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Lynhales Hall Nursing Home Requires improvement

Reports


Inspection carried out on 24 August 2017

During a routine inspection

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 carried out on 14 February 2017

During a routine inspection

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 carried out on 6 July 2016

During a routine inspection

Lynhales Hall Nursing Home is registered to provide nursing care and accommodation to up to 73 older people. At the time of our inspection 67 people were living there.

The inspection took place on 6 and 15 July 2016 and was unannounced.

At the time of our inspection no registered manager was in post. The former registered manager had left in February 2016. Since this time the provider had made arrangements to ensure the home was managed. A new manager who worked for the provider elsewhere was in place at the time of our inspection. This person commenced work at the home on 1 July 2016. They told us they intended to apply for registration as the manager as soon as possible.

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.

Lynhales Hall Nursing Home consists of two units. The ‘main house’ provided accommodation for up to 53 people. The ‘John Sperry unit’ is a ground floor extension to the main house. The unit provided care for up to 20 people who lived with dementia.

Management systems to monitor the quality of care and ensure events and incidents were followed up and acted upon were in place. These however did not reflect fully reflect incidents and actions taken.

Staff members were often seen to be kind and caring while they provided care and support for people. People believed staff to maintain their privacy and dignity.

People and their relatives we spoke with felt people were safe living at the care home. We found staff had knowledge about how to keep people safe and were aware of the action they would need to take if they were aware of abusive practice taking place. Relatives were pleased with the care their family member received and with the welcome and involvement they received.

We found medicine administration and management did not consistently make sure people’s medicines were available and administered as prescribed to meet their health needs.

Staff told us they had received training in order to provide them with the skills and knowledge needed to care and support people. We saw and heard occasions where staff demonstrated behaviour which did not consistently valued people and good practice.

People did not always receive the support needed to ensure their nutritional needs were met. Risks to people were identified and were known to staff. Records were not always maintained to show staff had provided the necessary care to reduce these risks.

There were sufficient staff on duty to care for people who lived at the home. Regular agency staff were used to ensure consistency of care where possible. Systems to ensure safe recruitment of staff were in place.

Staff felt supported by management and received training to ensure they had the skills and knowledge needed to care for people safely. The manager was aware of some training needs required.

People were consulted prior to them receiving care and support. Best interest decisions and referrals to local authorities were undertaken where people were unable to make an informed decision.

The healthcare needs of people were monitored as needed by professionals who were consulted as necessary. Relatives felt involved and were aware of their family member’s health as appropriate. Relatives were confident they could raise any concerns they may have about the care of their family member and believed they would be listened to.