Lyndhurst Rest Home

Lyndhurst Rest Home is a residential care home providing personal care to 34 older people who may be living with dementia at the time of the inspection. The service can support up to 44 people in one large extended detached building.

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

People told us, and they appeared, to be happy and safe living at the service. Potential risks to people’s health, welfare and safety had been assessed and there was guidance in place to mitigate risks.

Accidents and incidents had been recorded and analysed to identify any patterns and trends. Action had been taken to reduce the risk of them happening again and this had been effective.

Staff had been recruited safely and there were enough staff to meet people’s needs. Staff received training, supervision and appraisal to develop their skills. Medicines were managed safely. Staff monitored people’s health and referred people to relevant healthcare professionals.

People were supported to eat a balanced diet and to keep as healthy as possible. People had access to activities they enjoyed and were supported to maintain interests and hobbies.

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.

Each person had a care plan that contained information about people’s choices and preferences. These were reviewed regularly, people were involved as much as possible in developing the plan.

People met with staff before they moved into the service to check that staff would be able to meet their needs. People were treated with dignity and respect. People were supported to be as independent as possible and express their opinions about the service. People’s end of life wishes were recorded. Staff worked with the GP and district nurses to support people at the end of their lives.

There was an open and transparent culture within the service, people’s suggestions were acted upon. Complaints were recorded and investigated, following the provider’s policy. The environment had been developed to support people living with dementia following good practice guidelines. People received information in a way they could understand.

Checks and audits were completed on the quality of the service and action had been taken when shortfalls were found. The registered manager kept up to date with developments in social care to continuously improve the 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 Requires Improvement (published 9 October 2018) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulation.

Why we inspected

This was a planned inspection based on the previous rating.

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.

This inspection took place on 6 and 7 September 2018 and was unannounced.

Lyndhurst rest 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 can accommodate 44 people. At the time of our inspection there were 29 people living at the service.

Accommodation is spread over 3 floors in a large and extended detached property, overlooking the seafront at Tankerton, with many rooms benefiting from this position. There were 2 dining rooms and 2 communal lounge areas where people could choose to spend their time.

There was no registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run. A new manager had been appointed in June 2018, they had applied to CQC to become registered as the manager at the time of this inspection, but no decision had yet been made about their application. In the week following this inspection a decision was made to agree their application.

Lyndhurst was last inspected March 2018. At that inspection it was rated as 'Inadequate' overall. A number of breaches of Regulation were found during that inspection and the service remained in special measures.

Following the last inspection, we met with the provider to confirm what they would do and by when to improve all of the key questions at least good. Subsequently the provider has sent us a fortnightly action plan, detailing the improvements they were making.

At this inspection we found many improvements had been made, however we found one new breach of the regulations and three areas for improvement. The service is no longer in special measures.

At this inspection we found that recruitment systems had not remained robust. We reviewed recruitment records for staff, and found that safe processes had not always been followed.

Quality assurance audits had been recently introduced and were carried out to identify any shortfalls within the service and how the service could improve. Action was taken to implement improvements. Their effectiveness to ensure they are embedded into the service is an area for ongoing improvement.

Staff completed induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to care for, support and meet people's needs. Staff continued to receive training to ensure their skills and knowledge were current. The manager was in the process of reviewing the training offered, and making arrangements for staff to attend further training, working with new training providers. These actions require time to ensure they are fully embedded and sustained into the service and therefore this is an area for ongoing improvement.

People were encouraged to eat and drink enough and were offered choices around their meals and hydration needs. Staff understood people's likes and dislikes and dietary requirements and promoted people to eat a healthy diet. Some people required their food intake to be monitored; staff were completing this but not consistently. This is an area for ongoing improvement.

At our previous inspection medicines were not consistently managed safely. At this inspection we found that improvements had been made and medicines were now managed safely. At our last inspection there was not sufficient staff on duty to meet people's needs. At this inspection we found that staffing levels were safe and met people’s needs. People told us they felt there were enough staff and they didn’t have to wait long when they needed help.

At this inspection we found that people were protected from the risk of abuse. Staff had received safeguarding training. They were aware of how to recognise and report safeguarding concerns. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the provider or outside agencies if needed.

Equipment and the premises received regular checks and servicing in order to ensure it was safe. The manager monitored incidents and accidents to make sure the care provided was safe. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do. Suitable arrangements were in place to prevent and control infection and lessons had been learned when things had gone wrong.

At this inspection staff worked well together and ensured that clear communication between themselves and external health professionals took place; for example, with care managers, commissioner GP's and district nurses. There were staff meetings, so staff could discuss any issues and share new ideas with their colleagues, to improve people's care and lives.

Care was delivered in a way that promoted positive outcomes for people and care staff had the knowledge and skills they needed to provide support in line with legislation and guidance. This included respecting people’s citizenship rights under the Equality Act 2010. Suitable steps had been taken to ensure that people received coordinated care when they used or moved between different services. People had been supported to access any healthcare services they needed. The accommodation was designed, adapted and decorated to meet people’s needs and expectations.

People were supported to have maximum choice and control of their lives. In addition, the registered persons had taken the necessary steps to ensure that people only received lawful care that was the least restrictive possible. The care and support needs of each person were different, and each person's care plan was now personal to them. People had detailed care plans, risk assessments and guidance in place to help staff to support them in an individual way. The service was not currently supporting anyone at the end of their life. The service had begun to discuss and record people’s end of life wishes.

Staff encouraged people to be involved and feel included in their environment. People were offered varied activities and participated in social activities. Staff knew people and their support needs well. Staff were caring, kind and respected people's privacy and dignity. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff.

Staff told us they felt supported by the manager to make sure they could support and care for people safely and effectively. Staff said they could go to the manager at any time and they would be listened to. People who lived in the service and members of staff were engaged in developing the service. There were systems and procedures to enable the service to learn, improve and assure its sustainability. The manager was working in partnership with other agencies to support the development of joined-up care.

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

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

Lyndhurst rest 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 can accommodate 44 people.

Accommodation is spread over 3 floors in a large and extended detached property, overlooking the seafront at Tankerton, with many rooms benefiting from this position. There were 2 dining rooms and 2 communal lounge areas where people could choose to spend their time.

The service did not have a registered manager in post. The last registered manager left the service in December 2017. A new manager was appointed shortly after; however, they have since left. 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.

Lyndhurst was last inspected September 2017. At that inspection it was rated as 'Inadequate' overall. A number of breaches of Regulation were found during that inspection and the service was placed into special measures.

At this inspection, although people and relatives gave some positive feedback about the service, and we found improvement in some areas; we continued to have significant concerns about the safety and well-being of people. Risks continued to be identified and a number of continued breaches of Regulation were found. The service remains in special measures.

Risks including those associated with medicines, risks to people’s health and wellbeing including falls, eating and drinking, skin care, moving people and accidents and incidents had not been properly assessed or minimised in order to keep people safe. There had been improvements to the environment and recruitment procedures.

There were not enough staff to safely meet people’s needs, the provider did not use a recognised tool to assess and determine safe staffing levels. Staff training had not been effective in some areas. Training with a new provider had been booked, however we were not able to make a judgement at this inspection on its effectiveness. There continued to be minimal evidence that lessons had been learned and improvements made when things went wrong. The new deputy manager and the provider’s area manager had begun to carry out staff supervisions and implement competency checks.

People’s healthcare was not always consistently and effectively monitored. Risk assessments and new care plans were not always current; posing a risk that people could receive inappropriate care or treatment. Care plans had been written by a consultant and lacked person centred detail. End of life care plans required attention to ensure they were person-centred. The provider’s management team were aware of this and told us about the plans they had to improve this.

The principles of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards had not been properly understood or applied in the service. The commission had not been notified of the outcome of all DoLS applications, as is legally required. The service had begun to notify the Commission of other incidents and events that they were legally required to and had displayed their CQC rating.

Complaints were not responded to and investigated effectively. There were times when people were not treated with dignity and their privacy was not respected. People’s involvement in care decisions and planning was not clearly evidenced. There was little adaptation to the premises to make them suitable for those living with dementia, although we were told of plans to implement changes.

The service was not well-led. Issues raised at our last inspection remained unaddressed; the provider had been slow to ensure changes were implemented to address the identified shortfalls. Although there had been some improvements, the areas of highest risk had not been prioritised. Auditing had stopped taking place and as a result was not used to identify shortfalls or give the provider oversight of the service.

Staff were able to tell us how to recognise and report safeguarding concerns. However, in practice they had not consistently reported concerns to management.

People were offered a range of activities to participate in. Feedback was sought from people and their relatives, although this was not effectively used to drive improvements.

People had routine appointments with GPs, health and social care specialists, opticians, dentists, chiropodists and podiatrists. People told us that on the whole they enjoyed their meals and were supported to eat if necessary. Meals were not reflective of the displayed menu and were not based on people’s choice.

Overall, staff were kind and caring and ensured visitors felt welcome. People were encouraged to remain as independent as possible. We received mostly positive feedback from the people and relatives about the service.

People, relatives and staff felt the new deputy manager was approachable and responsive. They were working with the provider’s area manager as well as receiving input from the local authority and a range of visiting health professionals.

The overall rating for this service continues to be ‘Inadequate’ and the service therefore remains in ‘special measures’ whilst we continue our enforcement action. 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 found a number of continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Lyndhurst Rest Home is a very large and extended detached property spread over three floors. It is situated on the seafront at Tankerton and has direct sea views from many of the windows. There were two lounges for people to use and two separate dining rooms where some people took their meals.

There was a registered manager in post who was present throughout the 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.

Lyndhurst Rest Home was last inspected in November 2016 when it was rated as good in every area. At this inspection we identified serious concerns which placed people’s health and well-being at risk.

There had been a lack of adequate oversight by the provider and registered manager and the shortfalls in safety and quality had not been picked up until we highlighted them during our inspection. The registered manager took immediate action in response to some of our concerns but the scope of our concerns led to a large number of breaches of Regulation. We raised five safeguarding alerts with the local authority immediately following our inspection.

Risks to people’s safety had not been adequately assessed, monitored and minimised. This included risks associated with medicines, hygiene, falls and eating and drinking. Staff had received safeguarding training but did not challenge poor practice that was happening in the service.

There were not consistently enough staff to meet people’s needs and their deployment was not effective at times. Training in a range of subjects had been delivered to staff but understanding was lacking in some crucial areas. Recruitment processes were generally robust but required further improvement to ensure all necessary checks were made on applicants’ documentation.

Risks to people’s health were not always properly monitored or addressed. Mental capacity assessments sometimes conflicted with what happened in practice.

People did not all appear well-kempt and their personal care needs had not been appropriately supported. Staff did not always act to preserve people’s dignity and their independence. Plans about people’s end of life decisions needed to be improved to ensure people’s choices and rights were observed.

Care plans were written in a person-centred way but did not always reflect practice in the service. The registered manager told us that no complaints had been received since the last inspection however some relatives said they had repeatedly raised concerns with staff.

Feedback had been sought from relatives via a questionnaire but action had not been effective in

remedying concerns about people’s personal presentation.

The premises were reasonably well maintained throughout and maintenance tasks had been completed promptly. Safety checks on equipment and utilities had been routinely carried out. Fire alarms were tested weekly and emergency lighting and extinguishers were checked regularly.

The district nurse, GP and other professionals visited the service to provide health checks and treatment to people.

Deprivation of Liberty Safeguards (DoLS) had been applied for and authorised when necessary.

Staff spoke directly with people with kindness and compassion. There was a range of activities available to people, delivered by designated staff. People and relatives said the registered manager was approachable and visible in the service.

We found a number of breaches of Regulation. 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.

Lyndhurst Rest Home provides accommodation and personal care for up to 44 older people, living with dementia. Accommodation is provided in 36 single and 3 double rooms, of which 29 are ensuite. There are two upstairs floors which can be accessed by a passenger lift. People living at the service share two communal lounges and two dining rooms. There is a garden to the rear of the property with a grass area and a patio with seating. Rooms to the front of the service have a sea view.

The service has a registered manager who was available and supported us during the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff knew how to follow the service’s safeguarding policy in order to help people keep safe. Checks were carried out on all staff to ensure that they were fit and suitable for their role. Staffing levels ensured that staff were available to meet people’s needs.

Assessments of individual risks to people’s safety and welfare had been carried out and action taken to minimise their occurrence, to help keep people safe. Accidents and incidents were recorded and the appropriate action taken to reduce the likelihood of them happening again.

Regular checks were made of the environment to ensure it was safe; and to services and equipment to make sure they were in good working order.

Medicines were managed and stored appropriately. Staff received training in how to give medicines safely and their competency in administering medicines was checked to ensure that people received their medicines as intended by their doctor.

The service was clean and staff knew what action to take to minimise the spread of any infection.

People had their health needs assessed and monitored and effective relationships had been developed with health professionals. People were offered a choice at mealtimes and support was provided in an individual manner when people needed it.

New staff received an induction which included shadowing existing staff. They were provided with a regular programme of training in areas essential to their role. Staff had received training in the Mental Capacity Act 2005 and understood its main principles. CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager had submitted DoLS applications for everyone to ensure that people were not deprived of their liberty unlawfully.

Staff were proud to work in a strong staff team where there was effective communication and they felt well supported. Staff were able to make their views known through supervision and staff meetings.

Everyone gave positive feedback about the caring nature of the staff team. Staff communicated with people in a kind manner and treated them with compassion, dignity and respect. Staff had developed positive and valued relationships with people and their family members.

A plan of care was developed for each person to guide staff on how to support people’s individual needs. Information had been gained about people’s likes, and past history; and staff demonstrated they understood and acted on people’s choices and preferences.

People were offered a range of group and individual activities. An activities co-ordinator manager had been employed to increase the range and suitability of what was on offer to ensure people received personalised activities. Special events were celebrated which involved people, their family members, friends and staff.

The views of people, their relatives and staff about the quality of care provided at the service were regularly sought and acted on. People felt confident to raise a concern or complaint, but said they had not needed to. The service had received a number of compliments about the caring nature of the staff team and the management of the service.

The registered manager was a visible presence at the service and together with the providers, they had planned and initiated a number of improvements for the service.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives and visitors, and the staff supporting them. We also looked at records.

We 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.

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

Is the service safe?

People were treated with dignity and respect by the staff. Visitors told us that people were always smartly dressed. One relative told us, 'I feel that they (person who lives in the home) are in safe hands when I leave so I do not worry'.

A range of equipment was available in the home to aid people with their mobility. This equipment had been serviced and maintained regularly. Staff had been trained in how to assist people with their mobility needs and we saw that this was safely carried out at our visit.

Recruitment practices were safe and thorough. Appropriate checks were undertaken before staff began to work at the home.

The home had obtained guidance in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards, but had not developed its own policies or procedures. No applications had been submitted, but the registered manager was seeking advice on whether an application now needed to be submitted.

Is the service effective?

We saw that people were asked for their consent before undertaking an activity or being supported with their care or treatment. Staff had received training in the Mental Capacity Act 2005 and most knew how to support people to make decisions in their best interests on a day to day basis. However, some staff were more confident than others in this area.

People and visitors told us that they were happy with the care provided in the home. Comments from people included, 'Staff are lovely' and, 'I am very happy living here. There is a choice of food and I can sit in which room I like'; and 'Staff are helpful'.

People's health and care needs were assessed with them and/or their family members. These records were reviewed regularly and generally kept up to date.

Staff had a good understanding of people's care and support needs and knew them well. However, they did not know some people's personal histories as this information was not always available.

Staff had received training in how to support people with dementia and challenging behaviour and said that this had helped them to gain the skills and experience they needed to support the people living in the home.

Is the service caring?

People were supported by kind and attentive staff. We that staff showed patience and gave encouragement when supporting people. For example, during an activity people were encouraged to play musical instruments and to dance. We saw that people enjoyed this activity.

We observed that care and support was provided in accordance with people's wishes, although these individual preferences were not always recorded in people's plans of care.

People using the service completed an annual satisfaction survey. An action plan was in place to address any shortfalls or concerns identified.

Is the service responsive?

People's needs had been assessed before they moved into the home. However, the home did not proactively seek information about people's life history or always record their method of communication which is important for people with dementia.

The home employed an activities coordinator five mornings a week. She offered people a range of activities in the home. People had been on an outing the day before our visit. This meant that people had access to activities in and outside the home.

During the day we saw many relatives and visitors in the home which showed that people were supported to maintain relationships with their friends and relatives.

People and visitors said that they felt confident to make a complaint if they were unhappy.

Is the service well led?

The home manager had worked at the home for a number of years, was registered with the Care Quality Commission (CQC) and had achieved a national qualification to manage a social care service.

The service had a quality assurance system in place which consisted of internal and external audits from the provider.

Records about people's care and welfare were not always comprehensive, person centred or accurate. We have asked the provider to tell us how they are going to make improvements and meet the requirements of the law in relation to providing accurate, personalised care and treatment records.

People completed an annual customer satisfaction survey. The home manager told us that this would be extended to include staff and social and health care professionals when it was next sent out.

Staff told us they were clear about their roles and responsibilities.

We were told that the home was a good place to live, that the staff were, "Lovely. Never ending patience", and that, "Nothing is too much trouble". We were told that the manager was, "Very good. The place is very well run".

The staff and the manager were proactive in the provision of care, treatment and support. The welfare and safety of people living in the home was considered paramount and closely monitored. Changing needs were quickly noticed, care plans adjusted and action

taken. There was an effective working relationship with visiting health care professionals who contributed much to the delivery of health care and who provided consultation and guidance in relation to specific health issues.