Archived: Lyme Green Hall

Lyme Green Hall is a residential care home providing personal care to 12 people aged 65 and over at the time of the inspection. The service can support up to 60 people. Lyme Green Hall can accommodate people across three separate wings, each of which has separate adapted facilities. At the time of inspection, only one wing was in use.

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

A new care management company had been in place since the last inspection and they had made a number of improvements. These improvements addressed a significant number of issues we raised at the last inspection, however we still found issues that needed to be addressed.

Most of the service was clean however there was a lack of suitable bathing facilities on the wing of the home people were living in.

Staffing levels had improved since the last inspection, however appropriate recruitment documentation was not in place to ensure the safe recruitment of staff.

People were being supported safely to receive their prescribed medication, however we did identify some issues relating to non-prescribed medication. We have made a recommendation about the management of some medicines.

Safeguarding processes had improved and safe systems were in place to help protect people from the risk of harm or abuse.

The new manager demonstrated a good understanding of their role and responsibilities and worked in partnership with other agencies to ensure people received care and support in line with their assessed needs. People had access to appropriate equipment where needed. staff knew the needs and preferences of people living in the home well. People were treated with kindness and respect.

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 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 inadequate (published 27 December 2018) and there were five 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 some improvements had been sustained however the provider was still in breach of regulations.

This service has been in Special Measures since 28 December 2018. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement

We have identified continued breaches of regulation in relation to the cleanliness and suitability of parts of the building being used to provide care. Some audits were not robust enough to ensure safe recruitment. 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We carried out an unannounced visit to the home on the 15 and 22 November 2018.

Lyme Green Hall is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. This home is not registered to provide nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 61 people across three separate units. At the time of our inspection there were 16 people living at the home. A notice of decision to restrict new admissions into the home remained in place at the time of this inspection.

This location requires a registered manager to be in post. 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 no registered manager in post at the time of our inspection.

At the last inspection which we carried out on 3 and 4 October 2018, we found the provider was rated requires improvements overall. Since the last inspection there had been a change of management of the home. During this inspection we focused on two key questions: is the service safe? and is the service well led? We found the service was not safe or well led.

We identified breaches of the regulations in respect of Safe Care and Treatment, Safeguarding Service Users from Abuse and Improper Treatment, Premises, Good Governance, Staffing and Fit and Proper Persons.

We found safeguarding systems were not being followed and the manager was unclear which safeguarding policy they were adhering to. We found allegations of abuse had not been reported in a timely way during our inspection. There was no safeguarding tracker/log of concerns.

The premises were not always safe. There was a maintenance manager in place across all of the provider’s locations however, there was a vacancy for a maintenance worker for Lyme Green Hall. We observed three windows on the first floor with inadequate window restrictors which could be easily opened or which broke when a minimal degree of pressure was placed through them. There were no records to confirm weekly fire alarms were being tested, no water check records or mattress checks seen. The manager had put a mattress check system in place by the end of our second day of our inspection.

People were not always receiving safe care and treatment. We found sensor mats were not always working, there were no Pro Ra Nata (as and when) prescribed medication protocols in place, supplementary charts for prescribed creams had not been completed consistently, people’s weights had not always been monitored and people’s food and liquid intake had not been recorded when appropriate. People were not receiving regular checks as stated in their care plans.

Not all staff employed or deployed by the provider to work in Lyme Green Hall had been through appropriate checks. The manager of the home had not had a DBS (Disclosure Barring Service) which is a police check to ensure the provider is aware of any previous convictions or concerns prior to them starting in their role as manager of the home. We also found another staff member had no references or an application form in their recruitment file. A third staff member had no risk assessment in place for a previous conviction seen on their DBS certificate.

The governance arrangements of the home were that the provider had instructed a management company to manage the home on their behalf. We found the communication between the provider and management company was not effective in ensuring strong leadership. The managers had not followed basic safeguarding principles and procedures and had not escalated their concerns to ensure risks were being managed effectively.

Staffing numbers were not always meeting the care needs of people living at the home. We received concerns raised by the manager confirming they had to step in during one shift due to the shortage of suitably qualified, skilled and competent staff on shift. There was a high use of agency staff due to the staff turnover within the home. We observed poor practice by an agency worker which placed a service user at increased risk of falls.

The overall rating for this provider is 'Inadequate'. This means that it has been placed into 'Special measures' by CQC. The purpose of special measures is to: Ensure that providers found to be providing inadequate care significantly improve. Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration. The service will 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 we will move to close the service by adopting our proposal to vary the provider's registration to remove this location from the providers registration.

This inspection took place on 03 and 04 October 2018 and was unannounced. At our last inspections in October to December 2017 and April 2018 we found that the service was not meeting the required standards. We found eleven breaches of Regulations including concerns that placed people at serious risk of harm. These related to person centred care, dignity and respect, need for consent, safe care and treatment, safeguarding people from abuse and improper treatment, meeting nutritional and hydration needs, premises and equipment, receiving and acting on complaints, good governance, staffing, employing fit and proper persons and notification of other incidents. Following the inspection in April 2018 the provider implemented an action plan. At this inspection we found that the actions had been met and the provider was no longer in breach of those Regulations.

At the last inspection, we rated the service overall inadequate and the service has been in special measures. Services that are in special measures are kept under review and are inspected again within six months. We expect services to make significant improvements within this time frame. During this inspection the service demonstrated that improvements have been made and is no longer rated inadequate overall or in any of the key questions. Therefore, this service is now out of special measures.

Lyme Green Hall is a ‘care home’ operated by Pendlebury Care Homes Limited. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Lyme Green Hall has the capacity to accommodate 60 people across three units. At the time of the inspection there was one unit open. There were 20 people living in the home. This was because CQC had served a notice to restrict admissions while the service implemented improvements. The premises are set within its own grounds in a semi-rural residential location in Macclesfield.

The service did not have registered manager in place. 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. A manager had applied to register with CQC but this application was on hold and a different manager was in place. The manager at the time of the inspection was employed by an external management team who the provider had brought in to implement and oversee the improvements. During the inspection the manager told us they planned to register with CQC as a matter of priority.

The home was now working in a person-centred way. This means they treated people as individuals. Care was planned and carried out in a way that respected people’s personal choices and lifestyles. Care planning had significantly improved with the implementation of new records.

People told us they felt safe living there. Staff had received recent training and were knowledgeable about their roles and responsibilities around keeping people safe and protecting them from the risk of abuse.

Staff were recruited safely and new staff received an induction into the role before working independently.

People who may display behaviours that challenge had appropriate up to date risk assessments in place and staff were seen to manage behaviour of this type well.

Accidents and incidents were documented and audited. Actions and outcomes to prevent re-occurrence were noted.

The service employed a full-time chef who provided appetising and nutritious meals. People were given choices with their meals and their preferences were respected.

There was an activities co-ordinator who arranged a variety of activities but people and their relatives told us they were not aware of activities taking place.

Improvements were needed to the environment in order to enhance the lives of people living with dementia. The premises were safe but not effective for dementia care.

The service was working in line with the Mental Capacity Act. People who had their liberty deprived did so in their best interest. Families were involved in the decision-making process.

The manager had oversight of the service and all the people who lived there. They conducted a daily meeting where issues were discussed and completed monthly, quarterly and annual quality assurance checks. The manager worked for a company that had been brought in to oversee and implement changes, this meant the manager was not in substantive permanent post which affected the service’s ability to ensure stability and sustainability.

Lyme Green Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. This home is not registered to provide nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 60 people across three separate units, each of which have separate adapted facilities named the Villa Suite, Lymes Suite and Manor Suite. Staff and the people who live at the home refer to each unit as the Villa, Lymes and the Manor and we have done the same throughout this report. At the time of our inspection there were 24 people living at the home.

This focused inspection of Lyme Green Hall was undertaken following our receipt of a number of concerns raised by the local authority. We visited the home unannounced on the 19 April 2018 and requested further information in writing from the registered provider on the 25 April and 26 April 2018.

This location requires a registered manager to be in post. 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 no registered manager in post at the time of our inspection.

At the last inspection which we carried out between 31 October and 19 December 2017, we found the provider was not providing safe, effective, caring, responsive and well led services and was rated inadequate overall. The provider was not meeting the requirements of multiple regulations including regulations 9, 11, 12, 13, 14, 15, 16, 17, 18, and 19 of the Health and Social Care Act Regulations 2014 and regulation 18 of the Care Quality Commission (Registration) Regulations 2009. The service was put in special measures and we took enforcement action adding a condition to the provider’s registration restricting new admissions to the home until such time as the service was deemed safe, effective, caring, responsive and well led. This additional condition remained in force at the time of this inspection.

This inspection focused on two key questions only safe and well led. Whilst we could see that the provider had made some improvements we again found that the service was not safe or well led and people were at risk of receiving unsafe and ineffective care. We identified breaches of the regulations in respect of Person Centred Care, Safe Care and Treatment, Safeguarding service users from abuse and improper treatment, Good Governance, Staffing and Requirement as to display of performance assessments.

We found that people did not always receive care that was centred on their needs. The registered provider had failed to carry out an assessment of each person’s needs with the involvement of the relevant person and failed to develop plans of care designed to meet their needs and personal preferences.

Care was not being provided in a safe way. The registered person was not assessing the hazards presented to people or developing plans and effective arrangements for care to mitigate risk of harm.

Managers and staff failed to protect people from the risk of abuse. Poor communication in the home meant that managers were not always aware of incidents of abuse and on some occasions when they were made aware they failed to operate effective adult safeguarding procedures.

Whilst there were sufficient numbers of staff on duty the registered provider failed to ensure that staff had received appropriate training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform. The registered person was unable to demonstrate that a sufficient number of staff had received adequate training on first aid to ensure staff would know what to do in the event of an emergency.

We found that there was confusion and poor communication between managers and staff. The registered person told us that one person had been designated as manager but another manager told us that the person designated as manager had refused to take on that responsibility.

The provider had instigated systems to monitor the quality of care provided but these did not identify the concerns we identified during our inspection.

The provider had failed to display the ratings awarded to them at our last inspection on the home’s website.

The home was clean and odour free throughout. We could see that the registered provider had made a number of improvements including redecoration of some parts of the home.

The fire services told us that they were pleased with improvements made to the home’s fire integrity and emergency fire procedures so people were safe in the event of a fire.

All the residents presented as relaxed and at ease in the home’s environment. They all spoke well of the care provided and we could see they had good relationships with the staff. They told us that they were offered plenty of drinks and the food was good. Records showed that staff were monitoring people’s weights and took appropriate action if there was any unintended weight loss or weight gain.

The overall rating for this provider is 'Inadequate'. This means that it has been placed into 'Special measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

The service will 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 we will move to close the service by adopting our proposal to vary the provider's registration to remove this location from the providers registration.

Lyme Green Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. This home is not registered to provide nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 60 people across three separate units, each of which have separate adapted facilities named the Villa Suite, Lymes Suite and Manor Suite. Staff and the people who live at the home refer to each unit as the Villa, Lymes and the Manor and we have done the same throughout this report. At the time of our inspection started there were 49 people living at the home.

This comprehensive inspection of Lyme Green Hall was undertaken following our receipt of a number of concerns raised on behalf of people who used the service. We visited the home unannounced on the 31 October 2017 and carried out five further visits on the 01, 07 and 17 November and 04 and 19 December 2017.

At the last inspection on 16 August 2016, we found the provider was not meeting all the requirements of the regulations. Regulation 18 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Staffing) had been breached because the provider had failed to deploy sufficient numbers of suitably qualified and experienced staff.

Regulation 12 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Safe care and treatment) had also been breached because staff were not following policies and procedures on the administration and recording of medicines.

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This location requires a registered manager to be in post. A registered manager was in post 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. The registered manager resigned on the third day of our inspection and left without prior notice of her decision to leave.

At this inspection, we found that the provider was in breach of regulations 9, 11, 12, 13, 14, 15, 16, 17, 18, 19 and 18 of the Health and Social Care Act Regulations 2014 and regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

We found that the service was not safe, effective, caring, responsive or well led.

We found that there was an insufficient number of suitably trained and competent staff on duty to meet the needs of the 49 people who lived at the home. We found evidence of poor communication between the registered manager and staff, ineffective and inappropriate care practice, and a lack of knowledge regarding the requirements of the regulations designed to ensure safe and effective care. The registered manager responded ineffectively when we asked for information or highlighted concerns about people’s care and did not demonstrate that they had the necessary competencies to manage the home safely and effectively. Vulnerable people did not always have their needs assessed when their circumstances changed so they remained at risk of their needs not being met. Staff were found to be improvising when assisting people with their mobility in the absence of effective assessment, care planning, training, equipment and skill.

People who were identified as being at high risk of falls were not being reviewed following each fall to mitigate the risks of a reoccurrence. Therefore, the provider was not taking reasonable steps to keep people safe.

At the start of our inspection we found that people were at risk because their medicines were not being recorded, administered and stored in accordance with their doctor’s prescription. Despite receiving assurances from the provider that action would be taken to address these issues we found that vulnerable people remained at risk at the end of our inspection. This was because we found that care staff were unable to administer peoples medicines safely and effectively. There was no medicines policy and any training staff had received had proven to be inadequate.

Vulnerable people remained at risk of abuse because staff failed to take action as soon as they were alerted to alleged or actual abuse, or the risk of abuse.

Recruitment and selection of staff was not always carried out safely which meant vulnerable people were at risk of receiving care from unsuitable people.

The registered person had not taken appropriate action to ensure the fire integrity of the premises and ensure that staff would know what to do in the event of a fire. Fire alarms were not adequately checked. Important documents known as personal emergency evacuation plans, designed to ensure the welfare of people in the event of a fire had not been revised or updated in over five years even though the person’s condition and ability had changed significantly. This rendered the documents useless and placed vulnerable people, staff and members of the fire authority at risk in the event of a fire.

Care plans were not person centred and did not always reflect the personal care needs of the individual. The registered person’s had not ensured that the care and treatment of the people who lived at the home was appropriate and met their needs.

The quality of food was poor and inadequate. The registered persons were not effectively monitoring the dietary intake and weights of people who were deemed at risk of malnutrition. They did not ensure that people were offered a suitably varied and nutritious diet.

Staff support systems including staff training and supervision were found to be lacking or non- existent in some cases. Staff presented with a lack of knowledge about the work they did in some important areas including the safe recording and storage of medication, assisting people with their mobility and the Mental Capacity Act. We also found that managers and staff were not always following the principles of the Mental Capacity Act 2005.

Care staff told us that they had not seen some people’s care plans and that they did not get time to read them. In the absence of effective person centred care planning we found that staff had developed inappropriate care practices that restricted peoples freedom of movement or left them at risk of harm. These included moving a person’s zimmer frame away from them to prevent them from attempting to walk and not allowing a person to sit at the dining table in an attempt to avoid confrontation.

Quality assurance systems were in place but these had failed to identify uncontrolled risks presented to the people who lived at the home. There was evidence of a failure to notify the CQC of serious notifiable incidences and failure to analyse incidents and learn from experience when things had gone wrong.

Recruitment and selection of staff was not always carried out safely which meant vulnerable people were at risk of receiving care from unsuitable people.

During the course of our inspection we raised concerns with the local safeguarding authority because we believed people were at risk of receiving unsafe and ineffective care. The local authority took action to mitigate the risk including deploying their own staff in the home in the absence of suitably qualified staff provided by the registered persons. The local authority carried out assessment on all the people who lived at the home and found that a large proportion of them were inappropriately placed because they presented with needs which the home could not meet.

You can see what action we told the provider to take at the back of the full version of the report. Providers will be asked to share this section with the people who use their service and the staff that work there.

The overall rating for this provider is 'Inadequate'. This means that it has been placed into 'Special measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

The service will 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 we will move to close the service by adopting our proposal to vary the provider's registration to remove this location from the providers registration.

Lyme Green Hall offers accommodation for a maximum of 60 people who require nursing or personal care. The premises are set within its own grounds in a semi-rural residential location in Macclesfield. The home is subdivided into three distinct areas, each with individual bathroom facilities, communal lounges and dining rooms: Villa Suite, Lymes Suite and Manor Suite. Most of the bedrooms have en-suite toilet facilities and access between floors is by stairs or passenger lift. At the time of our inspection there were 54 people living at the home.

The service had a registered manager. 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 the last inspection on 12 November 2013, we found the provider was meeting the requirements of the regulations inspected.

During this inspection, the provider did not ensure staff followed policies and procedures on the administration and recording of medicines.

This was a breach of Regulation 12 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Safe care and treatment.) You can see what action we told the provider to take at the back of the full version of the report.

We observed the provider failed to deploy sufficient numbers of suitably qualified and experienced staff throughout the home to keep people safe and meet their care and treatment needs.

This was a breach of Regulation 18 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Staffing.) You can see what action we told the provider to take at the back of the full version of the report.

Staff received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

Staff had received training to identify abuse and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.

People and their representatives told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People, who were able, told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

We found people had access to healthcare professionals and their healthcare needs were met. We saw the management team had responded promptly when people had experienced health problems.

Care plans were organised and identified the care and support people required. We found they were informative about the care people received. They had been kept under review and updated when necessary to reflect people’s changing needs.

People told us they were happy with the activities organised at Lyme Green Hall. The activities were arranged for individuals and for groups.

A complaints procedure was available and people we spoke with said they knew how to complain.

People and staff spoken with felt the registered manager was accessible, supportive and approachable.

The registered manager had sought feedback from people who lived at the home and staff. They had consulted with people and their relatives for input on how the service could continually improve. The provider had regularly completed a range of audits to maintain people’s safety and welfare.

During the inspection we looked at care planning, food preparation and complaints records. We also observed care practices during the day and talked with people and relatives about the home. Comments were positive and included, 'The staff and manager are caring people I have no worries with my relative being here.' Also from a person living at the home, 'The staff entertain us all the time. They do make sure people are able to do what they want within reason.'

We spoke with people who lived at the home. They told us they could express their views and were involved in making decisions about their care. They told us they felt listened to when discussing their care needs.

We spoke with people about their diet and how their nutritional needs were being met. They told us they were satisfied with the food and the quality and quantity. One person said, 'The food is wonderful.' Another person said, 'We are lucky to have good cooks who make homemade meals.'

There were a range of audits and systems in place to monitor the quality of the service being provided.