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Lynhales Hall Nursing Home Requires improvement

We are carrying out checks at Lynhales Hall Nursing Home using our new way of inspecting services. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 22 April 2017

This was an unannounced inspection carried out on the 14 February 2017, with a further announced visit on the 17 February 2017.

Lynhales Hall Nursing Home is registered to provide nursing care and accommodation for a maximum of 73 older people. At the time of our inspection there were 57 people living at the home. Lynhales Hall Nursing Home is divided into two units. The 'main house' provides accommodation for up to 53 people. The 'John Sperry Unit' is a modern ground floor extension to the main building, which provides nursing care for up to 20 people living with dementia.

We last inspected this service in July 2016, however due to concerns raised about the quality of nursing care provided at the home this inspection was brought forward. During this inspection we identified four breaches of Regulations under The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider had not protected people against the risks associated with the safe management of medication. Prescribed creams were not always given as prescribed by the GP. One person who had been prescribed a daily emollient for their skin condition, had not been applied for a period of nine mornings. People who were prescribed medicines to be taken ‘when required,’ such as for pain relief, information was not always recorded to help staff decide when the medicines were needed. Medicines were not always administered in accordance with the manufacturers’ directions. One medicine was still applied after it should have been discarded. One person was prescribed a medicine to be administered twice daily. We found it was being given only once daily. Records supporting and evidencing the safe administration of medicines were not always complete and accurate. The provider did not always effectively monitor pain relief for people.

The management of Deprivation of Liberty Safeguards (DoLS) renewal applications did not reflect the requirements of the MCA. People were therefore being unlawfully deprived of their liberty without independent scrutiny. A number of DoLS authorisations had expired and that there had been delays in submitting reassessment applications, some of which were significant delays.

People were not always treated with respect and dignity. One person with a skin condition on their legs received treatment from a nurse in the main communal lounge, in the presence of other people, which placed the person in an undignified situation. They failed to ensure the privacy of the person when delivering care and treatment with little regard to their dignity.

The provider had failed to ensure that records were accurate, complete and contemporaneous in respect of each person.

The home lacked any clear strategy in relation to the effective monitoring of the quality of services provided by staff. Though the provider had management systems in place to record and monitor the standards of care delivered within the home, these were not always completed or were effective. Medication management checks had been undertaken, but these failed to identify the series of concerns we found during our inspection regarding the safe management of medicines.

The provider had failed to display conspicuously and legibly their performance rating from there last inspection visit in July 2016.

There was no effective leadership. Staff told us that the registered manager had failed to provide support and leadership since their appointment. The registered manager told us they had resigned from the service as they had received no support from the provider. No improvement plans had been initiated following internal inspections undertaken by the provider.

Staff told us they were concerned about night time staffing levels at the home. However, during our inspection visit we were told that staffing levels had improved and we saw there was enough staff on duty to meet people's needs.

Supervision and support was inconsistent. We were therefore not confident that all staff received the support and development they required to undertake their role effectively.

We saw examples of both spontaneous and affectionate interaction and of less positive interaction between staff and people.

People and relatives felt that they or they family members were safe living at Lynhales Hall Nursing Home.

Staff had received training in how to recognise when people were at risk of abuse. Staff had received appropriate checks prior to starting work at the home.

You can see what action we told the provider to take at the back of the full version of the report.

Inspection areas

Safe

Requires improvement

Updated 22 April 2017

The service was not always safe.

The registered provider had not protected people against the risk of associated with the safe administration and management of medication.

People's risks were assessed and action taken to minimise risks to them.

Staff raised concerns about night time staffing levels throughout the home.

The provider carried out appropriate checks when recruiting new staff.

Effective

Requires improvement

Updated 22 April 2017

The service was not always effective

Some people had been deprived of their liberty for the purpose of receiving care or treatment without lawful authority in place.

Regular staff supervision and support was inconsistent.

People received effective support to access a variety of health professionals to meet their specific health needs.

Caring

Requires improvement

Updated 22 April 2017

The service was not always caring.

The provider failed to ensure the privacy and dignity of people at all times.

We saw examples of both spontaneous and affectionate interaction and of less positive interaction between staff and people.

Staff understood the importance of supporting people to make day-to-day decisions and encourage people to be independent.

Responsive

Requires improvement

Updated 22 April 2017

The service was not always responsive.

Care plans did not always accurately record information relating to people’s treatment need.

People's spiritual needs were catered for.

There were systems in place to routinely listen to people’s experience, concerns and complaints

Well-led

Requires improvement

Updated 22 April 2017

The service was not well-led.

There was no effective leadership.

The provider failed to effectively assess, monitor and improve the quality and safety of services provided and maintain accurate, complete contemporaneous records in respect of each person.

The provider had failed to display conspicuously and legibly their performance rating from there last inspection visit in July 2016.

The registered manager had resigned from the service as they had received no support from the provider.