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Inspection carried out on 21 June 2018

During a routine inspection

We inspected Lyle House on 21 and 26 June 2018. This was an unannounced inspection.

At our previous inspection on 16 & 18 May 2017 we found the provider was not meeting regulations in relation to the outcomes we inspected, we found a breach of regulation in relation to Good Governance. At this inspection, we found the provider had met the breach we found at the previous inspection.

At the last inspection, the service was rated Requires Improvement.

At this inspection, the service was rated Good.

Lyle House 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. Lyle House provides personal care for up to 45 older people. The home is arranged over three floors and accommodates some people with a diagnosis of dementia.

There was a registered manager at the service. 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 had been with the provider organisation for a number of years. She had implemented changes which had been received positively by people, relatives and staff. The introduction of a care manager had led to improvements in a number of areas, including the relationship with external health professionals.

People and their relatives told us they felt safe at Lyle House. We received complimentary feedback about the caring nature of staff. Staff that we spoke with were aware of people’s preferences in relation to their personal care and were respectful of peoples religious and cultural support needs.

People’s needs were assessed before they moved into the home. Risk management plans, including ways in which the risk could be managed were in place. Care plans reflected people’s individual needs and were reviewed on a monthly basis which helped to ensure people received the right support.

The provider managed people’s support needs in relation to their medicines and general health. A GP visited the service on a regular basis and appropriate referrals were made to relevant professionals such as community nurses, psychologists and dietitians if people’s needs changed and they needed specialist input.

People’s consent was taken in line with the Mental Capacity Act 2005. Where people did not have the capacity to consent, formal capacity assessments were completed and if required, decisions were taken in their best interests. The provider applied for lawful authorisation if restrictions were needed to keep people safe.

There were appropriate recruitment checks in place to ensure suitable staff were employed. These included reference and criminal record checks. There were enough staff employed to meet people’s needs. New staff received appropriate induction training to prepare them for their jobs and regular refresher training was provided to al staff.

People were given information about how and who to complain to. Complaints were recorded and responded to in a timely manner.

There were systems in place to monitor the quality of service people received. A monthly reporting tool was used to monitor quality indicators such as falls, pressure sores, complaints and safeguardings. The registered and area managers undertook periodic audits that covered a number of areas including infection control, food quality, medicines and care planning. These were reviewed regularly and action taken in response to any concerns identified.

Inspection carried out on 16 May 2017

During a routine inspection

This inspection took place on 16 & 18 May 2017. The first day of the inspection was unannounced, the provider knew we would be returning for a second day.

A comprehensive inspection was carried out on 22 March 2016 during which breaches of regulation were found in relation to safe care and treatment, consent and good governance. We then carried out a focussed inspection on 21 December 2016 at which time the provider had met their action plan in response to the breaches found, however we did not improve the overall rating at this inspection.

There was a registered manager at the service, although they were not managing the service. A new manager had been recruited but had not officially started 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.

Lyle House provides residential care for up to 45 older people. The home is arranged over three floors and accommodates some people with a diagnosis of dementia. At the time of the inspection, there were 41 people using the service.

People and their relatives told us that care workers spoke with them nicely, respected their choices and respected their privacy and dignity. They said they felt safe in the company of care workers.

Although we received mixed feedback about the food, people were offered a choice. There was a four week menu that was changed seasonally and there were theme days once a month. Textured modified food was available to make soft food more presentable and appetising to people who were on a soft diet.

Care workers were familiar with people’s preferences such as the name they liked to be called and their dietary preferences. Staff we spoke with were aware of recent changes to people’s support needs following any incidents. We observed some good examples of staff having a caring attitude, care workers supported people in a patient manner. Staff seemed to know the people and anticipated their needs. However, we also saw some examples of care practice that were not as caring as they could be.

Staff recruitment procedures were thorough and staff files included completed application forms, references, proof of identity and Disclosure Barring Service (DBS) checks. We found there were enough staff to meet people’s needs, however there were occasions where a deputy manager was not available on the weekends although this was the provider’s expectation.

Although the provider maintained an accurate record of training, we found that not all of the staff were keeping up to date with their training.

Risk assessments and care plans were not consistently documented or updated.

Standard risk assessments for areas such as falls, pressure sores and nutrition were in place but staff were not always completing these appropriately. Where they were completed correctly, actions were identified for staff to manage the risk.

We found that although people’s healthcare needs were met by the provider and people had been referred to and assessed by healthcare professionals such as community based support services and nurses, there were occasions where care plans had not been updated to demonstrate involvement of these professionals or updated to reflect changes in their needs.

People told us they were happy with the support they received with regards to their medicines. Care workers had received training in medicines administration which included both a theoretical test of their knowledge and a practical observation. A care worker followed good practice when administrating medicines to people when we observed them during the inspection.

Care workers demonstrated an understanding of the Mental Capacity Act 2005 (MCA). Mental capacity assessments for specific ar

Inspection carried out on 21 December 2016

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 22 March 2016. Some breaches of legal requirements were found. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to safe care and treatment, consent and good governance.

We undertook this focussed inspection to check that they had followed their plan and to confirm that they now met the legal requirements in relation to the breaches found. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lyle House on our website at www.cqc.org.uk.

The service had a manager in post who was in the process of submitting their application to become the 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.

Lyle House provides residential care for up to 45 older people. The home is arranged over three floors and accommodates some people with a diagnosis of dementia. At the time of the inspection, there were 43 people using the service.

At our previous inspection we found that some risk assessments were not completed properly and some did not include an associated care plan. Some care plan reviews did not always reflect changes to people's support needs. We also found that consent to care and treatment was not always clearly documented.

At this inspection, we found that improvements had been made in all of these areas.

Risk assessments and associated records, such as care plans and monitoring records were in place which helped to identify and manage risks to people. Referrals were made to health care professionals if extra support was needed.

The provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The provider sought authorisation if restrictions were in place to keep people from coming to harm. We found that some care workers were not familiar with the Act and its uses and the manager told us that this would be addressed in team meetings and supervision.

Excess controlled drugs were recorded correctly and stored securely.

Care plans included life and social histories and personal preferences records were completed for people to ensure that staff were responsive to people’s individual needs.

Where people’s support needs had changed, these were reflected in risk assessments and care plan reviews.

Inspection carried out on 22 March 2016

During a routine inspection

This inspection took place on 22 March 2016 and was unannounced. This service was previously registered under a different name; this was the first inspection of this service under its new registration.

Lyle House provides residential care for up to 45 older people. The home is arranged over three floors and accommodates some people with a diagnosis of dementia. At the time of the inspection, there were 40 people using the service, although one person was in hospital.

There was a registered manager at the service. 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 using the service told us that staff were caring and ensured they had privacy and dignity when delivering personal care. We observed care workers interacting with people and they did so in a caring manner, taking time to speak with them and ensuring their needs were met. People told us they felt safe living at the home.

People had their support needs in relation to eating and drinking met by the provider. People were given choices in relation to food and we observed staff offering drinks to people during the day. Care records included nutrition assessments and care plans based around nutrition. Referrals were made to specialists such as speech and language therapists and dieticians in response to assessed difficulties.

People were supported to receive their medicines on time from trained staff. Their healthcare needs were managed by the provider, referrals were made to professionals such as their GP, district nurse, therapist and community teams.

Staff were aware of the need to ask people for consent before supporting them with personal care. The provider was not meeting the requirements of the Mental Capacity Act 2005 (MCA), we found that staff did not always know which people needed to be deprived of their liberty in order to keep them safe. Some of the care records related to assessing people’s capacity to consent and whether any restrictions placed on them were lawful were not always completed appropriately.

Care records although comprehensive in scope where not always completed fully or up to date. For example, some risk assessments were not completed properly and some did not include an associated care plan. Some care plan reviews did not always reflect changes to people’s support needs.

Staff underwent thorough recruitment checks before they started to work at the home. New staff completed an induction and thereafter, ongoing training which helped them to carry out their roles. At the time of our inspection, there was a high use of agency staff. The registered manager acknowledged this but confirmed that a number of posts had been filled and they were waiting for checks to be completed for them to start.

The registered manager who had only been in post a short while had plans in place to drive improvement within the service. These were seen through feedback surveys and staff meetings that had been held and identified areas of improvement had been highlighted. However, checks and audits had not always identified or addressed issues that we found during our inspection.

We found three breaches of regulation in relation to consent, safe care and treatment and good governance. You can see what action we have told the provider to take at the back of the full version of this report.