Lyndhurst House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Since the last inspection, improvements have been made and people were receiving safe care and treatment. Staff and leaders were clearly able to identify situations that amounted to safeguarding and staff were confident to use the whistle-blowing process if needed. Staff knew people well and were able to identify changes to health and identify care and support needs. Lessons were learned when things went wrong. Medicines were administered and recorded safely and staff understanding of when to administer PRN (as and when required medicines) was robust. Staff were recruited safely and were supported through training. There was a plan in place to ensure they had ongoing support in the form of supervision and appraisal meetings. There were enough staff to support people safely. Ongoing training made sure that staff had the skills needed to support people. Accidents and incidents were reviewed and actioned by the management team; safety checks were undertaken by staff and the management team. The provider had systems and processes in place to assess and manage the risk of infection. Risk assessments in relation to epilepsy care were not robust, however, the management team took immediate action to address this.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People benefited from a service that learned lessons from accidents and incidents and put measures in place to reduce the likelihood of these reoccurring. Relatives told us they were kept well informed when there were incidents, changes or concerns.

Staff knew how to report accidents and incidents and knew how lessons learned were shared with them. Staff told us they completed incident forms and reported the issue to the senior or management. These were reviewed, and actions taken with learning documented. The manager told us, “When a risk is identified, actions are put in place, for example, enhanced monitoring. We also have a Keep Safe plan in place to support someone to stabilise behaviours until the Mental Health Learning Disability Psychiatrist could review their medication.”

The provider had a culture in which concerns about safety were listened to. Safety events were investigated and reported, and lessons learned to identify and embed good practice. Accidents and incidents were reviewed and actioned by the management team. Safety checks undertaken by staff including maintenance were audited and checked by the management team.

People were supported to maintain their health and attend appointments both inside and outside of the service by staff who knew them well and supported them to understand what was happening. Relatives told us that staff kept them fully updated all the time. One relative told us, “The staff know how to communicate most effectively with us and our son.” Another relative told us, “Our son has been with Lyndhurst a year and the staff know his traits and emotions very well. In fact, the staff have picked up on things we didn’t realise, for example, when he expressed frustration it was because he needed his ears syringing.”

The management team worked closely with other health care professionals to resolve problems and make improvements to people’s health and well-being. The service maintained regular contact with the local authority social workers and with several health care professionals. Staff told us about a person who joined the service with poor oral hygiene that led to a stomach bacterial infection and affected their behaviours and contributed to weight loss. Staff worked closely with the dentist, GP, Dietician, learning disability nurse and a behavioural specialist. The person’s weight had stabilised, and their behaviour had improved with the support of a person-centred positive behaviour support plan.

One health care professional told us, “Lyndhurst seek support from professionals when they encounter ethical dilemmas such as when my client was declining medication that was essential for maintaining her health and well-being. The service sought support from Community Learning Disability Nursing team and me so that a resolution to this problem could be found.”

The provider worked with people and partners including the Learning Disability nurse, a behaviour specialist, the local authority care managers and other health care professionals to establish and maintain safe systems of care. Hospital passports were in place to support people when they needed to go to hospital or attend clinic appointments. A hospital passport helps to give health staff important information about the person and their health.

People communicated using pictures, verbal cues, sign language and gestures that they were happy and felt safe at the service. They trusted staff to keep them safe. People were assessed and received the level of staffing they needed to support them inside and outside the home. People were clearly comfortable and relaxed with staff who knew them well and who interacted in a fun and personal way. Relatives told us their loved ones were safe and protected from harm. One relative told us, “He is safe and well cared for because he has settled very well and developed in leaps and bounds after a very traumatic time at home. The continuity of care is there despite staff changes. It’s very much his home, he is happy and stable and that’s why I know he is safe.” Relatives told us they were confident to raise any concerns and knew that they would be responded to quickly.

Staff had received adult safeguarding training, refreshed every year. Safeguarding training included safeguarding children. Staff understood their responsibilities to report safeguarding concerns and were aware of whistle-blowing and confident to speak up if needed. A staff member told us, “I would contact the manager, record and report what had happened, body map and take photos. If I felt it wasn’t being addressed quickly enough, I would escalate to head office and raise a safeguarding referral.” The management team told us, “Safeguarding training is annually refreshed, and I check training has been completed. Safeguarding and whistle-blowing are standing items in staff meetings. The policies and procedures are updated and immediately accessible to staff and there are hard copies in reception.” The management team discussed safeguarding matters with the staff team on a regular basis throughout the week. This ensured that staff were aware of concerns and understood the escalation process.

Interactions between staff and residents were kind, friendly and respectful. We saw safe practice while enabling people to maintain their routines and promote their independence. The atmosphere was calm and the home felt homely. People were happy and comfortable, engaging with each other and with staff and the manager who were chatting and supporting people with things they wanted to do, for example making a drink, a meal, playing on their iPad, walking in the woods or watching a film. Residents were making their way around the service freely, unrestricted, using the lounge and kitchen. People were actively engaged in various meaningful activities and had activities planned every day including bowling, trips to the café, meeting friends and family. Staff were aware of people’s needs and communicated by using pictures, sign language, verbal cues/gestures or their body language. No one was in distress or appeared anxious. There was plenty of laughter and people were comfortable and happy with staff they trusted.

Safeguarding and whistle-blowing policies were in place and were accessible to all staff. Staff were aware of safeguarding concerns, and of the whistle-blowing policy and how to access them. Although the service had made safeguarding referrals to the local authority, there had been a lack of statutory notifications submitted to CQC. This was addressed with the registered manager who took immediate action to address this. The management team told us they had positive working relationships with the local authority and other statutory partners and were confident to seek advice and report concerns. In the event of any accident or incident, staff completed an incident report, notified the management who reviewed the report, took statements and informed the local authority. A recent incident led to the dismissal of an employee and the learning taken had been discussed in team meetings. Staff who are unable to attend a team meeting were obliged to read the minutes of the meeting, sign and date to record they have done so, and this was verified by the manager. People’s daily logs and behaviour trackers were also updated with learning taken from incidents and accidents.

Staff knew people’s needs well and responded to people’s risks in an individual way. People were encouraged to pursue their interests, maintain important relationships and be a part of their community through positive risk taking. Relatives told us: “The staff have given our son so many skills I didn’t think he’d have, for example, he is cooking things and doing housework chores with guidance because he has been taught patiently and kindly.”

Staff knew people well and were confident they could identify changes in a person's presentation that may be of concern. Staff described strategies used to prevent people from becoming anxious, for example, walking in the woods. Everyone had a plan in place to deescalate behaviours. Staff told us, “It’s a balance of supporting the person to express themselves, letting their emotions out while keeping people safe and being fair to everyone.” The management told us, “We support people with a wide range of activities, for example, cooking, using hand over hand support to make meals like pizzas. We listen to people, ask them how they are, and offer choices and options, for example we are currently doing a risk assessment to take a person swimming and have requested an increase in their hours to make this happen.”

People had been involved in evacuation drills in case of emergency. They were able to show us where they would evacuate to if they needed to. We observed that people were supported to manage their community safety risks well. Residents worked in the garden, planting vegetables and flowers, and their activities were documented in their daily logs. We were shown the closed Facebook page that all families could access, with pictures of their loved ones making meals and working in the garden and enjoying day trips out.

There were systems to assess and manage people’s risks however they were not always robust. One person had a diagnosis of epilepsy: There was an Epilepsy Protocol in place and while the person had not had a seizure for many years, there was a lack of guidance for staff about how different seizure activity may present itself and how to support people before, during and after any seizure activity to keep the person as safe as possible. Associated risk assessments in relation to bathing/showering (in case of seizure activity), and risk assessment regarding risks of falls and injury from seizure activity and Sudden Unexpected Death in Epilepsy (SUDEP) were also missing. The manager took immediate action and started an epilepsy risk assessment the following day. Other people’s risk assessments identified individual risks and provided information for staff to support people to manage and monitor the risks, including accessing the community, shopping, menu planning, cooking, and included people’s personal likes and dislikes. The organisation had health and safety procedures in place and routine checks and maintenance were also in place.

People benefited from an environment that was well maintained and clean. Radiators were covered and switched off due to the warm weather, and the fire extinguishers were securely wall mounted and routinely maintained. There were window restrictors to all windows. The stairs, corridors and hallway were unobstructed. The kitchen and lounge were light and airy. Toilets were clean, sanitised and fresh.

There was a large fire evacuation plan by the front door. The fire alarm was tested weekly, and fire drills took place fortnightly. Fire equipment was checked, and audits were in place. The management told us that all staff were trained in the use of the fire equipment and all upholstered furniture was compliant with fire regulations. An action plan was in place to ensure that the external lights to the side and rear of the building would operate in the event of a power failure.

Personal emergency evacuation plans (PEEPS) were in place, detailed and up to date. Fire doors and exits were clearly marked with signs and unobstructed. In the afternoon there was a fire alarm test, and the residents knew what it was and where they needed to be. The carpets, stairs and flooring were clean, handrails were safely secured and there was plenty of natural lighting. Communal walls were attractively painted with some art. Documents showed maintenance tasks had been completed in a timely manner. Rooms were clean and tidy and had been personalised in accordance with the person’s wishes.

The provider had systems and processes in place to ensure the delivery of safe care. Essential servicing and maintenance of the boiler, oil, electric, water system fire alarm and lighting had taken place and been audited. There was appropriate arrangements and provision of information for fire fighters and routine checks of escape routes, fire and exit doors were completed weekly. All staff had received fire safety training.

People communicated that there were enough staff because they could go out and do the things they enjoyed doing. A relative told us, “I think the staffing is just right. Our son gets exactly what he needs, and his social skills have grown considerably since he joined.”

Staff told us they received a comprehensive induction, including shadowing experienced staff and completing essential training before working on their own. Staff had undertaken training relating to the wide range of strengths and impairments that people with a learning disability and autistic people may have. Staff felt the training they had was adequate for their role, and that there were enough staff on duty to provide safe care for the people living at the service.

We observed there were enough staff on shift and the service adhered to the commissioned hours people had including 2:1 and 1:1 support. This enabled people to take part in in the activities they enjoyed both within and outside the service. Staff were responsive to people and did not rush anyone and took time listening to people and enjoying their company.

The recruitment process ensured that safe recruitment practice was followed. Designated 2:1 and 1:2 hours were allocated in accordance with funded hours. We reviewed 2 recruitment files, and all the required checks had been carried out and documents were all in date. The provider had a central system in place which ensured that all recruitment checks were completed before a staff member started. These included copies of references, photographic identification, and Disclosure and Barring Service forms (DBS). DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Staff had regular supervision meetings and induction included training and shadowing experienced staff to gain confidence and experience. Staff who joined without a Care Certificate had this added onto their training schedule with skills for care. The provider’s training matrix showed that all staff had completed mandatory training.

People communicated with us that their bedrooms and their home was clean and tidy. People showed us their rooms with pride and took part in keeping them well maintained by doing household chores which they appeared to enjoy.

Staff told us they had sufficient personal protective equipment (PPE) to provide safe care. Staff had received infection prevention and control training (IPC) and were familiar with IPC processes to mitigate infection risks. A staff member told us, “Infection control is vital. It reduces the risk of spreading infection and keeps the home tidy and clean for the people who live here.”

We observed that staff were using PPE effectively and safely. We were assured that the provider was promoting safety through the layout and hygiene practices of the premises. There were no restrictions to visitors.

The provider had systems and processes in place to assess and manage the risk of infection. The provider had a daily cleaning programme in place which included deep cleans for people’s rooms. Infection control audits were completed regularly, and actions taken if issues were found. The provider had plenty of PPE in place to keep people and staff safe. The kitchen area was clean and well managed.

People received their medicines safely. Care plans detailed how people preferred to have their medicines, for example, in bed before getting up, or in the medicine’s room. People showed me the medicines room and their basket with their name and picture.

People received their medicines from trained staff. Staff informed us that they had received training and felt confident to administer medicines and where to find the policies. The management told us that staff were competency assessed to handle medicines safely. Management carried out regular spot checks to ensure medicines practice was safe and following policies and procedures. Staff told us they supported people to reorder their medicines a month in advance to ensure people did not run out, and people were supported to collect their medicines from the pharmacy. Staff told us about STOMP (stopping over medication of people with learning disability and autistic people) and the importance of evaluating the efficacy of medicine taken. Staff understood what the PRN (as and when required medicines) protocols were for each person and where to find updated information in the event of a change in someone’s need. One staff member told us, “PRN is recorded on the MAR with the reason; most people can verbally tell us when they feel in pain, otherwise, their body language is clear, e.g. self-injurious behaviours which we know to look out for. For example, one person may punch their chest, or tug their ear.” Management told us, “We have quality assurance measures in place for medicines and the policies are in people's care plans. There is a weekly medication stock check count, and I complete a monthly audit. Staff complete stock check counts twice a day in the morning and in the evening. We have policy sign sheets; policy updates are added to the care plan and staff are required to sign to say they have read them. New staff receive medicines training and shadow experienced staff before being signed off and there is a full medicines competency completed every 6 months and kept in staff files.”

The provider had systems and processes in place to manage medicines. The medicines room was kept locked when not in use and the room was tidy and well stocked. Staff wore PPE and were left undisturbed during administration. Each resident had their own basket with their photo and name. Baskets were locked away and people’s creams, were kept in a separate locked cupboard to the tablets. Guidance and PRN protocols were in place to help staff give these medicines consistently. Body maps were in place for topical medicines. Medicine administration records (MAR) were signed and dated, and stock counts showed medicines had been accounted for. Care plans contained hospital passports with a short summary of key health and support needs in the event of an emergency.