Lynfords

Lynfords is a residential care home providing accommodation and personal care to 6 people with a learning disability. At the time of inspection there were 5 younger adults and older people living there. People living at Lynfords needed support with personal care, mobility, health and communication needs. Accommodation was on the ground floor only and the building had been specifically designed to meet the needs of people with physical disabilities.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Care

Care was not always person-centred. For example, we could not be sure that people always had their own toiletries. This was addressed immediately at the time of inspection. Records did not always demonstrate that people were given choices in relation to the food they ate and the activities they participated in.

We observed that staff were caring in their approach and people responded warmly to them. Relatives and professionals described staff as caring. We observed this and that people responded warmly to staff. When people needed personal care, staff ensured that this was provided by discretely taking people to their bedrooms. A professional told us, “The staff I have met have been very kind and caring on each of my visits. They seem to have the residents’ best interests. The interactions I have seen have been respectful and kind and take into account residents’ relatives.”

Right culture

There were systems to ensure people’s views were sought through keyworker meetings and there were plans to develop this further. There were no recent surveys for people or their relatives. Staff morale had been low but there were regular staff meetings and management had ensured that all staff attended a recent supervision meeting. Staff told us support had greatly improved and they felt confident this would continue. Visiting professionals all spoke positively of the impact the new manager had already made in the short time they had worked at the service.

The systems for auditing the service ensured that any shortfalls were identified. Following these checks an action plan was written to ensure that matters were assigned for addressing and a clear timescale was given.

Right Support

The model of care used ensured that people were able to make choices and decisions and any risks were assessed and reviewed regularly. As a result of reviews, applications had been submitted for additional funding to meet some people’s changed needs and to maximise their opportunities to be more independent and in control of their day. Emphasis had been placed on ensuring that staff had the skills, knowledge and experience to meet people’s individual needs. Lynfords was kept clean.

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 rating for this service was requires improvement (published 19 July 2019) and there were breaches 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 regulations. However, further progress is required to ensure that the progress made is sustained and embedded into everyday practice.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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 coronavirus and other infection outbreaks effectively.

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 remains Requires Improvement.

Please see the action we have told the provider to take at the end of this report.

Follow up

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

Lynfords is a residential care home for up to six people and there were six people using the service at the time of our inspection. People living at Lynfords needed support with personal care, mobility, health, behavioural and communication needs. Accommodation was on ground floor only and the building had been specifically designed to meet the needs of people with physical disabilities.

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

People’s experience of using this service:

Guidelines in one person’s care plan were not followed during inspection and some care plans did not included advice to meet people’s identified health needs. The provider’s governance systems had not identified shortfalls found at this inspection. For example, that a follow up to a fire drill that had not gone well had not been carried out. There had been limited monitoring to ensure people received activities as planned. The staff skill mix on the morning of our inspection was not appropriate to ensure people’s needs were met.

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.

The outcomes for people using the service reflected the principles and values of Registering the Right Support. People were supported to make choices in all areas of daily living from choosing clothes to wear to what they wanted to do. There were regular opportunities to use local facilities and amenities and people had equipment that enabled them gain new skills to increase their independence in whatever way they could.

There were enough staff who had been appropriately recruited, to meet people’s needs. Staff understood what they needed to do to protect people from the risk of abuse. Incidents and accidents were well managed. People’s medicines were managed safely.

Staff attended regular training to update their knowledge and skills. They attended regular supervision meetings and told us they were very well supported by the management of the home.

People were supported to attend health appointments, such as the GP or dentist and attended appointments for specialist advice and support when needed. People had enough to eat and drink and menus were varied and well balanced.

A visiting professional told us, “Staff are always pleasant, and the residents have always been cared for appropriately.”

Staff were kind and caring. They had a good understanding of people as individuals, their needs and interests. Most people needed some support with communication and were not able to tell us their experiences; those who could told us they were happy, and we observed that people were happy and relaxed with staff.

People were supported to take part in activities to meet their individual needs and wishes. This included trips to the local parks, theatres, cafes and restaurants, trips to places of interest and college. Entertainers provided musical entertainment and we observed one of these. This activity was lively and inclusive, and people were observed to really enjoy the activity.

The environment was well maintained. The bathroom and shower room had recently been refurbished. The provider had ensured safety checks had been carried out and all equipment had been serviced. Fire safety checks on equipment were all up to date.

Rating at last inspection: At the last inspection the service was rated good. (The last inspection was published 4/11/2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement:

We found two breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we asked the provider to take at the back of the report.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner. We will follow up on our recommendations at the next scheduled inspection.

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.

The registered manager and staff had received training and were knowledgeable about of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). However, mental capacity assessments were not always completed in line with legal requirements and the MCA Code of practice. Mental capacity assessments were needed for people who may not be able to consent to, for example, bed rails. We have identified these issues as an area of practice that needs improvement.

People were safe. The home's equipment was well maintained. Staff understood the importance of people's safety and knew how to report any concerns they may have. Risks to people's health, safety and wellbeing had been assessed and plans were in place which instructed staff how to minimise any identified risks to keep people safe from harm or injury. However, risks assessments did not consistently embed, implement or follow nationally recognised tools and guidance. We have made a recommendation for improvement.

Staff treated people as individuals with dignity and respect. Staff were knowledgeable about people's likes, dislikes, preferences and care needs. They approached people in a calm, friendly manner which people responded to positively.

Peoples' health was monitored and they were referred to health services in an appropriate and timely manner. Any recommendations made by health care professionals were acted upon and incorporated into peoples' care plans.

People had busy lifestyles which reflected their lifestyle choices and likes and dislikes. A visiting relative told us, “(Person) is always clean and well dressed and she is happy. They occupy her well. They understand her love of music.” Communication passports provided an overview of how they expressed themselves. Staff had a good understanding of people's needs and were observed positively interacting with people. Good use was made of easy to read documents using pictures and photographs to help people understand information. People had access to sensory stimulation in the home and in their bedrooms.

There was an open, transparent culture and good communication within the staff team. Staff spoke highly of the registered manager and their leadership style. There were sufficient numbers of staff to meet people's needs and to keep them safe. The provider had effective recruitment and selection procedures in place.

There were suitable arrangements in place for the safe storage, receipt and management of people’s medicines. Medicine profiles were in place which provided an overview of the individual’s prescribed medicine, the reason for administration, dosage and any side effects.

The registered manager took an active role within the home and led by example. There were clear lines of accountability and staff were clear about their roles and responsibilities. The provider had robust systems in place to assess and audit the quality of the service.

One person told us, 'I'm well and happy.' Another person said, 'Yes' when asked if they were happy.

Staff ensured that consent was obtained prior to providing care and support. We observed staff interacting positively with people. We noted that staff gave people choices and if they were unsure what a person had said they checked this out to make sure their wishes were met.

Specialist advice and support was obtained to meet people's individual needs. There were safe systems in place for the management of medication.

The home had a robust recruitment procedure in place to ensure that they employed suitable staff to work in the home. There were detailed systems to ensure that the quality of care provided was monitored and reviewed on a regular basis.

One person said “I like gardening when the weather is good.” They also said “I do flower arranging and I play board games with staff and make cards.”

We observed staff interacting positively with people. We saw that people were given choices and able to make basic decisions in relation to food and choices of activities. Where appropriate, specialist advice and support was obtained to meet people’s needs.

There were sufficient numbers of staff on duty and staff felt well supported. Staff were clear about what they should do if they suspected abuse. They also understood the home’s complaint procedure.