Lyons Court Care Home

Lyons Court Care Home is a residential care home providing personal and nursing care to up to 50 people in 1 adapted building. The service provides support to a range of people, including older people, people living with a dementia and people with mental health conditions. At the time of our inspection there were 38 people using the service.

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

The premises were not always effectively cleaned or well-maintained. Effective governance systems were not in place to monitor and improve standards.

Medicines were managed safely. People were safeguarded from abuse. The provider had safe recruitment procedures in place. Risks to people were assessed and monitored. 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.

We have made a recommendation about staffing levels.

People, relatives and staff spoke positively about the culture and values of the service. Feedback was sought and acted on. People and relatives spoke positively about people’s care outcomes.

Rating at last inspection and update

The last rating for this service was good (published 22 April 2021).

Why we inspected

The inspection was prompted due to concerns received about cleanliness and infection control. A decision was made for us to inspect and examine those risks.

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

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.

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

Enforcement and Recommendations

We have identified breaches in relation to cleanliness, infection control and governance systems at this inspection.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Lyons Court Care Home is a care home providing nursing and personal care for up to 50 people, some of whom are living with a dementia. At the time of the inspection, there were 30 people living at the home.

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

People were supported nutritionally and mealtimes were well supported. Activities had improved and people enjoyed a range of group and individual sessions on the day of our visit. Care plans had improved but more work was needed to ensure a person-centred approach and positive behaviour support guidelines were completely embedded across the service. The provider had plans to do this via additional training and support to staff.

Medicines were managed safely. There were sufficient staff deployed to meet people’s needs. Health and safety checks took place regularly regarding the environment.

Significant improvements had been made to the environment to ensure it was safe, clean and more stimulating. Staff were clear on the use of PPE and had been trained in infection control procedures. Measures to reduce the risk of COVID-19 were in place.

People and relatives were complimentary about the care provided by nursing and support staff. The atmosphere was calm and relaxed. Staff were respectful and interacting with people all the time.

People had the opportunity to give their views about the service. There was consultation with staff and people. Actions had been taken relating to improving activities available following feedback from people. People knew how to complain.

Staff spoke positively about working at the home and the people they cared for. Staff told us improvements had been made, and the registered manager listened to and supported them. The registered manager had worked with local partners such as the local GP practice and pharmacist to make improvements to medicines management.

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 requires improvement (published 14 October 2019).

Why we inspected

We carried out a focused inspection of this service in July and August 2019. We found issues in relation to staff training and supervision and ensuring people were supported to eat safely. This report only covers our findings in relation to the key questions of safe, effective and well-led which contained those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has improved from requires improvement to good. This is based on the findings at this 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 COVID-19 and other infection outbreaks effectively.

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

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.

Lyons Court provides care and accommodation for people with personal and nursing care needs and people who are living with dementia. The home is registered for 50 places across three floors which are adapted with their own facilities. At the time of the inspection the service supported 39 people.

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

The provider and the management team had taken steps to improve the service and ensured people received safer care. An action plan to address the warning notice carried out by CQC had been implemented. All the requirements of the warning notice had been met.

Quality assurance systems to measure the effectiveness of the service had been improved. The management team had a good oversight of the service and monitored the actions needed to improve the safety and quality of the service.

Food safety practices had improved and training had been delivered to staff regarding food safety and the risk of people choking.

Recruitment checks were more robust and key policies such as medicines and hot weather guidance were now in place for staff to access easily. Measures to improve internet access within the home had been taken and a more sustainable long term solution was being implemented by the provider.

The management team had a more robust approach to reviewing and checking issues with medicines and topical medicines such as creams were now being monitored for administration and dates of opening.

Staff recruitment was ongoing and the management team had adopted a robust approach to review sickness levels at the service. Deployment of staff was reviewed daily according to risk and we saw the management team led by example working shifts when required.

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 systems in the service supported this practice.

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 requires improvement (published 16 October 2019) when there were three breaches of regulation.

Following our last inspection, we served a warning notice on the provider. We required them to be compliant with Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 18 October 2019.

Why we inspected

This was a targeted inspection based on the warning notice we served on the provider following our last inspection. CQC are conducting trials of targeted inspections to measure their effectiveness in services where we served a warning notice.

Lyons Court Care Home provides accommodation for up to 50 people who require personal or nursing care. The service provides care to people with learning disabilities, mental health problems and physical disabilities. At the time of this inspection there were 42 people in receipt of care from the service.

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

The provider failed to ensure appropriate governance arrangements were in place. The quality assurance systems failed to identify that staff were not safely managing medicines, provided food service in line with best practice and adhered to infection control practices. The checks did not identify staff deployment was having a negative impact on people’s quality of life, the recruitment procedures did not meet legal requirements, staff were not trained to use the computer-generated care records, staff did not know how to provide drinks for people who had a compromised swallow, and IT equipment was not functioning properly.

Staff were unaware of the risks presented to people. We observed staff leave people at risk of choking unattended when they were eating and give people on restricted fluid intake more than was recommended for them to drink. Staff did not know how to make up thickened fluids.

The service had one hot-lock to cover all five units’ meals and this did not assist staff to serve meals in a safe manner. Hot meals were left to stand on kitchen benches for over an hour and then either served cold to people or reheated in microwaves. This is not in line with food safety guidance. Not all staff who prepared meals had completed level 2 food safety and hygiene training. It is a legal requirement for staff handling and cooking food to have received appropriate training.

Staff on some units did not ensure people had enough fluids. Temperatures throughout the service exceeded 27°c. The provider had a heatwave policy in place but neither the manager or staff ensured this was implemented.

The care record system did not support staff to develop person-centred care records, meet accessible communication standards, allow staff to produce communication records and could not be translated in to easy read. Staff had not completed records that were needed to comply with the Mental Capacity Act. This was impacted further, as staff did not know how to use the electronic systems used to record and review people’s care.

Staff deployment was not meeting people’s needs. Seven staff supported 13 people on the middle floor with the remaining seven staff supporting 29 people who used the other three units. Staff on these three units were not always able to meet people’s needs and left people needed to be observed because of their risk of falling or choking.

Recruitment procedures were not robust and failed to meet legal requirements.

Medicines were not managed safely. Issues had been identified regarding the recording, administration and storage of medicines.

Fire drills and simulated evacuations had not been completed and staff had not received training around how to use the evacuation equipment.

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

Enforcement

We have identified breaches in relation to having effective governance arrangements in place, providing safe care, recruiting staff and ensuring enough skilled and experienced staff worked at the service.

We served a warning notice in relation to failure to ensure governance systems in place assisted staff to assess, monitor and improve the quality and safety of the services provided (including the quality of the experience for people who used the service).

Rating at last inspection

Good (report published 2 February 2018).

Why we inspected

We undertook this focused inspection because concerns had been raised about the provider’s overall operation of their services.

This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led. The ratings from the previous comprehensive inspection for those Key Questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. 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 Lyons Court on our website at www.cqc.org.uk.

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.

Lyons Court 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. Lyons Court accommodates up to 50 people in one adapted building providing nursing care and support for people living with dementia including those who may experience behavioural disturbance or distress and younger adults. At the time of our inspection visit there were 36 people using the service. Lyons Court is divided into five separate units including a specialist behaviour unit called Raby and a general nursing unit called Windsor.

The service now had a registered manager in place who had been registered since August 2017. 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.

We last inspected the service in November 2016 and rated the service as ‘Requires Improvement.’ At that visit we found breaches of regulations in relation to staffing levels, medicines management, the safety of some fixtures and fittings and cleanliness and checks in relation to infection control. There was no registered manager in post. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective and Well-led to at least good. The provider sent us an action plan in which they set out how they would meet the regulations. At this visit we saw improvements had been made and the service was meeting all regulations at this time.

The service was now safe. People, staff and relatives we spoke with told us they felt safe at Lyons Court. Staff and people were aware of procedures to follow if they observed or were aware of any concerns. Accidents and incidents had been appropriately recorded and monitored and risk assessments were in place for people who used the service and staff.

Staffing levels were appropriate and a consistent staff team was in place. The service has implemented a recruitment drive for nursing and bank staff which had been successful and also ensured annual leave and sickness was managed more proactively resulting in much lower agency staff usage.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. Medicines were stored in a safe manner.

Appropriate health and safety checks had been carried out on the building and the home was clean and well maintained. We saw that infection control measures were now well embedded and a recent external audit by the infection control nursing team was positive.

The service was now effective. Staff were now suitably trained and received on-going training and support. Staff received regular supervisions and appraisals and told us they felt supported. We saw staff were supported by debrief sessions to review any incidents that took place at the service and staff members told us they were able to speak up and learn from these meetings.

People’s day to day health needs were met by the staff and the service had good relationships with external healthcare professionals. Care records showed that people’s needs were assessed before they started using the service and they were supported to transition to the service as smoothly as possible.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The home environment had recently been restructured to move units around. This had been well planned and the service ensured measures such as a hold on admissions enabled less impact on people using the service. There was still work on some units to complete décor to ensure a more focussed dementia friendly environment was in place but we saw this was action planned for completion by the provider.

The service remained caring. Staff supported people who used the service with their social and emotional needs. We observed that all staff were caring in their interactions with people at the service. We saw people being treated with dignity and respect and people told us that staff were kind and professional.

The service remained responsive. People’s care records were detailed and personalised which enabled staff to support people in line with their personal preferences.

The provider had a system in place for responding to people’s concerns and complaints. People and the relatives that we spoke with during the inspection told us they knew how to complain and felt confident that staff and registered manager would respond and take action to support them.

The service was now well-led. People and relatives told us they felt confident in the registered manager and our observations confirmed they knew the staff and all people within the service well.

Records looked at during the inspection demonstrated that audits were in place to monitor and improve the quality of the service provided. The service had responded to requirements and recommendations from the previous CQC visit in November 2016 and a clear record of actions was recorded and reviewed on a regular basis by the management team.

Lyons Court Care Home is registered to provide accommodation and personal care with nursing to up to 50 people and at the time of the inspection 45 people were living in the home. Everyone living at the home required varying levels of support with their personal care: 27 of these people had additional conditions which also required nursing care.

The home is divided into five separate areas referred to by staff as “units” and we were told by the home manager that these consist of an eight person unit supporting people with “behaviours of concern”, a nine person residential unit, a nine person unit support people with dementia, a 12 person unit supporting people with dementia and nursing needs and a 12 person nursing unit. Each unit has a name for example the “Auckland Unit.”

At the last inspection on 16, 17 and 21 July 2014, and it was compliant with CQC regulations inspected at that time. At this inspection we rated the home as ‘Good’ overall but as ‘Requires Improvement’ in relation to being ‘Well-led’. This was because we identified that quality assurance systems were failing to maintain continuous improvement.

At the time of our inspection visit, the home did not have a registered manager in place and there had not been a registered manager at this home since 29 January 2016. 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. There was, however, a manager in post who has worked in the home since June 2016 and who now intends to apply to be the registered manager.

Although we observed staffing to be sufficient at the time of the inspection people who used the service, their relatives and staff told us they had concerns about staffing levels. We also found that the home had failed to recruit sufficient staff to ensure cover for staffing contingencies and maintain adequate management oversight of the home. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that medicine management arrangements were not always clear or consistent and found this had led to medicine errors being made. We found examples of where people had received too much or too little medicine. We found examples where there was no documented evidence that topical medicines had been administered because records were inaccurate or did not exist. The acting manager agreed that they could not discern from the medicine containers that these had been administered appropriately or at all. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that cleaning in the home and checks of the home were not sufficient to ensure good infection control practices and reduce the risk of the spread of infections. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that fixtures and fittings were not always maintained and secured so as to ensure people’s safety. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found staff understood what actions to take if they thought people at risk of abuse.

There was a process for managing accidents and incidents to ensure the risks of any accidents re-occurring would be reduced.

Staff employed by the registered provider had undergone a number of recruitment checks to ensure they were suitable to work in the service. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Staff told us they felt well supported by the registered manager and had received support through supervision; however, we found that records demonstrated that some staff had not received regular or recent supervisions or appraisals. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Training records demonstrated that staff had completed mandatory training but required some refresher training in-line with the provider’s policy.

We found that the home was not able to recruit a full permanent staff team and were frequently using agency staff who were not always knowledgeable about people’s needs.

We saw that people had person centred support plans that reflected their needs and were reviewed regularly. Support plans reflected the person’s needs and preferences.

Individual support plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. We found however that the tools to support these were not always completed accurately or used in a meaningful way.

The care records showed us that people’s health was monitored and health care professionals where involved where necessary for example: their GP, district nurse or social worker.

We saw a compliment and complaints procedure was in place and this provided information on the action to take if someone wished to make a complaint and what they should expect to happen next. People also had access to safeguarding contact details if they needed them.

The service adhered to the requirements of the Mental Capacity Act. This meant people’s capacity to make decisions had been assessed. Where required we found decisions had been made in people’s best interests involving their family members and other professionals.

We found people who used the service and their representatives were regularly asked for their views about the service.

There were quality assurance systems in place to but these failed to consistently identify and address issues in the home. They also failed to take actions following audits carried out at the home by other regulatory bodies. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that the home was not always well-led at the last inspection and required improvement. The failure to significantly improve the management arrangement of the home means the home is now rated as inadequate in relation to being well-led. Social Care Act 2008 [Regulated Activities] Regulations 2014.You can see

During our inspection we found a number of breaches of the Health and what action we told the registered provider to take at the back of the full version of the report. Following this inspection the provider agreed to regularly submit information on how the breaches in this report would be addressed. CQC will continue to monitor this location closely.

Details of any enforcement action taken by CQC will be detailed once appeals and representation processes have been completed.

We received an action plan on the 27th November 2013. The provider told us they would complete further health and nursing care assessments of people and where necessary increase staffing levels to ensure people's needs were appropriately met.

We carried out our recent visits to ensure improvements had been made, but also in response to concerns raised anonymously about the service and staffing levels.

We carried out a visit on the evening of the 19 December 2013 which commenced at 8pm and finished at 11:45pm. During our visit majority of people were in bed so they were not able to tell us there experience of care. We looked at how care was provided on each unit and looked at staffing rotas for a two week period and spoke with care and nursing staff. Staff told us they felt there was sufficient staff on duty and they were able to carry out their care tasks effectively. They told us staffing levels had increased recently.

We spoke to the manager during our visit as we were concerned only one nurse was on duty administering medication for all the people in the home. We observed some people had their sleep disturbed at 10pm onwards to receive their medication because no other staff were qualified to assist in medication administration. The manager acknowledged our concerns and told us they would ensure staff were trained in medication administration so they could support the nurse in charge on an evening, but also ensure minimal sleep disturbance.

We carried out a visit on the 27 December 2013 to observe how staff cared for people during the day time and also ensure there was sufficient numbers of staff on duty. We found there was sufficient staff of duty to meet people's needs. We observed staff had a good knowledge and understanding of people's care needs but required further professional development and knowledge for caring for people with dementia. We spoke with the manager who acknowledged our concerns. The manager sent us an immediate plan of action detailing how continued improvements would be made.

During our observation we saw people were treated with consideration and respect. All people we spoke with said they were respected by staff. Comments include: "My privacy is respected at all times".

We reviewed care records and saw that people's preferences and care needs had been well documented. Staff were knowledgeable about people's care needs and what they should do to support them. We found people experienced care, treatment and support that met their needs and protected their rights.

We saw staff were very busy as they provided care and support to people who used the service. We spoke to people who lived at the home who told us staff were kind and helpful but they were kept very busy. One person said;" The girls are marvellous." Another person said;" They'll do anything for you but they're very busy." Other comments included "I can't grumble." Another person said; "On the whole I have no complaints."

We found the building was suitably designed for the needs of people who used the service.

There were not enough qualified, skilled and experienced staff to meet people's needs.

People were protected from the risks of unsafe or inappropriate care and treatment because the care records reflected the care provided.