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Inspection carried out on 8 July 2020

During an inspection looking at part of the service

About the service

Lyndhurst nursing home provides residential and nursing care for up to 16 people. At the time of the inspection, 13 people were using the service.

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

The service had safeguarding procedures in place and staff had a clear understanding of potential abuse and reporting concerns. There were enough staff available to meet people’s care and support needs. People’s medicines were managed safely. Accident and incidents were recorded and acted upon. Lessons learnt were used as to improve the quality of service.

There were systems in place to monitor the quality and safety of the service. The registered manager and staff worked in partnership with health and social care providers to plan and deliver an effective service.

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 good (published 14 June 2018).

Why we inspected

We undertook this targeted inspection to check on a specific concern about restrictions placed by the Nursing Midwifery Council (NMC) on the registered manager’s nursing registration. We wanted to check the impact of this on the service and ensure people were safe.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

Inspection carried out on 11 April 2018

During a routine inspection

This inspection took place on 11 April 2018 and was unannounced. Lyndhurst Nursing Home 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. Lyndhurst Nursing Home accommodates 16 older people in one adapted building. There were 10 people using the service at the time of our inspection.

At the last inspection on 27 and 28 April 2017, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the provider had not carried out satisfactory background checks for some staff before they started working. Staff had not completed all trainings relevant to their roles and responsibilities and they had not received regular supervision and annual appraisal. The service did not have effective system and procedures to monitor the quality of the care people received, and some of the provider’s policies and procedures were inaccurate and incomplete. Following that inspection the provider sent us an action plan showing how they planned to make improvements.

At this inspection we found improvements had been made. People and their relatives told us they were satisfied with the way staff looked after them, and that staff were knowledgeable about their roles. The provider carried out comprehensive background checks of staff before they started work. We also saw checks had been made on the registration of qualified nurses with their professional bodies to ensure their suitability.

Records showed the provider supported staff through regular supervision and yearly appraisal. Staff told us they felt supported and could approach their line manager, and the registered manager at any time for support.

The service had system and process to assess and monitor the quality of the care people received. As a result of these checks and audits the provider made improvements, for example, care plans and risk management plans were up to date, and the premises had been redecorated where required.

The provider had reviewed their policies and procedures and updated as appropriate. For example, the complaints and whistleblowing blowing, staff training, and the recruitment policy and procedures and they were fit for purpose.

The service had a registered manager 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.

Staff knew how to keep people safe. The service had clear procedures to support staff to recognise and respond to abuse. The manager and staff completed safeguarding training. Staff completed risk assessments for every person who used the service and they were up to date with detailed guidance for staff to reduce risks.

The service had an effective system to manage accidents and incidents, and to prevent them happening again. Medicines were managed appropriately and people were receiving their medicines as prescribed. Staff received medicines management training and their competency was checked. All medicines were stored safely.

The service had arrangements to deal with emergencies and staff were aware of the provider’s infection control procedures and they maintained the premises safely.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People consented to their care staff provided them.

Staff assessed people’s nutritional needs and supported them to maintain a balanced diet. Staff supported people to access the healthcare services they required, and monitored their

Inspection carried out on 27 April 2017

During a routine inspection

This unannounced inspection took place on 27 and 28 April 2017. Lyndhurst Nursing Home is a care home service for up to 16 older people living with dementia, sensory impairment or a physical disability. There were 14 people using the service at the time of our inspection. We previously carried out an unannounced inspection of this service on 19 March 2015 and the home was rated good overall.

At this inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014.

Staff had not completed all training relevant to their roles and responsibilities. Staff training in relation to first aid, end of life care, equality and diversity, and diabetes were outstanding for all staff from the year 2016. Staff had not received regular supervision and annual appraisal.

This was a breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities Regulations 2014).

The provider had not carried out satisfactory background checks for some staff before they started working. This meant staff checks were not adequately carried out to reduce the risk of unsuitable staff working with people who used the service.

This was a breach of regulation 19 of the Health and Social Care Act 2008 (Regulated Activities Regulations 2014).

The home had a registered manager in post, but they were not working consistently at 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. The service was not consistently managed at all times to ensure good quality of service.

The registered manager had not encouraged and empowered people and their relatives to be involved in service improvements through residents and relatives’ forum meetings. The provider’s information return (PIR) submitted to CQC stated that there were regular residents meetings. However, we found this information was not correct. The registered manager told us that there have not been any residents meetings and they plan to reinstate these within next week.

The service did not have an effective system and process to assess and monitor the quality of the care people received. The provider had not carried out staff files audits; the monthly audits for care plans, incidents and accidents, falls, infection control and the environment of the premises including people’s bedrooms after 28 February 2017.

Some of the provider’s policy and procedures were inaccurate and incomplete. The registered manager told us since 2009 the home’s policies and procedures had not been reviewed and updated to reflect that they were accurate and complete.

These issues were a breach under Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

Improvement was required to ensure that people’s choices regarding the time they would like personal care provided was recorded, and staff deployed in order to meet these needs.

Staff supported people to take their prescribed medicines, but some aspects of their management required improvement.

The provider had carried out satisfactory background checks for the remaining staff we looked at. These checks included qualification and experience, employment history and any gaps in employment, references, criminal records checks, health declaration and proof of identification.

Staff knew how to keep people safe. People who used the service and their relatives told us they felt safe and that staff treated them well. The service had clear procedures to support staff to recognise and respond to abuse.

Staff completed risk assessments for every person who used the service which were up

Inspection carried out on 19 March 2015

During a routine inspection

This inspection took place on 19 March 2015 and was unannounced. At our last inspection in August 2014, we found the provider breached regulations related to monitoring the quality of the service provided. The provider sent us an action plan on 1 September 2014. They told us they had introduced a new system of recording accidents and incidents in the home and we saw at this inspection the recording and follow up of incidents and accidents had improved.

Lyndhurst Nursing Home is a care home providing nursing care for up to 16 people. When we inspected, 12 people were living in the home. Some people were living with the experience of dementia, others were receiving end of life care and some had general nursing and care needs.

The home has 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.

People using the service and their relatives told us they were very happy with the care and support provided in the home. The provider assessed people’s health and social care needs and developed care plans to meet these.

The registered manager, nurses and care staff communicated very effectively to make sure all staff were up to date with each person’s care and support needs.

Staff supported people in a caring and professional way, respecting their privacy and dignity.

Staff had the training they needed to care for people. Specialist training had been organised to help nurses and care staff meet people’s end of life care needs. Nurses and care staff were able to tell us about people’s individual needs and how they met these in the home.

Staff understood and followed the provider’s safeguarding and whistleblowing procedures. They also understood the importance of reporting any concerns about the welfare of people using the service to the local authority safeguarding team.

People and their relatives told us they knew about the provider’s complaints procedure. They were confident the provider would respond to any concerns they might have.

People consistently received their medicines safely and as prescribed.

We found the service to be meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

Inspection carried out on 5 August 2014

During a routine inspection

We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspections, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see evidence supporting our summary please read our full report.

Is the service safe?

Safeguarding procedures were in place and staff understood how to identify abuse and report concerns to safeguard people using the service.

Risk assessments were completed for each person using the service to identify potential risks such as falls or poor nutrition. There were systems in place to ensure the environment was well maintained and people knew how to respond if a person using the service became unwell. Accidents and incidents were reported and recorded; however, there was no evidence to show what actions had been taken in response to reported incidents. There was no evidence that analysis of incidents had been undertaken to identify trends and minimise the risk of reoccurrence of incidents. Staff received health and safety training and

There were systems in place and staff had received training to ensure people were protected from abuse and their human rights were upheld.

Is the service effective?

People�s health and care needs were assessed with their involvement where possible. A care plan was then developed which reflected the level and type of support each person required to be safe and receive care appropriate to their needs. People�s mental capacity to make informed choices had been assessed and we saw relatives had been involved to ensure their best interests were considered. People we spoke with told us they felt safe and their personal needs were met and staff ensured any changes they requested regarding their day to day care were acted upon.

Is the service caring?

We observed people using the service had their privacy and dignity respected. We spoke with people and their relatives. A relative said ''The staff have been here for several years and know how to care for my mother. They understand her, she is not the easiest person to look after but they never get ruffled and are kind and are genuinely caring.''

People had been involved in the planning of their care and supported to identify their preferences and what was important to them. Staff demonstrated a good understanding of each person�s needs and how to effectively communicate with them. This ensured people were supported and involved in decisions about their day to day care. We noted staff took time to answer people�s questions and provide suitable explanations in a respectful manner. One person we spoke with said ��the staff are very respectful but you can always have a joke and a bit of a banter with them.��

Is the service responsive?

People were invited to be involved and make decisions about their group activities but their wishes were respected when they did not wish to participate. We saw people had access to information about how to raise a concern. We noted safeguarding concerns had been correctly reported and responded to in a timely manner so people were protected. There was evidence to show the service worked effectively with other health care professionals such as dentists and doctors to ensure people received care they had needed. We observed peoples wishes about aspects of their care and daily activities were respected and responded to appropriately. We saw people had access to information about how to raise a concern or make a complaint.

Is the service well led?

The registered manager had completed infection control audits to check hand washing facilities were appropriate and available to staff to ensure the safety of people using the service. People using the service had been supported by their families to participate in a satisfaction survey and there was evidence to show the registered manager had responded to people�s feedback to improve the service.

Inspection carried out on 7 May 2013

During a routine inspection

People living at the home and their family members we spoke with at inspection told us they were generally well cared for. A relative said they could "only speak well of the home". We found that care plans and risk assessments were updated on a regular basis and people's capacity to give consent to everyday issues was considered. The provider took steps to protect people from the risk of abuse and people told us they felt safe at the home. People were provided with adequate amounts of food and drink that met their individual needs.

However we found that the provider did not have appropriate recruitment processes in place and there were insufficient staff to meet people's needs on the day of our inspection.

Inspection carried out on 5 October 2012

During an inspection looking at part of the service

We inspected the service previously on 22 August 2012 and found the provider was failing to meet the essential standards including training and supporting staff, infection control, supporting people with nutrition, providing suitable activities for people, consulting with people about their care and storing records in a way that allowed them to be accessed when required. We inspected the service again on 5 October 2012 and found the provider had taken steps to address these issues.

Inspection carried out on 22 August 2012

During a routine inspection

We spoke to two people at the home and some relatives visiting the home on the day of our inspection.

People told us the staff were kind to them and helped them with what they needed, but that some people did not have much to do with their time. Relatives told us they thought people at the home were treated well by the staff but that it would be good to see more staff to help at lunch time.

We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We saw that staff treated people kindly and were patient, however we noted that people spent periods of time with only very limited interaction with others.

Inspection carried out on 5 January 2012

During an inspection in response to concerns

People we spoke with told us that the staff were kind and involved them in their care.

people said that the night staff did not always respond as quickly as some people would like them to.

People told us that medication was given promptly and that staff always provided a drink to take their tablets and stayed with them until they had taken them.

Some people told us the food was good and they had enough to eat.

People said that they liked brown bread as it was healthier but only got it occasionally.

People we spoke with were unsure as to whether they or their relatives had been asked to complete a satisfaction survey

Reports under our old system of regulation (including those from before CQC was created)