This inspection took place on 26 October 2017 and was unannounced.Lyndhurst is a ‘care home’ and is registered to provide care and support for up to 20 people who have physical disabilities and/or mental health problems. The registered provider also supports people who are living with dementia. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.
At the time of the inspection there were 16 people living at the home. Accommodation is provided across three floors and facilities include two dining rooms/social areas, a smoking area, a large garden area to the rear of the building as well as a small car park at the front.
At the time of the inspection there was two registered managers in post. 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 the previous comprehensive inspection which took place in April 2017, the home was rated as ‘Inadequate’ and placed in ‘special measures’. We found the registered provider was not meeting legal requirements in relation to person centred care, need for consent, premises and equipment, good governance and staffing.
Services in 'special measures' are kept under review and inspected again within six months. The expectation is that providers who have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvements are made and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service.
Following the previous inspection the registered provider submitted an action plan which outlined how they were improving the standards of care and quality of service. We checked at this inspection to make sure that the provider had made enough improvements to meet their legal requirements.
During this inspection we found a number of improvements had been made however the registered provider was found to be in breach of ‘safe care and treatment’.
We reviewed a number of care records for the people who lived at Lyndhurst care home and found that care plans and risk assessments were not being maintained. Some risks had not been appropriately recorded and there was inconsistent information found in different assessments. This meant that the delivery of the care being provided was not safely monitored or reviewed, meaning that people were exposed to unnecessary risk.
You can see what action we have told the registered provider to take at the back of the full version of the report.
During the previous inspection the registered provider was found to be in breach of ‘good governance’. During this inspection, we identified a number of improvements which had been made in relation to this regulation although it was still evident that further systems and processes needed to be implemented and maintained in order to improve the standard and delivery of care which was being provided.
We have made a recommendation to the registered provider in relation to continual improvement of quality assurance systems.
There was evidence to suggest that most documents we showed that the service was operating in line with the principles of the Mental Capacity Act, 2005 (MCA). This was because most people were involved with the decisions taken in relation to their care and treatment, and there was a best interest process in place for people who lacked capacity to be involved. However some records we reviewed evidenced that there was still some confusion regarding the principles of the MCA. The registered provider was no longer in breach of the regulation in relation to ‘need for consent’ however we have made a recommendation regarding further improvements needed.
There was evidence during this inspection that improvements had been made to the environment and risks which had been identified on the previous inspection. During this inspection we did identify a number of areas which could have potentially posed a risk to people living at the care home. We discussed our concerns with the registered managers and they immediately responded and rectified the areas which were discussed. The registered provider was no longer in breach of the regulation in relation to premises and equipment.
During the inspection we found that the area of ‘staffing’ had improved since the last inspection. Routine supervisions and appraisals were taking place, staff were receiving the necessary training to enable them to fulfil their roles to their full potential and staff expressed that they felt supported on a daily basis. The registered provider was no longer in breach of the regulation in relation to ‘staffing’.
During the previous inspection we found the provider in breach of regulations in relation to ‘person centred care’. This was because people were not receiving the care and support which was right for them or met their needs. During this inspection we found that care records were personalised, staff were able to provide person centred care and the environment had been adapted to provide support to people who were living with dementia. The registered provider was no longer in breach of the regulation in relation to ‘person centred’ care.
Recruitment was being safely and effectively managed within the home. Staff personnel files which were reviewed during the inspection demonstrated safe recruitment practices. This meant that all staff who were working at the home had suitable and sufficient references and the appropriate criminal record checks had been conducted.
Accidents and incidents were being recorded and there was evidence which demonstrated that the registered managers were analysing and assessing the data on a monthly basis. The process and systems which were in place to assess and monitor accidents and incidents enabled the registered managers to analyse if changes needed to be made within the home and if further risks needed to be mitigated.
Medication processes and systems were safely managed. During the inspection we found that routine medications audits were being conducted, medication administration records (MARs) were being appropriately completed and staff had received the appropriate training. This meant that people were receiving a safe level of care in relation to the medications which they were being prescribed.
The day to day support needs of people living in the home was being met. The appropriate referrals were taking place when needed and the relevant guidance and advice which was provided by professionals was being followed accordingly.
People told us that their privacy and dignity was respected. Staff were able to provide examples of how they ensured privacy and dignity was maintained as well as describing how people’s choices and preferences were supported.
Staff provided support to people with care, compassion and kindness. Staff were observed speaking to people in a friendly, sincere and warm manner. People were observed looking happy and content in the environment and there was a positive atmosphere throughout the course of the inspection.
There was an activities co-ordinator in post at the time of the inspection who was responsible for organising a range of different activities. The feedback we received about activities was positive. People we spoke with said they enjoyed the activities which were organised and people were observed taking part in the activities.
We received positive comments about the standard of food throughout the course of the inspection. People expressed that they were happy with the variety of food and enjoyed the different choices available.
There was a formal complaints policy in place at the home. There was evidence of how complaints were being responded to which were in accordance to the organisational procedures. At the time of the inspection there were no formal complaints being investigated.
Staff morale was positive. Staff expressed that they were ‘happy’ in their roles and expressed how much they ‘loved’ working at Lyndhurst. Staff said that they felt supported by both registered managers and believed there was an open and supportive culture.
The registered managers were aware of their responsibilities and had notified the CQC of events and incidents that occurred in the home in accordance with the CQC’s statutory notifications procedures. The registered provider ensured that the ratings from the previous inspection were on display within the home.
There was a vast amount of policies and procedures in place. Specific policies which we reviewed included confidentiality, whistle blowing, safeguarding adults, equality and diversity and supervisions policies. Policies and procedures were available to all staff and they were able to discuss specific procedures and processes with us during the inspection.