Lynfield

Updated 26 February 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by three inspectors. Two inspectors carried out the inspection visit and the lead inspector co-ordinated the inspection remotely.

Service and service type

Lynfield is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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 manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed the information we had received about the service since the last inspection, including notifications which the service is required to send us by law to alert us to significant incidents.

We used all of this information to plan our inspection.

During the inspection

The people who used the service were not easily able to talk to us about their care. We observed staff providing care and support and spoke with three relatives about the care provided. We also spoke with four staff, including two senior staff members, the registered manager, the regional manager and the director of compliance. We spoke with members from the local authority safeguarding team and an assessor working with the local authority Deprivation of Liberty Safeguards (DoLS) team.

We reviewed a range of records. This included three people’s care records and five people’s medication records. We looked at three staff files in relation to recruitment and at other records relating to the quality and safety of the business.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data, further rotas, staffing hours and quality assurance records.

Updated 26 February 2021

About the service

Lynfield is a residential care home providing personal care for up to nine people with complex needs, including physical and learning disability. At the time of our inspection nine people were resident. The service is one of a small number of specialist care services operated by the provider, Kingsley Healthcare Limited. People who use the service share some communal spaces, including a hydrotherapy suite, and each has their own bedroom.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some the underpinning principles of right support, right care, right culture.

Right support:

The model of care was designed to maximise people’s independence. The provider had negotiated additional hours to help people who used the service access and be part of their local community. During lockdown this access had understandably decreased. Daily care records showed in-house activities were not always offered as a substitute. Staff told us they wanted to do more to promote people’s independence.

Right care and right culture:

Care interactions we observed were kind and focussed on each person’s needs. Care aimed to promote people’s dignity, privacy and human rights. However, judged that the culture of the service was to occasionally treat the people who used the service as if they were young children rather than adults. This is something we have asked the provider to review and work on before we carry out our next comprehensive inspection. This culture did not appear to impact negatively on the people we saw, and staff were clearly very caring in their interactions. However, treating people in a way which is not appropriate to their age can be demeaning and impact on their dignity.

Oversight and monitoring of the safety and quality of the service needed to improve. Both the registered manager and the provider needed to have more effective systems in place to ensure safe recruitment of staff.

Risks to people’s health, safety and welfare had not always been robustly assessed and mitigated. This could have placed them at increased risk of harm. Care plans were detailed and provided staff with clear guidance to help them support people’s distressed reactions. We were not fully assured that staff always followed all this guidance.

We have made a recommendation about reviewing incident and accident records to ensure care plans had been followed.

Records were not always accurate and some concerns we identified may have been recording issues rather care issues. Electronic care plans were very detailed and contained a lot of guidance but one record had been replicated from a previous year which could have been very confusing for staff.

Medicines were well managed and medicines to help people with their distress and anxiety were closely monitored and given appropriately.

Staff were clear about how to recognise and report signs of abuse and had received training about this. The provider was clear about their safeguarding responsibilities and worked in co-operation with the local authority safeguarding team to investigate issues.

There were usually enough staff for them to carry out their roles, although sometimes numbers dipped below the provider’s assessed levels.

Risks relating to Covid-19 had been assessed and actions to mitigate these risks were recorded. Infection control procedures were mostly good, and staff promoted this well with the people who used the service. Some small improvements were needed to further reduce risks.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 29 November 2017.)

Why we inspected

We received concerns in relation to poor staffing practices and an overuse of medicines to manage people’s distress reactions. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach of regulation 19 relating to the recruitment of staff. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.