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Lynhales Hall Nursing Home Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 20 October 2017

This was an unannounced inspection carried out on the 24 August 2017, with a further announced visit on the 29 August 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 48 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.

There was no registered manager in post at the time of our inspection. The home had been managed since our last inspection in February 2017 by a temporary manager, who was the provider’s Quality Assurance Auditor. However, a new manager had just been appointed by the provider, who confirmed to us their intention to register with the Care Quality Commission (CQC). 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.

We last inspected this service on the 14 and 17 February 2017, when the service was rated as ‘requires improvements in each of the domains of safe, effective, caring, responsive and well-led. We also identified four breaches of Regulations under The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. As part of this inspection, we looked to see what improvements had been made and how the provider had addressed the breaches of regulation.

Since our last inspection, the provider had been working closely with Local Authority and the Herefordshire Clinical Commissioning and an embargo had been imposed on new admissions at the home.

During our last inspection in February 2017, we found the provider had failed to effectively monitor the quality of services provided. During this inspection, we found that overall improvements had been made in the governance of the home. However, further improvements were still required. Staff described communication with management as poor. There was no managerial presence to quality check or have an insight into the quality or presentation of the food provided for people.

At out last inspection in February 2017, we found that people's medicines were not always managed safely. We found that overall improvements had been made by the provider. However, further improvements were still required in specific areas. Staff were able to describe how they gave people their medicines, for example by adding them to food. However, this information was not always clearly documented. Some people were prescribed medicines to be given ‘when required’. Additional information was available for staff to help ensure they gave these medicines in a safe and appropriate way. However, some examples lacked sufficient detail.

The provider was unable to satisfy themselves that agency staff had the necessary skills and knowledge to effectively support people. Training and development of staff was inconsistent. Staff did not always receive the support and training they needed to meet people’s individual needs.

The home was working within the within the principles of the Mental Capacity Act.

On the whole, people were supported to have the right amount of food and drink to maintain good health.

People were supported by staff who were kind and caring. People enjoyed positive working relationships with staff. Staff treated people with respect and promoted their independence. Staff actively involved people and their relatives in decisions about their care.

People received support that was individual to their needs and preferences. Staff knew people well and were quick to recognise and respond to any changes in their needs.

People received individual and group stimulation.

Most people knew how to complain and felt any concerns they had would be listened and responded to.

Inspection areas

Safe

Requires improvement

Updated 20 October 2017

The service was not always safe.

Improvements had been made by the provider with regard to the safe management of medicines. However, further improvements were still required in specific areas.

There were systems in place to ensure that risks to people’s safety and wellbeing were identified and addressed.

The provider had sufficient numbers of staff effectively deployed to ensure people were safe.

Effective

Requires improvement

Updated 20 October 2017

The service was not always effective.

Training and development of staff was inconsistent. Staff did not always receive the support and training they needed to meet people’s individual needs.

The home was working within the within the principles of the Mental Capacity Act.

On the whole, people were supported to have the right amount of food and drink to maintain good health.

Staff supported people to access health services as required.

Caring

Good

Updated 20 October 2017

The service was caring.

People were supported by staff who were kind and caring. People enjoyed positive working relationships with staff.

Staff treated people with respect and promoted their independence.

Staff actively involved people and their relative in decisions about their care.

Responsive

Good

Updated 20 October 2017

The service was responsive.

People received support that was individual to their needs and preferences.

Staff knew people well and were quick to recognise and respond to any changes in their needs.

People received individual and group stimulation.

Most knew how to complain and felt any concerns they had would be listened and responded to.

Well-led

Requires improvement

Updated 20 October 2017

The service was not always well-led.

Communication between management and staff was described as poor.

People expressed concern on the reliance of agency staff.

Regular audits and checks were undertaken on the safety and quality of the care being provided.