Lynfield

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.

At the last inspection in August 2016, the service people received at the home was rated as good over all. However, there was one breach of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. This related to staff understanding of how to support people who may lack capacity to make informed decisions about their care. This meant that the service was not as effective as it should be.

At this inspection, we found that improvements had been made and there was no longer a breach of regulations. People received an effective service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The registered manager ensured they took appropriate action to protect people’s legal rights where they were subject to restrictions that were essential for their safety. Staff were alert to each person’s way of communicating so they could support people in making decisions. They understood how they needed to involve others where appropriate, to help assess people’s understanding. They knew that, where people could not make an informed decision about their care or treatment, any actions they took had to be in people’s best interests.

Staff supported people competently and effectively. They had a clear understanding of the care and support each person needed and of the importance of delivering this in a consistent way. Where some staff had not updated training in a timely way, the provider’s representative was taking action to ensure this improved. They were aware that supervision to discuss staff performance and development needs had slipped from the expected frequency. They were reviewing this to ensure improvements were made but staff said they felt well supported and people using the service were not affected.

People had a choice of enough food and drink to keep them well, and staff support in this area if they needed help. Staff monitored people's health and wellbeing and sought professional advice promptly when people needed this.

The service continued to be safe. Staff understood their roles in protecting people from the risk of harm or abuse and how to report any concerns or suspicions. Staff could explain how they followed guidance for minimising risks to people and there were enough of them to support people safely. Recruitment processes contributed to protecting people from the employment of staff who were unsuitable to work in care. Staff also supported people safely with their medicines.

Staff had developed warm and compassionate relationships with people. Relatives valued the family atmosphere this had created. Staff respected people's privacy and intervened in a discreet way when they needed to. They understood how people indicated anxiety or distress so they could try to establish what was wrong.

Staff were aware of people's preferences and their likes and dislikes. They supported people to keep in touch with their family and with professionals who could support them with planning their care. People’s representatives were confident that, if they needed to, they could make a complaint and have their concerns investigated and addressed.

There was stable and consistent leadership within the home, contributing to good staff morale and teamwork. There were regular checks to see what improvements could be made to ensure a good quality service. They were confident that the management team would act to address any concerns about poor practice that might place people at risk.

Further information is in the detailed findings for this report.

We inspected this service on the 24 August 2016 and the inspection was unannounced.

Lynfield provides accommodation and support for adults living with a learning disability. On the day of our inspection there were nine people using the service which is the maximum number the service is registered for. People living at the service could not easily give us their views and opinions about their care. Therefore, to help us gain a better understanding of people's experiences of living in the service we observed interactions between staff and people living in the service and saw care and support being provided in the communal areas. We also spoke to staff and looked at responses from visitors and healthcare professionals.

At the time of the inspection there was a registered manager 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.’

We assessed this service to be providing good outcomes for people with only a number of minor improvements required.

People received their medicines as intended and medicines were administered by staff who had the skills and training to do this safely.

Risks to people’s safety were minimised by good staff supervision and staff who had knowledge of people’s needs. Risk assessments were reviewed in line with people’s needs.

There were enough staff at this service which meant that people were supported around their individual needs and interests. Staff recruitment was mostly robust but records did not always demonstrate this.

Staff training induction, and support was adequate but we were not assured of the frequency of staff supervision and whether all staff had the required knowledge and skills. We have made a recommendation about supervision.

Staff promoted people’s choice but we were not clear that staff followed the principles of the Mental Capacity Act. The MCA ensures that, where people have been assessed as lacking capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. DoLS ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation.

People’s health care needs and dietary were monitored and met by staff.

Staff provided good support to people and recognised individuals potential and strengths. They provided individualised care and promoted people’s independence, validating how people felt and expressed themselves.

Consultation with people using the service was difficult but staff tried to offer choice in everything they did and valued and respected people's choices.

Care plans were comprehensive and person centred. Staff knew people's needs well and tried to enhance people's experiences.

Complaints or feedback about the service was taken into account when planning and developing the service.

The service was mostly well led with a system of audits and ways to measure the effectiveness and quality of the service. The manager led her staff team and was well respected. Improvement in records would demonstrate how the staff were meeting people’s changing needs and responding accordingly.

We found breaches of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014 in multiple regulations. You can see what action we told the provider to take at the back of the full version of this report.

People also told us that their rooms were comfortable and that they had their own belongings around them.

Not all of the people who used this service were able to communicate verbally. However, we observed that the staff were attentive to people's needs. Staff interacted with people in a friendly, respectful and professional manner. We saw that staff sought people's agreement before providing any support or assistance.

During our inspection on 19 August 2013 we found that the service was not compliant with the medication outcome, regulation 13. On this occasion we found that the service had made improvements in the way that they managed the medication and had obtained and properly fitted a cabinet to safely store controlled drugs.

We spoke with three staff members, they told us that they believed there were enough staff on duty to keep people safe and that they were trained sufficiently to support people with learning disabilities in all aspects of their lives.

We saw that the provider had an effective system in place to enable people to make complaints and for them to be managed appropriately.