Archived: Lyndhurst Residential Home

Lyndhurst Residential Home is a residential care home providing personal care to 14 people aged 65 and over at the time of the inspection. The service can support up to 15 people.

The home is a converted property with two communal lounges and a dining room. Bedrooms are situated in the ground and first floor.

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

People were not always protected from the risk of harm. Although people told us they felt safe, risks to people’s health and safety were not always identified or robustly assessed. Some areas of the environment posed a risk to peoples safety. People were not adequately protected from the risk of fire, the kitchen was not clean, and medicines were not always stored safely. There were enough staff on duty and recruitment procedures were safe.

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. However, care records did not include assessments of people’s capacity to make decisions regarding specific aspects of their care. People were enabled to access other health care professionals. There was effective communication between staff. Staff had received training and supervision. Feedback about the meals was positive but records relating to people’s food and fluid intake needed to be improved.

Staff were caring and kind. People’s right to privacy was respected and staff took steps to maintain people’s dignity. Confidential information was stored securely.

Information in people’s care files was detailed and person centred, although we noted one person who had been living at the home for two weeks did not have a care plan in place. People were not enabled to engage in meaningful, person centred activities. There was a system in place to manage complaints in the event people were dissatisfied.

The service was not well led. There was a lack of robust and effective leadership. Systems of governance were weak and ineffective. Quality monitoring systems had not highlighted where there were concerns or issues, had consistently failed to ensure regulatory compliance and had not identified the issues we have raised as part of this inspection. There was no evidence the registered provider monitored the quality of the service people received. Despite our findings, people told us they were happy with the care provided and staff felt supported by the registered manager.

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 26 April 2019) and there were three 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 enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to person centred care, consent, safe care and treatment and governance.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

People’s experience of using this service:

The service needed to ensure robust systems were in place to maintain compliance with CQC regulations and standards. The service had a poor regulatory history and action was needed to bring the home up to a consistent, high performing standard. Because of this, there were widespread and significant shortfalls in service leadership. Leaders did not assure the delivery of high-quality care.

Improvements were needed to the building environment, and grounds to bring them up to a good standard. This had been an issue at the previous inspection and had the potential to impact upon the care and support outcomes. For example, some carpets were not dementia friendly and the lack of a shower reduced people’s bathing choices.

People and staff praised the registered manager and we saw they had made some improvements to such as to care plans. The staff team said they felt more settled.

People provided positive feedback about the care and support they received at Lyndhurst. People said staff were kind and caring and supported them appropriately.

People said they felt safe from abuse and staff understood the correct processes to follow. Some improvements were needed to the way people’s money was managed to ensure people were fully protected from the risk of financial abuse. Some improvements were needed to medicine management processes to ensure people consistently received their medicines as prescribed.

Care plans were thorough, person centred and detailed. These were subject to regular review and were written in an accessible format.

There were enough staff deployed within the home. Safe recruitment processes were followed. However, action was needed to bring staff training up-to-date.

People had a choice of food and action was taken to address any weight loss. The service worked with healthcare professionals to meet people’s healthcare needs.

A registered manager was 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.

We identified three breaches of regulations relating to Regulation 12 (Safe Care and Treatment), Regulation 17 (Good governance) and Regulation 18 (Staff training) of the Health and Social Care Act (2008) Regulated Activities 2014 Regulations.

Rating at last inspection: The service was rated Requires Improvement at the last inspection. It had been rated Requires Improvement at the two inspections prior to that and Inadequate at the inspection before that.

Why we inspected: The service was a routine inspection which also followed up on concerns found at the previous inspection in November 2017. At this inspection we checked if improvements had been made.

Enforcement: We issued a warning notice for Regulation 17 (Good Governance) and Regulation 18 (Staffing) requesting the service make improvements in these areas.

Follow up: We will meet with the provider and manager to make it clear that improvements are required to the service. We will re-inspect the service in the future to check the required improvements have been made.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Prior to this inspection we had received some information of concern regarding staffing levels, food provision and staff training. We did not find evidence to corroborate these allegations. However, during this inspection we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Regulation 17, good governance.

Lyndhurst is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Lyndhurst is registered to provide care for up to a maximum of 15 people, some of whom are living with dementia. Accommodation is provided over two floors, which can be accessed using a stair lift. Eleven rooms are single occupancy and two rooms are shared, accommodating two people in each room. There were ten people living at the home on a permanent basis at the time of our inspection and one person staying at the home on a temporary, respite basis.

The home had a manager in post, who had recently been appointed. They had not yet registered with the Care Quality Commission, although they had begun the process of their application. 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 provider had a safeguarding policy in place and the staff we spoke with understood the signs to look for which may indicate potential abuse. Staff were clear about who they would report safeguarding concerns to.

We observed sufficient numbers of staff to keep people safe and everyone we asked told us there were enough staff to keep people safe. However, we recommended the manager consider using a tool or system to ensure staffing numbers are sufficient. Staff were recruited safely.

Risks had been assessed, such as those relating to medication, skin integrity or falls. Measures had been introduced to reduce risk. However, the risk assessments had not been updated regularly. We saw moving and handling plans were in place which provided staff with information in order to safely assist people to move.

Regular safety checks took place and fire, gas and electrical systems had been tested. Plans and evacuation equipment were in place to safely evacuate people in the case of emergencies. Staff had been trained how to use evacuation equipment effectively.

Medicines were managed, stored and administered effectively and in a safe way. Staff that administered medicines had received specific training to do so safely.

Staff received regular training and observations of their practice. Staff told us they felt supported. However, regular formal supervision for staff was lacking.

The home was in need of cosmetic improvements such as redecorating and carpeting in some areas. There was only one bathroom in use which people used to bathe. There was no facility to shower. This was also found at our last inspection.

Decision specific mental capacity assessments had been completed for people who lacked capacity to make specific decisions, and decisions were made in people’s best interests, as required by the Mental Capacity Act 2005.

People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible; but only in so far as the amenities of the building would allow. For example, people did not have the choice to have a shower because these facilities were lacking.

People received appropriate support in order to have their nutrition and hydration needs met. Mealtimes were a pleasant experience and people enjoyed the food.

All of our observations indicated staff treated people with kindness and compassion. People told us staff were caring and we observed people’s privacy and dignity being respected. People were encouraged to maintain their independence. Visitors were welcomed and there was a pleasant atmosphere in the home.

Care plans contained person centred information, including people’s personal histories, likes and dislikes. Staff were aware of people’s needs and preferences and care was provided in line with care plans. Although staff clearly knew people well, care records showed limited information had been gathered in relation to people’s cultural, religious or sexuality needs. End of life wishes were not consistently recorded.

Some people told us, and records showed, activities were not meaningful for some people living at the home. This was also found at the last inspection.

Up to date records of the care and support offered and provided were not always kept.

Since the last inspection, efforts had been made to gather people’s views in relation to their meal-time experience. However, regular meetings with residents and relatives had not taken place.

Audits and quality assurance systems had continued to develop and improve some areas of the service since the previous inspections. However, these were not consistently effective and some areas which had been identified for improvement had not been actioned.

We made some recommendations in relation to how staffing numbers are determined and also in relation to the environment. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 no longer in Special Measures.

Lyndhurst Residential Home is registered to provide care for up to a maximum of 15 people, some of whom are living with dementia. Accommodation is provided over two floors, which can be accessed using a stair lift. Eleven rooms are single occupancy and two rooms are shared, accommodating two people in each room. There were ten people living at the home on a permanent basis at the time of our inspection and three people staying at the home on a temporary, respite basis.

The home had a manager in post, who had recently been appointed. They had not yet registered with the Care Quality Commission, although they told us this was their intention. 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 provider had a safeguarding policy in place and the staff we spoke with understood the signs to look for which may indicate potential abuse. Staff were clear about who they would report safeguarding concerns to.

Sufficient numbers of staff were employed to keep people safe and staff were recruited safely.

Risks had been assessed, such as those relating to diabetes or falls. Measures had been introduced to reduce risk and we saw moving and handling plans were in place which provided staff with information in order to safely assist people to move.

Regular safety checks took place and fire, gas and electrical systems had been tested. Plans and evacuation equipment were in place to safely evacuate people in the case of emergencies. Staff had been trained how to use evacuation equipment effectively.

Medicines were managed, stored and administered effectively and in a safe way and the new manager was introducing new, improved systems to reduce the risk of error.

Staff received regular training and supervision, which included observations of their practice. Staff told us they felt supported.

The home was in need of cosmetic improvements such as redecorating and carpeting in some areas.

Team leaders had received training in relation to the Mental Capacity Act 2005 and demonstrated a good understanding of the requirements of the Act. This training had not yet been provided for care and support staff, although they demonstrated they understood the principles of the Act. Decision specific mental capacity assessments had been completed for people who lacked capacity to make specific decisions, as required by the Mental Capacity Act 2005.

People received appropriate support in order to have their nutrition and hydration needs met. Mealtimes were a pleasant experience and people enjoyed the food.

All of our observations indicated staff treated people with kindness and compassion. People told us staff were caring and we observed people’s privacy and dignity being respected. Advocacy was accessed for people when this was appropriate. There was a pleasant atmosphere in the home.

Care plans contained person centred information, including people’s personal histories, likes and dislikes. Staff were aware of people’s needs and preferences and care was provided in line with care plans.

Some people told us, and records showed, activities were not meaningful for some people living at the home.

Audits and quality assurance systems had continued to develop and improve since the previous inspections and these had identified areas for improvement. Actions resulting from audits were evident.

Regular meetings with residents and relatives had not taken place and people’s views had not been gathered through other means, such as questionnaires.

There was a permanent manager in post, although they had not yet registered with the Care Quality Commission. The new manager was working with the registered provider and a consultant who had developed an action plan in order to continue to make improvements in the quality and safety of service provision.

Lyndhurst Residential Home is registered to provide care for up to a maximum of 15 people, some of whom are living with dementia. Accommodation is provided over two floors, which can be accessed using a stair lift. Eleven rooms are single occupancy and two rooms are shared, accommodating two people in each room. There were 12 people living at the home at the time of our inspection.

The previous registered manager had left the organisation and had not been managing the service since December 2013. The current manager had been in post since then but was not registered with the Care Quality Commission. The current manager was on leave and not available during our inspection. The return to work date for the manager was unclear.

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 provider had a safeguarding policy in place and the staff we spoke with understood the signs to look for which may indicate potential abuse and staff were clear about who they would report concerns to. However, not all staff had received safeguarding training.

Staff were not always recruited safely. A member of staff had commenced work prior to their employments checks being returned.

Although some risks had been assessed and measures had been introduced to reduce risk, some, such as those related to diabetes or moving and handling, had not been adequately assessed.

Improved plans had been implemented since the last inspection in relation to emergencies and evacuating the building. New evacuation equipment had been provided and staff had been trained how to use this effectively. A policy was in place which outlined the procedures to follow in an emergency.

Building and equipment safety and maintenance had improved since the previous inspection. Regular safety checks took place and fire, gas and electrical systems had been tested.

A dependency tool was used to help determine staff numbers and we found the numbers of staff deployed were able to effectively meet people’s needs.

Medicines were managed, stored and administered effectively and in a safe way.

Although staff observations had increased and improved since the last inspection, not all staff had received appropriate training and supervision.

Consent to care was not always sought in line with legislation. No staff had received training in relation to the Mental Capacity Act 2005. This was also highlighted as a concern at the previous inspection.

People received appropriate support in order to have their nutrition and hydration needs met. Mealtimes were a pleasant experience and people enjoyed the food.

All of our observations indicated staff treated people with kindness and compassion. People told us staff were caring and we observed people’s privacy and dignity being respected. There was a pleasant atmosphere in the home.

Care plans had been recently updated and contained person centred information, including people’s personal histories, likes and dislikes. However, some essential information such as safe moving and handling plans was lacking.

Audits and quality assurance systems had improved since the last inspection and these had begun to identify areas for improvement, although further development was required, for example to ensure care plans were effectively audited.

There were two newly appointed team leaders who were temporarily managing the day to day running of the home. They were supported by the registered manager of a domiciliary care agency who was associated with the registered provider, a consultancy company whom the registered provider had commissioned to work with the home to improve standards and the registered provider. However, we found a lack of structured support mechanisms in place and there was a lack of management presence at the home.

Policies and procedures were out of date and related to obsolete legislation and organisations.

At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found there was not enough improvement to take the provider out of special measures. CQC is now considering the appropriate regulatory response to resolve the problems we found.

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

Lyndhurst Residential Home is a residential care home in Dewsbury. The home provides accommodation, personal care and support for up to 15 older people, some of whom are living with dementia. Accommodation at the home is provided over two floors, which can be accessed using a stair lift. Eleven rooms are single occupancy and two rooms are shared, accommodating two people in each room.

At the time of the inspection there were 15 people using the service.

A registered manager was registered with the Care Quality Commission at the time of the inspection however they had left the organisation and had not been managing the service since 17 December 2013. The current manager had been in post since then as acting manager and subsequently as the manager but they had not registered with the Care Quality Commission.

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.

During this inspection we found the registered provider had breached regulations in relation to safe care and treatment, staffing, good governance, person centred care and dignity and respect. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Medicines were not managed safely. There were no risk assessments or care plans in place, nor were there any guidance documents for staff to follow when administering ‘as and when required’ medicines such as diazepam or paracetamol. Staff made decisions as to whether people should be given a medicine used in the management of diabetes based on the amount they had eaten. This had not been agreed with people’s doctors. There was no system for checking the temperature of the medicine fridge or medicine cupboard, and liquid medicines did not have an opened date recorded on them. This meant medicines could be stored at the wrong temperature and be administered after the ‘discard by’ period. The medicine fridge was not locked and was in an area used by people and visitors.

Staff told us there were not enough staff to meet people’s needs. Some people needed two to one care and this meant whilst staff were supporting them, there was no one available to support other people unless the assistant manager or manager were on the floor. Care staff were also responsible for engaging people in activities, doing the laundry and preparing people’s tea as the cook finished work at 2pm. The manager agreed with our observations that there were not enough staff.

There were concerns in relation to fire safety which were passed on to the fire service. This included fire doors not closing properly, no evacuation aids to support people to who lived on the first floor and a fire exit leading to a gate which was locked with a padlock.

There were no premises risk assessments or emergency contingency plan. There was also no evidence of an electrical installation condition report having been completed at the service. Evidence of portable appliance testing (PAT), gas safety check and lifting operations and lifting equipment regulations (LOLER) could not be found at the time of the inspection however they were submitted at a later date.

Staff had not had an annual appraisal nor did they receive regular supervision. Training records showed that staff had not received appropriate training to support them to meet people’s needs.

Some people had authorised Deprivation of Liberty Safeguards (DoLS) in place but one person’s care records stated they did not have capacity to make decisions and a DoLS had not been applied for. The assistant manager confirmed this should have been addressed.

There were two shared bedrooms at Lyndhurst residential home. These were occupied by people who did not have capacity to make this decision, but there were no recorded best interest decisions in place to support the decision that they should share a room.

Dignity and privacy was not always respected as there were no care plans in place in relation to the specifics of maintaining privacy whilst people shared a room. We saw two people’s prescriptions were pinned to a noticeboard in the dining area and care records were not stored securely.

Care plans did not detail strategies for staff to follow in relation to managing behaviour that challenged, nor did they detail how to support people with mobility needs. Information was vague and stated, ‘assist with personal care’ but there was no detail on the exact nature of the support people needed. There was no information on people’s preferences or social history and background.

People were supported to access healthcare professionals, however where professionals had made recommendations in relation to people’s care and support this was not always included in care plans.

There was no effective audit or quality assurance system in place to identify areas for improvement. None of the concerns noted during the inspection had been identified by the provider.

Staff knew people well and engaged with them in a respectful, caring and compassionate manner.

Recruitment practices included an interview, two satisfactory references and the receipt of a clean Disclosure and Barring Service (DBS) check.

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.

We went back on this visit to see whether improvements had been made.

On the day of our visit there were 13 people living at Lyndhurst Residential Home. During our visit we observed people who lived at the home interacting with staff in one of the lounges and the dining area. We spoke with the registered manager and one person living at the home. The other people living at the home were having their tea in the dining room.

We found that, since our previous visit, the registered manager had been on an appropriate training course with the local council. We looked at people's care records and saw there were now suitable arrangements in place for obtaining, and acting in accordance with, the consent of the people living at the home. This demonstrated that people living at the home had consented to their care and treatment.

The care assistant we spoke with said they felt care at the home was good; they received appropriate training for their role and felt well-supported. They said 'I love working here, I really do. We have a good team that works well together to look after people'.

Three people living at the home told us Lyndhurst was a good place to live. They told us they felt safe living at the home, it was clean and tidy and they had never needed to make a complaint.

Comments from the people we spoke with included:-

'I like living here. They feed us too well though; I've put weight on'.

'I like reading and I prefer to stay in my room. There are some lovely staff here and the food is good.'

Staff and people living at the home told us there were enough staff working there to support them in the way they needed to be looked after.

Following our visit we spoke with the local authority Infection Prevention and Control team. They confirmed that the home had been issued with an action plan following a visit by them in April 2013 and that the home was working towards complying with the deficiencies identified.