Archived: Lyles House

We found the following examples of good practice:

The provider had implemented effective zoning within the service. Visitors to the service were to enter the building by the door nearest to the area they were visiting and travel the shortest route possible. This minimised the risk of transmission within the building.

Staff were observed wearing Personal Protective Equipment (PPE) in line with current government guidance. PPE was doffed within the individual's bedroom following personal care and disposed of appropriately to reduce the risk of cross contamination.

There were systems to reduce the risk of exposure to COVID-19 from individuals entering the service. This included only one external contractor to visit the service every 14 days. When a contractor entered the building they were required to complete a Lateral Flow Test (LFT) to confirm their COVID-19 status,receive a temperature check and wear appropriate PPE.

The staff team were tested in line with current government guidelines for COVID-19, in addition the provider had also ensured the visiting chiropodist was tested for COVID-19 alongside the staff team. This ensured that the people being supported had their footcare needs met safely throughout the pandemic.

Clear policies and procedures were implemented by the provider detailing what to do if an individual displays signs or symptoms of COVID-19. These ensure that staff knew how to appropriately respond to maintain the safety of those within the setting.

The last inspection at this service was on1 March 2017. In 2017 the service was rated requires improvement in the key question of safe and well led with a breach of regulation 12 Safe care and treatment. This means that the service was rated ‘Requires Improvement’ overall. At that inspection, we assessed the care as being safe but identified risks associated with the environment, which could have affected people’s safety. The registered provider/manager took immediate actions and submitted an action plan to tell us what they had done.

At this inspection on the 3 May 2018, we found the service offered safe care and have rated it good against all key questions we inspect against. There were certain aspects of the service which were very good but other areas of the service which could be strengthened to enhance people’s experiences

Lyles 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.

The service had a registered manager who was also the registered provider. 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.

At this inspection, on the 3 May 2018 we found Lyles House was a well- planned, well- managed service. People said they felt safe and in the main risks were well documented in relation to people’s individual’s needs. Adequate steps were taken to mitigate risk as far as reasonably possible. The service had a low number of incidents, accidents and falls. We attributed this to the steps the service had taken reduce risk. However, we identified a couple of potential risks, which had not been adequately responded to. This was fed-back to the registered provider/manager to address.

People received their medicines as intended by staff who were sufficiently trained and competent. Medicines were audited to ensure they were available and administered as required. Medicines were only prescribed when necessary and reviewed to ensure they remained appropriate to the needs of the individual.

Staffing levels were sufficient and staff worked cohesively to ensure people’s needs were met in a timely manner. The hours specifically allocated to activities were limited and if increased would further enhance people’s well -being.

Staff understood how to keep people safe and who to report concerns to if they suspected a person was at risk or harm or actual abuse. Staff were confident in their role and felt able to report issues internally and externally if necessary.

The service recorded accidents, incidents or any event affecting the well- being and safety of people using the service. The service was open and transparent and lessons were learnt.

The registered provider/manager had adequate staff recruitment processes to help ensure only suitable staff were employed. Once employed staff were supported to work independently and as part of the team. Staff received support, supervision and training to help them fulfil their role. Staff kept up to date with best practice through training updates and a detailed induction to care.

People were supported to stay adequately hydrated and receive sufficient nutrition. This was monitored to help ensure people did not have unintentional weight loss and if this happened, steps were taken to reverse it. People had their health care needs met. Their needs were carefully monitored and steps taken to ensure people had access to other health care professionals.

Staff had a good understanding of the Mental Capacity Act 2005 and sought to provide care according to people’s express wishes and after gaining their consent.

People’s needs were assessed before moving into the service. Care plans and risk assessments gave staff a good insight into people’s needs and how they wished to be supported. These were regularly reviewed and families were involved and consulted. Staff knew people well and provided high standards of individualised care.

People were supported with their end of life care and staff ensured people’s wishes and dignity was upheld.

People chose their routines and staff respected this. Different activities were provided in the afternoon including external activities. People lived in pleasant surrounding and could choose to socialise or sit quietly, although the way the chairs were arranged did not encourage people to socialise. They also had access to gardens, which were nicely maintained.

There was an established complaints procedure, which took into account feedback from people and showed how this had been addressed. We saw lots of positive feedback and an overarching quality assurance system.

The service enhanced peoples well -being by providing personalised care. People had established good relationships with other people and the staff supporting them. Staff were kind and respectful and clearly enjoyed working at the service. There were different opportunities for people to join in activities and to maintain contact with family, friends and the wider community. However, this was limited.

The service was well managed and run in the interest of people using it.

Staff were supported and sufficiently competent. The registered provider/manager was open, transparent and working hard to provide a service which was the best it could be.

Regular audits and feedback from people shaped the service and helped the home improve and develop.

Lyles House is a care home that provides accommodation and personal care for up to 20 people. There were 20 people living in the home on the day of the inspection, some of whom were living with dementia.

The home did not require a registered manager as the provider is an individual.

During this inspection, we found one breach of the Health and Social Care Act 2008 (Regulated Activities) 2014. This breach occurred because the provider had not always assessed and managed risks to people’s safety appropriately. These risks were in relation to adequate protection from burns or scalds, being safe to leave the home unaccompanied and fire safety at night. You can see what action we have told the provider to take at the back of this report. Immediately after the inspection visit, the provider took some action to reduce the identified risks to protect people from the risk of harm.

Systems were in place to protect people from the risk of abuse, and the staff had received sufficient training and supervision to provide people with good effective care. People received their medicines when they needed them and there were enough staff on the day of the inspection visit to support them when required and to meet people’s individual needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Consent was sought from people before a task was undertaken. Where people lacked capacity to make their own decisions about their care, consent had been obtained in line with the relevant legislation.

People received enough food and drink to meet their individual needs and they were supported to maintain their health.

The staff were kind, caring and compassionate and knew the people they supported well. They listened to people, quickly dealt with any concerns they raised and treated them with dignity and respect.

People’s individual wants and needs had been assessed and the staff were meeting these. People were treated as individuals and were encouraged to be as independent as they could be and to participate in activities that were meaningful to them. This enhanced their well-being.

The provider had instilled an open culture within the home where people, their relatives and staff were listened to and their opinions respected. The staff received good direction and leadership and understood their individual roles and responsibilities. The provider was passionate about providing people with care that enhanced their wellbeing and this passion was also demonstrated by the staff team.

People and staff were involved in the running of the home. Their suggestions for improvement were listened to and where possible, implemented. Some systems that were in place were effective at monitoring and improving the quality of care people received. However, not all systems were effective at identifying and managing risks to people’s safety.

Care plans were person-centred and demonstrated that people had been involved in making decisions about how they wished to be supported. We noted that people had signed their care records and consented to their plan of care. We observed care staff interacting with people in a kind and compassionate manner. The staff demonstrated that they knew the people living in the home, and their needs, very well.

We saw that the premises were safe and clean. There was detailed information regarding hygiene and infection control and we found evidence that this was followed in practice.

There were enough staff on duty to meet people's needs in a timely manner. The people we spoke with all stated that they were well cared for. One person said, 'The carers are wonderful and the manager is fantastic. All of them are very kind and take their time. They don't rush you'. We noted that there were effective recruitment and selection processes in place and that staff received regular supervisions and appraisals.

We looked at the records held by the service and noted that they were accurate and fit for purpose. We saw evidence that records containing confidential information were stored securely.