Background to this inspection
Updated
17 December 2022
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 Health and Social Care Act 2008.
Inspection team
This inspection was carried out by two inspectors, a medicines inspector and a specialist nurse advisor.
Service and service type
Lyndhurst Nursing home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Lyndhurst Nursing home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
This inspection site visit took place on 27 October 2022 and 8 November 2021 and was unannounced.
What we did before inspection
Before the inspection we reviewed the information, we held about the service. This included details about incidents the provider must tell us about, such as any safeguarding alerts that had been raised. We spoke with the local authority safeguarding and commissioning teams about the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.
During the inspection
We met and spoke with the registered manager, a bank nurse, two healthcare assistants and the cook/activities coordinator. People living at the home had varying levels of communication, however we spoke with two people using the service and spent time observing the support provided to people in communal areas and the interactions between people and staff.
We reviewed a range of records including six people's care plans and medicines records. We also looked at staff training, staff recruitment, supervision records and records used in managing the service.
Updated
17 December 2022
About the service
Lyndhurst nursing home provides residential and nursing care for up to 16 people. At the time of the inspection 6 people were using the service.
People’s experience of using this service and what we found
During this inspection we found an effective system was not in place to manage and monitor concerns of abuse, medicines were not managed safely and risks to people's health and safety were not always assessed or guidance available to staff to reduce the risks. There were staff available, however we could not be assured they were effectively deployed as people were left unattended at times. An effective system was not in place to manage accidents and incidents and no analysis had been conducted to identify any lessons learnt to improve the service. There were some examples of poor infection control practices, staff were not trained appropriately, and their performance assessed to ensure they were competent enough to carry out their roles. People were not always treated with dignity and respect and staff showed a lack of respect and consideration towards people using the service. Staff did not provide and were not aware of the support people required in accordance to their needs and there were instances where some advice from healthcare professionals had not been implemented and followed by the service. There was no effective system in place to ensure better oversight of complaints received and monitoring to learn from complaints. End of life care was not always followed to ensure people were treated in a dignified manner at the end of their life. Good governance and quality assurance systems were ineffective.
Appropriate recruitment checks had taken place before staff started work. People’s care and support needs were assessed before they started using the service. Staff received an induction and supervision. 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. People were supported to maintain a balanced diet and had access to healthcare professionals.
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 (11 October 2021). At this inspection we found the provider remained in breach of regulations.
Why we inspected
We undertook a focused inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about people’s nursing care needs, medicines management, inappropriate staff behaviours, a lack of healthcare professionals’ involvement, records management and staff training. A decision was made for us to inspect and examine those risks.
We inspected and found there were concerns with people’s nursing care, so we widened the scope of the inspection to become a comprehensive inspection which included the key questions of effective and caring.
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 COVID-19 and other infection outbreaks effectively.
The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lyndhurst Nursing Home on our website at www.cqc.org.uk.
Enforcement and Recommendations
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 monitor the service and will take further action if needed.
We have identified breaches in relation to medicines management, risk management, safeguarding adults, staff training, dignity and respect, person centred care and good governance at this inspection. We have also made recommendations in relation to staffing and accessible information.
We have issued warning notices in relation to regulations 12 and 17 requiring the provider to comply with these regulations within 8 weeks.
Follow up
We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.