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Inspection carried out on 12 October 2017

During a routine inspection

Lynfield is a residential home for up to nine people with a learning disability. People living there need support with behaviour that could challenge the service. There is a large shared dining area, sitting room and people also have access to a hydrotherapy pool. When we inspected, nine people were living there.

At the last inspection in August 2016, the service people received at the home was rated as good over all. However, there was one breach of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. This related to staff understanding of how to support people who may lack capacity to make informed decisions about their care. This meant that the service was not as effective as it should be.

At this inspection, we found that improvements had been made and there was no longer a breach of regulations. People received an effective service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The registered manager ensured they took appropriate action to protect people’s legal rights where they were subject to restrictions that were essential for their safety. Staff were alert to each person’s way of communicating so they could support people in making decisions. They understood how they needed to involve others where appropriate, to help assess people’s understanding. They knew that, where people could not make an informed decision about their care or treatment, any actions they took had to be in people’s best interests.

Staff supported people competently and effectively. They had a clear understanding of the care and support each person needed and of the importance of delivering this in a consistent way. Where some staff had not updated training in a timely way, the provider’s representative was taking action to ensure this improved. They were aware that supervision to discuss staff performance and development needs had slipped from the expected frequency. They were reviewing this to ensure improvements were made but staff said they felt well supported and people using the service were not affected.

People had a choice of enough food and drink to keep them well, and staff support in this area if they needed help. Staff monitored people's health and wellbeing and sought professional advice promptly when people needed this.

The service continued to be safe. Staff understood their roles in protecting people from the risk of harm or abuse and how to report any concerns or suspicions. Staff could explain how they followed guidance for minimising risks to people and there were enough of them to support people safely. Recruitment processes contributed to protecting people from the employment of staff who were unsuitable to work in care. Staff also supported people safely with their medicines.

Staff had developed warm and compassionate relationships with people. Relatives valued the family atmosphere this had created. Staff respected people's privacy and intervened in a discreet way when they needed to. They understood how people indicated anxiety or distress so they could try to establish what was wrong.

Staff were aware of people's preferences and their likes and dislikes. They supported people to keep in touch with their family and with professionals who could support them with planning their care. People’s representatives were confident that, if they needed to, they could make a complaint and have their concerns investigated and addressed.

There was stable and consistent leadership within the home, contributing to good staff morale and teamwork. There were regular checks to see what improvements could be made to ensure a good quality service. They were confident that the management team would act to address any concerns about poor practice that might place people at risk.

Further information is in the detailed findings for this report.

Inspection carried out on 24 August 2016

During a routine inspection

We inspected this service on the 24 August 2016 and the inspection was unannounced.

Lynfield provides accommodation and support for adults living with a learning disability. On the day of our inspection there were nine people using the service which is the maximum number the service is registered for. People living at the service could not easily give us their views and opinions about their care. Therefore, to help us gain a better understanding of people's experiences of living in the service we observed interactions between staff and people living in the service and saw care and support being provided in the communal areas. We also spoke to staff and looked at responses from visitors and healthcare professionals.

At the time of the inspection there was 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.’

We assessed this service to be providing good outcomes for people with only a number of minor improvements required.

People received their medicines as intended and medicines were administered by staff who had the skills and training to do this safely.

Risks to people’s safety were minimised by good staff supervision and staff who had knowledge of people’s needs. Risk assessments were reviewed in line with people’s needs.

There were enough staff at this service which meant that people were supported around their individual needs and interests. Staff recruitment was mostly robust but records did not always demonstrate this.

Staff training induction, and support was adequate but we were not assured of the frequency of staff supervision and whether all staff had the required knowledge and skills. We have made a recommendation about supervision.

Staff promoted people’s choice but we were not clear that staff followed the principles of the Mental Capacity Act. The MCA ensures that, where people have been assessed as lacking capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. DoLS ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation.

People’s health care needs and dietary were monitored and met by staff.

Staff provided good support to people and recognised individuals potential and strengths. They provided individualised care and promoted people’s independence, validating how people felt and expressed themselves.

Consultation with people using the service was difficult but staff tried to offer choice in everything they did and valued and respected people's choices.

Care plans were comprehensive and person centred. Staff knew people's needs well and tried to enhance people's experiences.

Complaints or feedback about the service was taken into account when planning and developing the service.

The service was mostly well led with a system of audits and ways to measure the effectiveness and quality of the service. The manager led her staff team and was well respected. Improvement in records would demonstrate how the staff were meeting people’s changing needs and responding accordingly.

We found breaches of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014 in multiple regulations. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 1 October 2013

During a routine inspection

We talked with two of the people who used the service. They told us that they liked living in the service and that staff were good to them. People also told us that they got on well with the staff, who supported them to follow their favourite activities, to be part of the local community and to go on holiday. This was substantiated by the records we looked at.

People also told us that their rooms were comfortable and that they had their own belongings around them.

Not all of the people who used this service were able to communicate verbally. However, we observed that the staff were attentive to people’s needs. Staff interacted with people in a friendly, respectful and professional manner. We saw that staff sought people’s agreement before providing any support or assistance.

During our inspection on 19 August 2013 we found that the service was not compliant with the medication outcome, regulation 13. On this occasion we found that the service had made improvements in the way that they managed the medication and had obtained and properly fitted a cabinet to safely store controlled drugs.

We spoke with three staff members, they told us that they believed there were enough staff on duty to keep people safe and that they were trained sufficiently to support people with learning disabilities in all aspects of their lives.

We saw that the provider had an effective system in place to enable people to make complaints and for them to be managed appropriately.

Inspection carried out on 19 August 2013

During an inspection in response to concerns

We inspected this service with our pharmacist inspector to assess compliance with Outcome 9 Medicines Management. We found there were not appropriate arrangements in place for the recording and safe administration of medicines placing the health and welfare of people living at the service at risk. We were told there were soon to be improvements to information about people’s medicines. We noted there were appropriate arrangements for the storage of most medicines, however, medicines that were deemed controlled drugs were not being stored within an appropriate cabinet. Staff authorised to handle and administer people’s medicines had received training and their competence had been assessed as satisfactory.

Inspection carried out on 20 July 2012

During a routine inspection

We spoke with two people who used the service and one of the people we spoke with told us that the support they were provided with was was "Good."

We observed staff as they supported people with everyday tasks, and noted that people responded in a positive way to all the staff on duty.

Four of the eight people currently receiving care and support answered a recent quality assurance questionnaire, and all said they felt the provider listened to their views.