Archived: Lyndridge Care & Support

Updated 16 May 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was prompted in part by notification of an incident where a person sustained a serious injury and died later in hospital. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.

However, information shared with Care Quality Commission (CQC) about the incident also indicated there may be possible risks to other people. There were potential concerns about staffing, staff training particularly in respect of the management of risk of falls. This inspection examined those risks.

At the time of inspection, the CQC was made aware of concerns about the care provided at some supported living houses where personal care was provided by Lyndridge Care and Support. These concerns related to the care provided to people at night, the staffing levels, medicine administration and staff knowledge and experience. These concerns had triggered safeguarding meetings for individuals and the service as a whole. Safeguarding meeting had been attended by provider, members of staff from Lyndridge Care and Support, members of the safeguarding team, commissioners of care, staff from the local authority’s Quality Assurance and Improvement Team (QAIT), the police, health professionals including community nurses and CQC inspectors Relatives of people receiving care have been informed of the safeguarding concerns.

The first day of this inspection took place on 20 February 2018 and was unannounced. On this date, two inspectors visited the office location to meet with office staff and arrange visits to people living in supported living houses who received personal care from the provider. We also visited one supported living house on this date. Further inspection dates were carried out by one of the inspectors on 13 and 22 March; these were all announced.

A pharmacy inspector also visited five houses where Lyndridge Care provided personal care to people living there on 28 March 2018. We gave the service notice of the inspection visits to the houses as we needed people’s consent to visit them.

The lead inspector visited the offices of Lyndridge Care and Support on 4 April 2018; during this visit we inspected paperwork relating to staff recruitment and training, the service improvement plan as well as other records. We also gave feedback to the provider and senior managers of the organisation.

During our visits to seven supported living houses, we met many of the people living in these houses. We spoke with 21 people using the service; we also spent time in communal areas observing the care and support provided to people. We met and spoke with one relative. We interviewed and spoke to 19 staff on duty including senior staff. We met with the provider who was also the registered manager as well as the operations manager and an external consultant who was undertaking work to support the registered manager. We reviewed ten care records including care plans, risk assessments and daily notes. We reviewed sixteen medicine administration records. We also looked at four staff records including recruitment information, incident and accident logs, policies and procedures, audits and checks carried out in the last 12 months, the service improvement plan, minutes of staff meetings, quality assurance surveys and feedback.

Prior to the inspection, we contacted the local Healthwatch team to ask if they had received any feedback from the general public about the service. They responded to say they had not received any feedback about Lyndridge Care and Support. We

Updated 16 May 2018

Lyndridge mainly provides care and support for older people and people with a learning disability living in ‘supported living’ settings in Crediton, Okehampton and surrounding areas, so that they can live as independently as possible. People live in houses which they share with other people. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. As the housing and care arrangements are entirely separate, people can choose to change their care provider without losing their home. Lyndridge Care and Support also provide personal care and support to people living in their own homes in Okehampton and the surrounding areas.

The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’, which is help with tasks related to personal hygiene and eating. Where they do receive personal care we also take into account any wider social care provided

Some people supported by Lyndridge Care and Support did not require support with personal care, but did need support with enabling activities such going out and shopping. We do not inspect this aspect of service provision.

Lyndridge Care and Support provide personal care to older people living in 10 supported living houses. At the time of inspection there were around 60 people living in these houses. People had their own bedroom or in the case of couples, shared a bedroom. People in each house shared communal areas including sitting rooms and dining rooms. Staff were present in all the houses throughout the day and night, although in six houses staff slept in while on duty at night. Some houses had an office where staff were able to work and store records related to the service. On this inspection we visited seven of the 10 houses where older people lived.

Lyndridge Care and Support also provide personal care to people with a learning disability living in six supported living houses. We did not visit any of these houses on this inspection. We also did not visit any people receiving personal care who lived in their own homes.

The inspection took place over six days; two inspectors visited the offices of the provider and one supported living house on 20 February 2018. One of the inspectors visited five supported living houses on the 8, 13 and 22 March 2018. A pharmacy inspector visited five supported living houses where some or all of the people received personal care on 28 March 2018. On the 4 April 2018 the inspector returned to the provider’s offices to meet with senior staff and the provider.

The inspection was prompted in part by notification of an incident where a person sustained a serious injury and died later in hospital. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.

However, we also received information after the incident which indicated there may be possible risks to other people. There were potential concerns about staffing levels, poor care, staff training, the privacy and dignity afforded to people. This inspection examined those risks. We did not find evidence to support these allegations at the time of our inspection.

The first day of inspection was unannounced. All subsequent days were announced as we needed the provider to check with people whether they were happy for us to visit and talk with them. Where people did not have capacity to make that decision, the provider checked with the person’s legal representatives whether they agreed, on the person’s behalf, for inspectors to visit the person’s home, speak with them and review their care records.

At the last inspection in July 2016, the service was rated Good. At this inspection, we found the service remains Good in all five key areas.

The provider of Lyndridge Care and Support had also registered with the CQC as the manager of the service. A registered manager is a person who has registered with the CQC 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.

The registered manager was supported by a team of senior managers called development managers. Development managers were responsible for overseeing the work in three or more supported living houses. Each house had a manager. House managers were responsible for the day to day running of the house, ensuring there were sufficient staff; supervising the staff and monitoring the quality and safety of the service provided. This information was fed back to development managers and the registered manager as part of the quality assurance and governance systems. The service had a service improvement plan. There was evidence that actions on the plan had been completed; the plan was monitored and updated at regular intervals.

Where incidents and accidents occurred, these were investigated and, where necessary action was taken to reduce the risk of similar incidents or accidents occurring again.

People living in the supported living houses said they were happy with the care they received. Comments included “Really good”; “Very happy here” and “Staff are lovely, they help me whenever I need it.” Our observations of interactions between staff and people confirmed this. Care plans were person centred and included background information provided by the person and their family. Staff knew people well and were able to describe the care and support each person needed.

Staff had been recruited safely and underwent a comprehensive induction which provided them with the knowledge and skills required to deliver effective care. Staff refreshed their training at regular intervals to ensure they remained up to date. Staff were supervised and appraised by managers and supported to undertake qualifications and additional training to meet people’s individual needs.

There were sufficient staff to meet people’s needs. Staff said they had enough time to work with people without rushing. Staff sought advice from health and social care professionals appropriately. Where a change in a person’s care was recommended, care plans were updated accordingly. 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 support this practice.

There was a complaints policy and procedures. No complaints had been received in the previous 12 months.

Further information is in the detailed findings below