication administered by staff, medications were stored and disposed of safely and generally recorded to an appropriate standard.

The home had robust recruitment procedures in place. However, no new members of staff had been recruited to work at the home since our last inspection to the home in 2012.

The home had a well-publicised complaints procedure. A log of complaints was maintained but none had been made about the service since our last inspection.