Archived: Lyndhurst Residential Care Home

Lyndhurst Residential Care Home is a care home without nursing care, providing accommodation for persons who require personal care for up to 42 people. The service provides support to older people, including people living with dementia. At the time of our inspection there were 26 people using the service. The care home accommodates people across 2 floors in 1 building.

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

The service had made some improvements in medicines management since the last inspection, however, we found medicines were not always managed safely. Risks were not always being appropriately identified and managed and recruitment practices were not safe. Staffing levels in the home had improved, the home was clean and tidy and infection control practices had improved. People were supported to have visitors, lessons learned were taking place and people told us they felt safe.

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.

Complaints were not being acted on in line with the homes policy. Records were being reviewed but they did not always contain the necessary information. We saw evidence that people were starting to be involved in their care planning and person-centred care had improved. People’s communication needs were being met. Activities were taking place and people spoke positively about the improvements in activities. Some people’s end of life wishes had been considered, the home was in the process of adding this information to people’s care plans.

The providers oversight of the service was not robust, the manager had however, implemented a number of audits, these needed to be strengthened to identify all the issues we found during the inspection. Incidents were still not always reported to the Care Quality Commission (CQC) when they should have been and various documents were not in place. The provider had not fully complied with the conditions CQC imposed during the last inspection. Staff meetings were taking place and some surveys had been carried out. People spoke positively about the new management and the service worked in partnership with the local authority and various health teams.

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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 inadequate (published 5 October 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service on 4, 8 and 10 August 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains inadequate. This is based on the findings 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 COVID-19 and other infection outbreaks effectively.

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

Enforcement

We have identified continued breaches in relation to medicines management, risk management, failure to send appropriate notifications to CQC, recruitment, complaints management and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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 remains 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 time frame 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.

Lyndhurst Residential Care Home is a care home without nursing care, providing accommodation for persons who require personal care for up to 42 people. The service provides support to older people some of who are living with dementia. At the time of our inspection there were 31 people using the service. The care home accommodates people across two floors in one building.

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

People were at risk of harm because of failures to identify and address safety concerns. Systems were not in place to ensure people received safe and appropriate support to take their medicines. Staffing in the home was not safe and relied upon agency carers on each shift to administer medication. Infection prevention control practices were not always being followed; however, people were supported to have visitors. Recruitment practices did not follow necessary processes and risks relating to people’s health and the overall environment were not being appropriately managed. The manager was unable to provide any examples of lessons learned. Systems were in place to safeguard people, however the policy which was in place to support this required updating.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. Although the policies and systems in the service supported this practice and necessary deprivation of liberty safeguards (DoLS) referrals were being made, we found an example where best interest decisions were not in place.

Various application and intake records were being completed in retrospect, whilst other records were not as person centred as they should have been, and people did not always receive person centred care. Complaints were not always being appropriately recorded and the complaints policy required updating. Peoples communication needs were being met. An activities coordinator was employed by the home, but they were not always able to offer activities to people as they had to also conduct caring duties when the service was short staffed. Peoples end of life wishes had been considered.

Continuous learning was not consistent, audits were not always robust, and the provider was not conducting any audits within the service. Incidents were not always reported to the Care Quality Commission (CQC) when they should have been, and a variety of documents were either not in place or required updating. The provider failed to fulfil the assurances they had given us on day one. Staff feedback about the service was poor. Surveys had been conducted in 2021 but had not been analysed.

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 2 September 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about staffing, medication management, poor management, poor record keeping and poor care. A decision was made for us to inspect and examine those risks.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this report. You can see what action we have asked the provider to take at the end of this report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lyndhurst Residential Care Home on our website at www.cqc.org.uk.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to infection prevention and control (IPC), medicines management, risk management, person centred care, failure to send appropriate notifications to CQC, staffing, training, recruitment, complaints management and good governance.

We imposed two conditions on the providers registration, one to restrict admissions to the home and the second to ensure there is appropriate clinical oversight of medicines. We have also issued a warning notice in relation to poor governance. 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 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.

We found the following examples of good practice.

There were effective measures in place to minimise the risks around COVID-19. Improvements had been made since our last inspection. Temperatures were now being taken and visitors were requested to complete a visitors' risk assessment.

The environment was clean, well maintained and hygienic. Cleaning schedules and audits were in place.

We observed staff wearing personal protective equipment (PPE) which was used effectively to safeguard people and current government guidance was being implemented. Systems were in place to ensure that relatives could visit their family members at the care home.

People and staff were tested regularly for COVID-19, in line with government guidance. All staff employed at the home had been vaccinated to help keep people safe from the risk of infection.

The registered manager had regular contact with the local authority and infection control teams. The service had policies and procedures in place to manage the risks of COVID-19.

On the day of the inspection there were strict rules in place throughout England relating to social restrictions and shielding practices. These were commonly known as the 'New National Restrictions'. This meant the Covid-19 alert level was very high and there were tighter restrictions in place affecting the whole community.

We found the following examples of good practice:

Staff, management and visitors were using personal protective equipment (PPE) correctly and there were procedures in place around the use of PPE. Some aspects of the disposal of PPE needed to be looked at and we saw that by the end of the inspection, improvements had been made in this area.

The provider and registered manager had processes to minimise the risk to people, staff and visitors from catching and spreading infection. These included weekly testing of staff and at least every 28 days for people living in the home. Hand sanitiser and PPE were available throughout the home. There were signs to remind staff, visitors and people about the use of PPE, the importance of washing hands and regular use of hand sanitisers.

Processes when visitors entered the home needed to be improved. This was to ensure appropriate measures were in place to prevent people bringing infection into the home. During the inspection, the registered manager implemented additional measures and amended policy in this important area of infection prevention.

Where appropriate, ‘socially-distanced' visits had been taking place. At the inspection however, and consistent with enhanced restrictions in the event of infection outbreaks, these visits had been restricted and were only allowed in exceptional circumstances.

Visiting rules and process were communicated effectively to people using the service and their relatives. At the time of the inspection, the provider was in the process of making alterations to the premises to facilitate safe visiting with relatives and friends. We saw the extent of the alterations and the proposals seemed a suitable way of allowing people to see their loved ones when guidance and legislation permitted.

Infection control policy and people's risk assessments had been considered and revised following the pandemic so that people were protected in the event of becoming unwell or in the event of a Covid-19 outbreak in the home. This did however require to be documented clearly so that people, staff and relatives could access the document as a point of reference and a definitive guide. The registered manager forwarded a revised document outlining the changes to policy after the inspection.

The registered manager insisted people were tested before admission and consistent with local guidance, people were not being admitted to the home at the time of the inspection. This will be reviewed as appropriate and in line with any changes in restrictions. We were satisfied the service, staff, people and visitors were following the rules.

People's mental wellbeing had been promoted by use of social media and mobile devices so people could contact their relatives and friends. Staff had knowledge of good practice guidance and had attended specific training. The records around this needed to be documented to assist the registered manager and provider in establishing whose training needed updating.

There were sufficient staff to provide continuity of support and ensure safeguards were in place should there be a staff shortage.

The home was clean and hygienic. Designated cleaners were working throughout the inspection.

Most staff had received Covid-19 related supervision and all had access to appropriate support to manage their wellbeing should it be required.

Further information is in the detailed findings below.

Lyndhurst Residential Care Home is registered to provide personal care and accommodation for up to 42 people. There were 37 people living at the home at the time of the inspection.

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

People were happy with the level of care and support they received and felt staff had a good understanding of their individual needs, wishes and preferences. People’s relatives were confident their family members were safely and effectively cared for. A range of activities were provided both in and away from the home providing variety to people’s daily routine.

A range of audits and checks were completed to monitor areas of the home. Action identified were recorded separately and needed consolidating to inform the development of the homes business plan evidencing on-going improvements of the service.

Improvements were needed to clearly demonstrate people’s medicines were managed and administered safely. Records for topical creams and thickeners needed to be expanded, guidance was not available for all ‘when required’ medicines and eye drops had not been administered. Training and competency checks were completed for staff responsible for the administration of medicines. Audits needed to be expanded on so that a thorough check was carried out.

People’s care plans and monitoring records needed to be reviewed and updated to accurately reflect their current and changing needs. Records showed people and their relatives, where appropriate, were involved and consulted about the care they wanted and needed.

Systems to ensure the safety and protection of people and premises needed improving. Internal fire safety checks needed to include means of escape and emergency lighting. Emergency evacuation plans were not easily accessible, nor had they been reviewed and updated so that accurate information about the needs of people was available in the event of an emergency arising. Appropriate action needed to be taken to ensure windows were restricted and were 'tamper proof'. Assessment into areas identified as a risk to people’s health and wellbeing needed updating to reflect changes in need so that people were kept safe.

We saw equipment was available for some people with a sensory impairment, however information provided for people was not available in different formats.

People were provided with a good standard of accommodation. The home was clean and tidy with no malodour other than one identified room. Ongoing improvements were being made to improve bedrooms and ‘older’ areas of the building.

Systems were in place to minimise the risk of cross infection. The laundry was clean and well organised and had a clear pathway to help manage clean and dirty laundry safely.

Sufficient numbers of staff were available. Ongoing recruitment had been undertaken to fill vacancies and help cover periods of sickness. Relevant recruitment checks were completed prior to new staff commencing work.

Staff were offered a programme of induction and training. Evidence to show all staff received supervision and support needed to be expanded upon. Staff spoken with said they were well supported by management and received good training and support.

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.

People had access to a range of healthcare support so their health and well-being was maintained. Suitable arrangements were in place to meet people’s nutritional needs. The dietary needs of people were understood and catered for by kitchen staff.

Systems were in place regarding complaints, concerns and safeguarding. We spoke with the local authority; no issues or concerns were raised.

Rating at last inspection: The last rating for this service was Good (published February 2017).

Why we inspected: This was a planned inspection based on the previous rating.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection of June 2015 the service did not meet all the regulations we inspected and were given requirement actions. The service sent us an action plan to show us how they intended to meet the regulations. At this inspection we saw the improvements had been made and the regulations were met. This unannounced inspection took place on the 05 and 06 January 2017.

The service had a registered manager. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff we spoke with were aware of how to protect vulnerable people and had safeguarding policies and procedures to guide them, which included the contact details of the local authority to report to.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow. Their competency was checked regularly.

The home was clean and tidy. The environment was maintained at a good level and homely in character. We saw there was a maintenance person to repair any faulty items of equipment.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities to help protect their health and welfare.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies.

People were given choices in the food they ate and told us it was good. People were encouraged to eat and drink to ensure they were hydrated and well fed.

Most staff had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of her responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed there were good interactions between staff and people who used the service. People told us staff were kind and caring.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and they were regularly reviewed. Plans of care contained people’s personal preferences so they could be treated as individuals.

People were given the information on how to complain with the details of other organisations if they wished to go outside of the service.

Staff and people who used the service all told us managers were approachable and supportive.

Meetings and supervision with staff gave them the opportunity to be involved in the running of the home and discuss their training needs.

The manager conducted sufficient audits to ensure the quality of the service provided was maintained or improved.

There were sufficient activities to provide people with stimulation if they wished to join in.

The service asked people who used the service, family members and professionals for their views and responded to them to help improve the service.

The provider had an effective system in place for engaging other health professionals in people's care. We spoke with a visiting health professional who said staff had been 'very observant' and said staff had requested health support from them appropriately when it had been needed. We spoke with people who use the service who told us they were visited by health professionals.

We found that the provider had an effective recruitment system in place and staff underwent an induction period before they started working independently.

We found that the provider had an effective complaints policy in place and that complaints information was available to people. We found that staff understood the process.