Lyme Valley House Residential Care Home

Lyme Valley House Residential Care Home is a residential care home providing personal care to up to 25 people. The service provides support to older people with dementia or physical disabilities. At the time of our inspection there were 20 people living over 2 levels in 1 adapted building.

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

The provider had not always identified and reduced environmental risks, including fire and building safety risks, to people. There was a lack of assurances around safe recruitment and staffing levels. Medicines were not always safely managed. People had care plans and risk assessments in place for staff to follow. People were protected from the risk of abuse. Staff wore Personal Protective Equipment in line with guidelines to reduce the risk of people catching and spreading infections.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. Staff received training to support people, however, this was not always effective. Staff supported people in line with their care plans. People were supported to have a suitable and balanced diet. The home was being redecorated to reflect the needs of people who lived there.

Quality assurance systems were not always effective in identifying areas for improvement. People were supported in a way that was person-centred and promoted their independence. People and relatives were involved in people’s support and staff worked with other organisations to maintain and promote people’s well-being.

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 12 December 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.

We received concerns in relation to there being no registered manager in post and after the local authority had been to visit, we were advised the service had not been making CQC aware of concerns. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements.

Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lyme Valley House Residential Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the building safety, medicines management, unauthorised restrictions, ineffective quality assurance systems and poor governance at this inspection.

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

We found the following examples of infection control practice.

Following a recent COVID-19 outbreak people who had tested positive for COVID-19 were found to be mixing with people who had tested negative. We found the registered manager had made improvements following this outbreak however they needed to ensure people had robust risk assessments in place where they were not able to isolate due to living with dementia. The provider's infection control and COVID-19 policy required updating to reflect current government guidance around COVID-19.

People were supported by staff who wore appropriate protective clothing such as masks, gloves and aprons. Staff were observed to change their masks regularly to reduce the risk of transmission. People were supported by staff who had all been double vaccinated against COVID-19.

People and their relatives were kept up to date around visiting within the home by the registered manager.

People had access to healthcare professionals in the form of a virtual weekly ward round.

We inspected this service on 14 November 2018. Lyme Valley House is a care home for up to 26 people, some of whom may be living with dementia. 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. The service is provided in one building, arranged over two floors, with three communal lounge areas, a dining room, a conservatory and a hairdressing salon. At the time of this inspection 23 people used the service.

The service had 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.

At our last inspection we rated the service ‘Good’ overall, with improvements needed to ensure people were supported in accordance with legal requirements when they lacked the capacity to make certain decisions. At this inspection we found the required improvements had been made and evidence continued to support the rating of ‘Good’. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People continued to receive safe care. People were protected from the risk of harm by staff who understood their responsibilities to identify and report any signs of potential abuse. We found that concerns were taken seriously and investigated thoroughly to ensure lessons were learnt. Risks associated with people’s care and support were managed safely. People received their medicines when needed and there were suitable arrangements in place in relation to the safe administration, recording and storage of medicines. There were sufficient, suitably recruited staff to meet people’s needs.

The provider had made improvements to ensure people consistently received effective care. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. The service worked very well with other organisations and health and social care professionals spoke highly of the registered manager and staff. Staff received training and support to meet the needs of people at the service. People were supported to have a varied and healthy diet and to access other professionals to maintain good health.

The care people received remained good. Staff knew people well and promoted their dignity and independence at all times. Staff placed great emphasis on ensuring people were living in a kind and caring, family atmosphere. Staff had good relationships with people and ensured people's friends and families were a part of daily life at the service.

The service remained responsive. People’s support plans reflected their needs and preferences and were reviewed when their needs changed. People’s diversity was recognised and promoted by the staff and systems were in place to meet people’s communication needs. People were supported to take part in activities and follow their hobbies, interests and religious beliefs. Arrangements were in place to ensure people’s end of life wishes were explored and respected. People knew how to raise any concerns or complaints and felt confident they would be acted on.

The service remained well led. There were suitable systems in place to assess, monitor and improve the quality and safety of the service. These were monitored by the provider to ensure any improvements needed were made in a timely way. The provider listened to the views of people using the service, their relatives to make improvements in the service. Staff felt supported and valued by the registered manager and provider.

Lyme Valley House Residential Care Home provides support and care for up to 26 people, some of whom may be living with dementia. At the time of this inspection 22 people used the service.

The service had a registered manager. 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.

Staff were aware of the actions they needed to take if they had concerns regarding people’s safety. Risks to people’s health and wellbeing were identified, recorded and managed. Procedures were in place that ensured concerns about people’s safety were appropriately reported to the registered manager and local safeguarding team.

The provider had a recruitment process in place. Staff were only employed after all essential pre-employment safety checks had been satisfactorily completed. Staff received training that provided them with the knowledge and skills to meet people’s needs.

Some people who used the service were unable to make certain decisions about their care and treatment. In these circumstances the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) were being followed.

People’s medicines were managed safely, which meant people received the medicines they needed when they needed them.

Most people told us they enjoyed the food and were provided with suitable amounts of food and drink of their choice. Health care professionals were contacted when additional support and help was required to ensure people’s health care needs were met.

Staff told us they arranged a varied range of social and leisure activities. These were arranged either on a one to one basis or in groups. People could choose whether they wished to participate or not and staff respected their choices.

People were aware of the complaints procedure and knew how and to whom they could raise their concerns.

The service had a registered manager; they were aware of the requirements of their registration with us and notified us of significant events related to care provision. The registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained.

We visited Lyme Valley Residential Home on a planned unannounced inspection which meant that the service did not know we were coming.

We spoke with four people who used the service, three relatives, four staff members and the provider to help us understand the experiences of people who used the service.

During this inspection we also checked that the provider had made improvements with regards to staffing for the service. This is because; in the previous inspection completed on 2 August 2013 we identified areas of non-compliance with regulations we inspect against.

Below is a summary of our finding based on our observations, speaking to people who used the service, their relatives, the staff supporting them, and from looking at records.

Is the service safe?

Sufficient staff were provided to deliver people's care needs and they received the training they needed to provide the necessary care and support.

Staff encouraged and supported people to make choices and decisions. When people did not have the capacity to make certain decisions, family and medical professionals were involved.

The required health and safety checks and servicing were completed to ensure that people were cared for in a safe environment. The home was being renovated to ensure that it was safe and comfortable for the people who used it. People who used the service told us that they felt safe at the home. One person said, 'I feel safe here; I've been in worse places'.

Is the service responsive?

People's health, social and support needs were assessed and reviewed. Records were seen to demonstrate that care plans were evaluated and updated as people's health needs changed.

We saw records of visits from other health and social care professionals. Relatives of people who used the service told us that staff at the home always took action when they had concerns about people who used the service. They told us that they were always kept informed if their relative was seen by another health care professional or needed to go into hospital.

People were provided with information on how to complain if they were unsatisfied with the care provided. We saw that the service had a complaints policy and we saw records to indicate that the procedure was followed and complaints responded to appropriately.

Is the service caring?

People who used the service told us that the staff were very good and they were satisfied with the care and support provided. One person told us, 'They're very caring and understanding'. A relative told us, 'The important thing is the staff and the love, and she [her relative] certainly gets that'.

People who were unable to comment or did not wish to speak with us looked comfortable and well cared for. Relatives of people told us that staff at the home were caring. A relative we spoke with told us, 'X was very confused when she went there [the home] but she got better with good food, medication and the appropriate care'.

Is the service effective?

People's care records were personalised, and the provider ensured that people's dietary, mobility and equipment needs had been identified in care plans where necessary. People who used the service told us that sometimes they liked to participate in group activities and at other times liked to spend time alone. We saw that staff respected these choices.

People's health and care needs were assessed. We saw that support plans were up to date and corresponded with the discussions we held with staff. We saw that risk assessments and management plans were in place for people who used the service. The provider would benefit from ensuring that risk assessments were carried out for people whom the renovation works directly affected to ensure that their safety and welfare was maintained during the period of renovations.

Staff had some understanding of the Mental Capacity Act 2005. We saw records that staff had undertaken training in the Mental Capacity Act and Deprivation of Liberties Safeguard and refresher training had been planned. The provider would benefit from ensuring that capacity assessments and best interest assessments were kept in people's current care records to ensure that all those providing care to people have access to these documents at all times.

Is the service well led?

Staff told us that there had there have been changes in the management of the home and a new manager has recently taken up the post. Staff we spoke with were clear about the management structure and felt supported by the managers.

People who used the service told us that they saw the provider regularly at the home. Relatives told us that they felt confident raising any concerns with the provider. Other professionals we spoke with told us that they worked well with the provider and the provider was always receptive to suggestions for improvement.

The provider had quality assurance systems in place to ensure that the necessary checks were in place to provide and maintain a good service.

At our previous inspection we saw that at times there were not enough qualified, skilled and experienced staff to meet people's needs. At this inspection we saw that staff had the appropriate qualifications and experience. We saw that there had been some improvements in the staffing levels at the home but there were still times when there were not enough staff to meet people's needs.

People who lived at the home told us that they were happy and satisfied with the care that they received. One person told us, 'I really do like being here, I would tell them if I wasn't happy with something. The staff are wonderful'. Another person told us, 'It is spot on. I know what I like and tell the staff what I want and they do it'.

Throughout our inspection we observed that people's privacy, dignity and independence were respected. We observed warm, compassionate interactions between the staff and people who lived at the home. On the day of our inspection we observed that staff met the needs of people. When we looked at the staff rotas we observed that at times there were not enough qualified, skilled and experienced staff to meet people's needs.

We saw that there were systems in place to maintain the electrical, heating and water supplies at the home but that the general d'cor of the home did not promote the welfare of all the people living there.

We observed that the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who lived at the home.

At this inspection we saw that clear policies had been put in place and staff had received appropriate training. This meant that 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.

During our inspection, we observed a very attentive staff team, who responded to people's requests for assistance quickly. One person told us, 'We never want for anything. Staff are always there when we need them.'

We looked at the care records for three people to check how well their needs were assessed and planned for. Everyone had an assessment of their care, which included information about their needs and preferences. There were also risk assessments in place to support people to keep safe. People were supported to stay healthy and well and there was clear and up to date guidance available for staff to support the safe administration of people's medicines.

We spoke to four members of care staff. They demonstrated a good understanding of the types of concerns that could constitute abuse and their responsibilities to help protect and keep people at the home safe. There were effective recruitment and selection processes in place to ensure that staff working in the home were suitable to work with vulnerable people. We found that these checks had not always been fully completed before staff started working at the home.