Archived: Lynwood

Lynwood is a ‘supported living’ service and is registered to provide the regulated activity of personal care to people living in their own home. At the time of the inspection, eight people with learning and physical disabilities who were all living in the same property, were being provided with personal care.

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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People had their own rooms and had independence to make choices about how they wanted to live their lives. Care was person centred with staff knowing people well and providing care to their liking. Staff understood the nature of the service they provided and sought to empower people to make choices.

People at the service were kept safe through robust safeguarding policy and practice. Risk assessments sought to keep people safe and mitigate risks to them. Fire risk systems were up to date and the service had acted on a recommendation we made at our last inspection. The service’s staff recruitment processes were robust. People’s medicines were managed safely. The service had implemented and was following government guidelines to limit COVID-19 transmission. Incidents and accidents were recorded and followed up on indicating lessons were learned when things went wrong.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The service had followed a recommendation from our previous inspection with regard to recording consent; consent to care agreements were in place as were records of best interest discussions to support people with their choices. Assessments were in line with the law and ensured people’s needs could be met by the service. Staff were supported in their roles through induction, training and supervision. People were supported to eat and drink and could make choices about the food they ate. Staff communicated effectively with each other and supported people with their health care needs.

People and relatives spoke positively about staff and management. Staff understood their roles and responsibilities. Documentation at the service had been reviewed since our previous inspection. Quality assurance measures were in place. People, relatives and staff were engaged with the service through regular meetings and/or communication with the service. The service worked in partnership with other agencies to benefit people using the service.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 12 March 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. The service has now improved to good.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lynwood on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Lynwood is a ‘supported living’ service and is registered to provide the regulated activity of personal care to people living in their own home. At the time of the inspection, eight people with learning and physical disabilities who were all living in the same property, were being provided with personal care.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service

The service did not have clear guidelines for people’s finances. We had concerns about people’s access to their own money and how they could spend it. The provider made improvements to their processes following our inspection. Whilst this was a supported living service and Care Quality Commission do not inspect the premises, we found concerns around fire safety. We have made a recommendation to follow best practice guidance on fire risk management. We found gaps in people’s employment history. The provider told us they were aware of the gaps but had not recorded them.

People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible; but the policies and systems in the service did not support this practice. There were no best interests decisions being recorded. Some people had no consent to care agreements in place at the time of the inspection though people told us and observations confirmed people’s consent was sought when staff provided care. We have made a recommendation about following best practice with regards to recording people’s consent.

The service did not always keep up to date records. We saw annual and monthly reviews which were overdue.

Staff knew what to do if they suspected abuse and who to report it to. There were sufficient staff working at the service to meet people’s needs. Risks to people were monitored and managed. People’s medicines were managed safely. Staff understood the importance of infection control. Incidents and accidents were recorded, and lessons learned when they occurred.

People’s needs were assessed before receiving a service to ensure the provider could meet their needs. Staff received inductions and training about how to do their jobs and told us they were supported in their roles by the registered manager. People were supported to eat and drink. Staff worked with other agencies to ensure people received effective timely care.

People and relatives told us staff were caring. The service supported equal rights. People and relatives could express their views and be involved in decisions about their care. People’s privacy and dignity was respected. Staff understood privacy and the need for confidentiality.

People’s needs and preferences were recorded in care plans which focused on how best to support them. The service worked to ensure people’s communication needs were met. People were supported to take part in activities both individually and as a group. People were supported to be able to complain, though the service had received no complaints since our last inspection.

People, staff and relatives spoke positively about the registered manager. Staff understood their roles. People, relatives and staff engaged with the service through regular meetings and surveys. Staff worked in partnership with other agencies to benefit people using the service. There were quality assurance measures in place.

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 01 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified three breaches in relation to safeguarding of people’s finances, seeking consent and good governance at this inspection. 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.

The service had a registered manager at the time of our inspection. 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 last inspection on 14 and18 July 2016 we found six breaches of the Health and Social Care Act 2008 (regulated activities) Regulations 2014. We issued two warning notices following the inspection.

This was because people were not safe at the service. There were poor arrangements for managing medicines and infection control. People were at risk of harm when moving around the service. Systems in place were not always effective to maintain the safety of the premises and equipment. People did not always have access to activities of their choice. Staff did not always receive up to date training, supervision and induction. Robust procedures were not in place to monitor the safety and quality of the service provided.

We inspected Lynwood on 7 June 2017. This was an unannounced inspection. At this inspection we found the service had made the required improvements.

People told us they felt safe using the service. Staff knew how to report safeguarding concerns. Risk assessments were completed and management plans put in place to enable people to receive safe care and support. There were effective and up to date systems in place to maintain the safety of the premises and equipment. We found there were enough staff working at the service and recruitment checks were in place to ensure new staff were suitable to work at the service. Medicines were administered and managed safely.

Staff received supervision and appraisals and training in line with the provider's policies and procedures. Staff had a clear understanding of application of the Mental Capacity Act 2005. Appropriate applications for Deprivation of Liberty Safeguards authorisations had been made. People using the service had access to healthcare professionals as required to meet their needs.

Personalised support plans were in place for people using the service. Staff knew people they were supporting including their preferences to ensure personalised support was delivered. People using the service told us the service was caring and we observed staff supporting people in a caring and respectful manner. Staff respected people's privacy and dignity and encouraged independence. People were offered a choice of nutritious food and drink. People using the service knew how to make a complaint.

Regular meetings took place for staff and people using the service. The provider sought the views of people and their relatives. The provider had quality assurance systems in place to identify areas of improvement. People and staff told us the registered manager and provider were supportive and approachable.

The service had a registered manager at the time of our inspection. 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 last inspection on 7 May 2015 we found four breaches of the Health and Social Care Act 2008 (regulated activities) Regulations 2014. The service was not always safe. Medicines were not always managed safely. Robust procedures were not in place to monitor and ensure fit and proper persons were employed at the service. Staff did not always receive regular supervision or appraisals. People did not always have access to activities during the weekend.

We inspected Lynwood on 14 and18 July 2016. This was an unannounced inspection. At this inspection we found six breaches of the Health and Social Care Act 2008 (regulated activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

People were not safe at the service. There were poor arrangements for managing medicines and infection control. People were at risk of harm when moving around the service. Systems in place were not always effective to maintain the safety of the premises and equipment.

People did not always have access to activities of their choice. This meant peoples personal preferences were not always met. Staff did not always receive up to date training, supervision and induction.

The systems in place to monitor the safety and quality of the service provided were not always robust. Staff had mixed views about the leadership of the service.

People told us they felt safe using the service and staff knew how to report safeguarding concerns. People knew how to make a complaint.

People told us the service was caring. Staff knew the people they were supporting, respected people’s privacy and encouraged independence. People using the service had access to healthcare professionals as required to meet their needs. The service enabled people to maintain links with their cultural and religious practices.

People’s needs were assessed and care and support was planned and delivered in line with their individual care and support needs. People were provided with a choice of food and drinks ensuring their nutritional needs were met.

People told us that the service was meeting their care needs. One person said "they're nice" when asked about the support staff. Care plans were not reviewed on a regular basis and people were not enabled to contribute to the development of their care plans on a regular basis. This meant that the planning and delivery of care was not conducted in such a way that ensured people's safety and welfare and that their individual changing needs were met.

At the last inspection it was noted that the recruitment process was not sufficiently robust to ensure the safety of people using the service. During this inspection we noted that appropriate improvements had been made and there were effective recruitment and selection processes in place.

A client satisfaction survey was sent out to relatives of people who use the service annually. Their views were acted upon. Risks were identified, assessed and managed. Staff meetings took place every two to three months and were an opportunity for staff to raise any concerns or comments about the quality of the service.