Lingfield

About the service

Lingfield is a residential care home providing accommodation and personal care support to up to 6 people with learning disabilities and autistic people. At the time of the inspection, 4 people were receiving a regulated activity.

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

Right Support

The opportunity for people to carry out individual pursuits was impacted by staffing levels. The provision of additional one to one support to enable full choice and control for people was unclear.

Risks were managed well to keep people safe while promoting their independence and staff supported people to access healthcare services when they needed them. People were not supported to have maximum choice and control of their lives due to the use of one to one time and staffing levels. However, staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care

Staff knew people well and provided them with the support they needed to keep safe and to meet their individual care needs. People were protected from discrimination. People were treated with dignity and their privacy was respected. Staff were kind and caring. They treated people with respect and encouraged them to make decisions about their care and support. One person told us, “They are kind and treat me well”.

Right Culture

There was a positive ethos at the service and a culture of open communication and familiarity. People were encouraged to give their views about the support they received and work as a team in the running of the household. Staff had inclusive attitudes and encouraged people to be as independent as possible.

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

Rating at last inspection

The last rating for this service was good (published 26 February 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

This location is registered to provide accommodation and personal care to a maximum of six adults with learning disabilities. Six people lived at the service at the time of our inspection. People who lived at the service had different communication needs. Some people were able to communicate verbally, and other people used gestures. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

This comprehensive inspection took place on 26 February 2018 and was announced. There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they liked living at the service, they were safe and supported by enough staff. However, there were concerns about the turnover of staff.

The service was last inspected in January 2016 and was rated as 'Good’ overall. At this inspection we found the evidence continued to support the rating of good.

During our inspection we reviewed how people's needs and risks were assessed and managed. We found that risks associated with people's care were appropriately assessed and staff were provided with guidance on how to manage these risks.

There were systems in place to manage the risk of fire.

People were supported to maintain their independence and control of their lives and staff supported them in the least restrictive way possible. People were supported to meet with family members and to attend activities.

Staff underwent recruitment checks before they worked with people. The home was clean and being maintained. People could be involved in cooking and staff undertook the cleaning. The premises suited people's needs.

People had support to keep well and healthy and to take the medicines they needed. People were involved in making decisions about what happened at the service so that they all had a say. The registered manager had been managing the service for five months and had experience of supporting people with learning disabilities.

There was a complaints procedure available for people who used the service.

Lingfield provides accommodation and personal care for a maximum of six adults with learning disabilities. The home is located in a residential area in East Grinstead. At the time of our inspection there were five people living in the service.

The service had a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons.’ Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The staff we spoke with were aware of their role in safeguarding people from abuse and neglect and had received appropriate training. We saw risk assessments had been devised to help minimise and monitor risk, while encouraging people to be as independent as possible. Staff were very aware of the particular risks associated with each person’s individual needs and behaviour.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “I’m happy and safe”. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People’s needs had been identified, and from our observations, people’s needs were met by staff. There was a lot of emphasis on observations, especially for signs of any discomfort, as people could not always communicate their needs verbally. Staff used touch as well as words and tone to communicate with some people in a positive way.

We found the service to be meeting the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). The staff we spoke with had a good knowledge of this.

People were supported to eat and drink sufficient to maintain a balanced diet. One person told us, “It’s nice food. There’s fish and chips and spagbol and a nice chicken dinner on Sunday”. People were supported to maintain good health, to have access to healthcare services. We looked at people’s records and found they had received support from healthcare professionals when required. A relative said, “[My relative] does suffer from some health conditions and the staff take a lot of notice”.

There was very positive interaction between people and the staff supporting them. Staff spoke to people with understanding, warmth and respect and gave people lots of opportunities to make choices. The staff we spoke with knew each person’s needs and preferences in great detail, and used this knowledge to provide tailored support to people.

People’s individual plans included information about who was important to them, such as their family and friends and we saw that people took part in lots of activities in the home and in the community.

The service had a complaints procedure, which was available in an ‘easy read’ version to help people to understand how to raise any concerns they might have. There was evidence that people were consulted about the service provided. We saw that house meetings took place for people to comment on their experience of the service.

The service regularly asked other stakeholders to fill in surveys about the quality of the service and people’s feedback was included in plans for future improvements. There were effective systems in place for monitoring the quality and safety of the service. Where improvements were needed, these were addressed and followed up to ensure continuous improvement.

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

The staff members we spoke with said they really liked working in the service and that it was an exceptionally good team to work in. The staff told us staff meetings took place and they were confident to discuss ideas and raise issues with managers at any time.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. The home could accommodate six people and, when we visited, there were five people living in the home.

People living in the home had complex needs and were not all able to tell us about their experiences at the home. We spoke with three people living in the home and two of their relatives. We looked in detail at three care plans. We spoke with the manager and four care staff.

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

Is the service safe?

The manager conducted assessments to ensure the right level of care was available and staff were guided in their work by detailed care plans. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Staff were trained and competent to deliver a safe level of care. This meant people were receiving a safe service.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Applications have been submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We found that staff had received appropriate training and frequent supervision to ensure that their skills were up to date and appropriate to the needs of the people living at the home. This included regular updates in areas such as manual handling, first aid and fire safety. In addition, there was additional vocational training in areas such as leadership.

Staff were using effective practices, for example, to prevent falls. We also found care staff sought advice, where appropriate, from the manager and other health care professionals. The home was providing an effective service.

Is the service caring?

We saw how the staff offered a caring service for people living in the home and that they were considerate and sensitive. One person who lived in the home said, "I like living at Lingfield."

One relative we spoke with said, 'We have no problems with the home and we are grateful for all the care and support.'

Is the service responsive?

We saw that staff were attentive and supported people to make choices. We found evidence in the care plans that staff contacted appropriate healthcare professionals when required and informed relatives of any changes.

The provider invited and listened to feedback and made changes where they were reasonably practical. Recent changes had included a monthly bulletin for relatives. The provider was responsive to the needs of people living in the home and their relatives.

Is the service well-led?

The home was well managed with a qualified team of professional care staff. The staff we spoke with said that they felt supported in their work.

The provider conducted a regular internal audit of the service and was working to continually improve standards and the safety and welfare of people living in the home.

We found that people were encouraged to make decisions for themselves and consent was obtained before support was offered. Where people did not have the capacity to consent to important decisions, the provider acted in accordance with legal requirements.

Care plan information for was up to date and written in a way that showed people as individuals. People were supported to be independent and take positive risks through the use of risk assessments. People experienced care, treatment and support that met their needs and protected their rights.

There were systems in place to make sure that people were kept safe. These included safeguarding training and up to date policies and procedures for safeguarding. People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found there was an effective complaints system in place and that comments and complaints were responded to appropriately. There was an easy read complaints form which supported people to make a complaint.

We found that people were encouraged to make decisions about their care and treatment. People were able to do the things that they enjoyed. One person told us "I go shopping" which they liked. The care records for people were up to date and written in a way that showed them as individual people. People were supported to be independent and remain safe through the use of risk assessments.

We spoke with four of the staff on duty and the manager. They told us that they felt supported and got the training they needed to carry out their roles effectively. We were told that the home was more settled after a period of staff changes last year. One staff member told us "We have a good team" and another said "The focus is on service users".

There were robust procedures in place for the administration of medication and staff had received appropriate training to make sure they were aware of how to manage medicines safely. This meant that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place.