At our last inspection on 15 December 2014 we found a number of breaches of legal requirements. At the time, we judged two breaches of legal requirements were serious enough, that we served two warning notices on the provider and told them to make the necessary improvements by 3 April 2015. This was because the provider did not carry out sufficient risk assessments of the premises and individual risk assessments for people and did not have an effective system to regularly assess and monitor the quality of services provided and did not submit a Provider Information Return to CQC in a timely manner. We undertook a focused inspection on the 6 May 2015 to check that the provider had met the legal requirements for these two breaches and found the necessary improvements had been made. During this inspection we looked to see if the provider was continuing to demonstrate good practice against these breaches of regulation.
Also at the inspection on the 15 December 2014, we found another seven breaches of legal requirements. These were in relation to the condition of the premises, the management of medicines, the standard of cleanliness of the premises and the level of support given to people who required help to eat and drink. Care plans for the support people required were not detailed enough to describe how to meet people’s individual needs and the provider had not taken the correct actions to ensure that the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. These safeguards ensure that a service only deprives someone of their liberty in a safe and correct way, when it was in their best interests and there was no other way to look after them.
The provider sent us an action plan and told us they would make the necessary improvements by the end of May 2015. We undertook a comprehensive unannounced inspection on 4 August 2015 to check that they had followed their plan to confirm that they now met legal requirements and to review the rating of the service.
Lynton Hall Nursing Centre provides accommodation and nursing care for up to 57 older people. There were 41 people living at the home when we visited. The home was based on two floors, the ground floor for people with nursing care needs and the first floor for people living with dementia. There were bedrooms, bathrooms and communal rooms on both floors.
The new manager at Lynton Nursing Centre had transferred from another BUPA home and had applied to the CQC to be the registered manager at this location. 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.
At this inspection we found the provider had made progress towards improving the safety of the home for the people who lived and worked there and for visitors. We saw communal bathrooms that were previously congested with equipment and emergency pull cords that were not within reach were now more accessible. This meant that people could use the bathrooms independently and safely and that equipment did not have to be stored in the corridors when a person wanted a bath or shower.
We saw that a new medicines room had been built on the ground floor, which was locked and only accessible to staff. These improvements meant risks associated with medicines storage were being mitigated.
We observed that the home was clean and free from malodours. Bathrooms were adequately equipped to promote people’s independence. There was a cleaning schedule of the kitchen area which was being followed. Risks to people and others from poor infection control practices were therefore minimised.
We saw the sluice rooms were locked and cleaning products and chemicals were safely stored within these rooms. This meant people no longer had access to dangerous substances.
We looked at the care records for six people and the accident/ incident records. The care plans we looked at identified a high risk of falls but this had not prompted staff to develop a falls action plan to address the matter. The manager stated this was something that was being developed with staff and was part of their on-going improvement of the service.
The service had contracts for the maintenance of equipment used in the home, including the lift, fire extinguishers and emergency lighting. Records showed that these items of equipment were being maintained as required.
The service helped protect people from abuse. Staff were aware of what constituted abuse and the actions they should take to report it.
Throughout the inspection we saw staff were available, visible and engaging with people. Staffing levels had improved since the last inspection. The provider now employed their own bank staff who were familiar with the service, rather than using agency staff.
We saw the correct procedures had been followed before staff were employed. New staff now had a statutory six month probation period built into the job. These checks and processes helped to ensure that people were cared for by people suitable to the role.
We observed a medicines administration round and the practices used were safe. We looked at medicine administration record (MAR) charts and saw that they were correctly completed and up to date. The checks we made confirmed people were receiving their medicines as prescribed by staff qualified to administer medicines.
We found that staff had a general understanding of the Mental Capacity Act 2005 and the need to assess a person’s capacity before taking any decisions. However we also saw there were restrictions around the home for the use of the lift or to access the doors leading to the stairs between floors because these were operated with the use of a key code pad. There were no assessments as to how these could restrict people’s freedom and how the risks could be mitigated. We have made a recommendation in relation to this.
There were sufficient staff during meals times to help people who require assistance with their meal. People could choose their meal from a variety of food on offer or if they wanted something else this would be made for them. These improvements have helped people to have a better experience at meals times.
People were cared for by staff who received appropriate training and support. Staff had the skills, experiences and a good understanding of how to meet people’s needs. Staff told us the training had enabled them to do their work to a good standard. The frequency of supervision for staff had improved and was now a more supportive and helpful discussion time with their manager.
People were supported to maintain good health and have appropriate access to healthcare services. Appointments people had with health care professionals such as dentists or chiropodists were recorded in their health care plan.
People were looked after by staff who were caring. Our observations found the interactions between staff and people were positive. We saw that staff showed people care, patience and respect when engaging with them. The atmosphere in the home was calm and friendly. Staff took their time and gave people encouragement whilst supporting them.
The main entrance hall had a notice board that gave people and visitors a variety of information so they knew what was happening in the home. This included information about events taking place, activities, important phone numbers and the minutes of the home meetings that all people and relatives were invited to.
We saw people had the privacy they needed and they were treated with dignity and respect. Staff used the correct procedures and equipment when moving people from their wheelchair to a lounge chair and people’s dignity was retained while they did this.
People’s needs were assessed before they moved into the home and improvements had been made to the details within care plans but more detailed information was still needed to make sure staff were clear about how to meet people’s needs. The care plans we looked at had been generated within the last six months.
Care plans covered the activities of daily living but we did note for some people there was a lack of personal history. The manager said they were gradually adding information to the care files to help staff understand who a person was through their background.
There was a programme of activities and it was noted in people’s daily records if they had attended. The home employed two full time activity co-ordinators and records showed they had regular contact with people and what activities were offered to them.
We reviewed the records relating to complaints or concerns. We noted the received complaints had been investigated and a record of statements and actions taken were retained, all within a timely manner.
Weekly, monthly and quarterly audits were carried out, including audits of medicines’ records and storage, care plans and infection control. A new cleaning checklist had been devised for domestic staff to follow and we saw this was being followed.
Staff told us the new manager was doing a good job and cited several improvements they had made. Staff said they could approach the manager with any issue and regular staff meetings had been started. Staff said these were a helpful way of sharing information and having an understanding of the improvements the home needed to make.
The manager had an understanding of their role and responsibilities. They understood their legal obligations with regard to CQC requirements for submission of notifications and these had been submitted in a timely manner.
The provider continued to ask people and staff for their opinion of the service through the annual survey. People and staff were able to give their opinions on the service through the staff meetings, the house meetings and having easier access to speak to the manager and deputy manager. This helped to ensure that people’s opinions were heard in a timely fashion and any concerns dealt with promptly.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations Act 2014. The actions we have asked the provider to take can be found at the back of this report.