This focused inspection of Lyme Green Hall was undertaken following a serious incident. This inspection did not examine the incident itself but the arrangements within the home to prevent a reoccurrence of a similar incident.

We carried out an unannounced visit to the home on the 15 and 22 November 2018.

Lyme Green Hall is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. This home is not registered to provide nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 61 people across three separate units. At the time of our inspection there were 16 people living at the home. A notice of decision to restrict new admissions into the home remained in place at the time of this inspection.

This location requires a registered manager to be in post. 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. There was no registered manager in post at the time of our inspection.

At the last inspection which we carried out on 3 and 4 October 2018, we found the provider was rated requires improvements overall. Since the last inspection there had been a change of management of the home. During this inspection we focused on two key questions: is the service safe? and is the service well led? We found the service was not safe or well led.

We identified breaches of the regulations in respect of Safe Care and Treatment, Safeguarding Service Users from Abuse and Improper Treatment, Premises, Good Governance, Staffing and Fit and Proper Persons.

We found safeguarding systems were not being followed and the manager was unclear which safeguarding policy they were adhering to. We found allegations of abuse had not been reported in a timely way during our inspection. There was no safeguarding tracker/log of concerns.

The premises were not always safe. There was a maintenance manager in place across all of the provider’s locations however, there was a vacancy for a maintenance worker for Lyme Green Hall. We observed three windows on the first floor with inadequate window restrictors which could be easily opened or which broke when a minimal degree of pressure was placed through them. There were no records to confirm weekly fire alarms were being tested, no water check records or mattress checks seen. The manager had put a mattress check system in place by the end of our second day of our inspection.

People were not always receiving safe care and treatment. We found sensor mats were not always working, there were no Pro Ra Nata (as and when) prescribed medication protocols in place, supplementary charts for prescribed creams had not been completed consistently, people’s weights had not always been monitored and people’s food and liquid intake had not been recorded when appropriate. People were not receiving regular checks as stated in their care plans.

Not all staff employed or deployed by the provider to work in Lyme Green Hall had been through appropriate checks. The manager of the home had not had a DBS (Disclosure Barring Service) which is a police check to ensure the provider is aware of any previous convictions or concerns prior to them starting in their role as manager of the home. We also found another staff member had no references or an application form in their recruitment file. A third staff member had no risk assessment in place for a previous conviction seen on their DBS certificate.

The governance arrangements of the home were that the provider had instructed a management company to manage the home on their behalf. We found the communication between the provider and ma

This inspection took place on 03 and 04 October 2018 and was unannounced. At our last inspections in October to December 2017 and April 2018 we found that the service was not meeting the required standards. We found eleven breaches of Regulations including concerns that placed people at serious risk of harm. These related to person centred care, dignity and respect, need for consent, safe care and treatment, safeguarding people from abuse and improper treatment, meeting nutritional and hydration needs, premises and equipment, receiving and acting on complaints, good governance, staffing, employing fit and proper persons and notification of other incidents. Following the inspection in April 2018 the provider implemented an action plan. At this inspection we found that the actions had been met and the provider was no longer in breach of those Regulations.

At the last inspection, we rated the service overall inadequate and the service has been in special measures. Services that are in special measures are kept under review and are inspected again within six months. We expect services to make significant improvements within this time frame. During this inspection the service demonstrated that improvements have been made and is no longer rated inadequate overall or in any of the key questions. Therefore, this service is now out of special measures.

Lyme Green Hall is a ‘care home’ operated by Pendlebury Care Homes Limited. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Lyme Green Hall has the capacity to accommodate 60 people across three units. At the time of the inspection there was one unit open. There were 20 people living in the home. This was because CQC had served a notice to restrict admissions while the service implemented improvements. The premises are set within its own grounds in a semi-rural residential location in Macclesfield.

The service did not have registered manager in place. 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. A manager had applied to register with CQC but this application was on hold and a different manager was in place. The manager at the time of the inspection was employed by an external management team who the provider had brought in to implement and oversee the improvements. During the inspection the manager told us they planned to register with CQC as a matter of priority.

The home was now working in a person-centred way. This means they treated people as individuals. Care was planned and carried out in a way that respected people’s personal choices and lifestyles. Care planning had significantly improved with the implementation of new records.

People told us they felt safe living there. Staff had received recent training and were knowledgeable about their roles and responsibilities around keeping people safe and protecting them from the risk of abuse.

Staff were recruited safely and new staff received an induction into the role before working independently.

People who may display behaviours that challenge had appropriate up to date risk assessments in place and staff were seen to manage behaviour of this type well.

Accidents and incidents were documented and audited. Actions and outcomes to prevent re-occurrence were noted.

The service employed a full-time chef who provided appetising and nutritious meals. People were given choices with their meals and their preferences were respected.

There was an activities co-ordinator who arranged a variety of activities but people and their relat

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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.

Lyme Green Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. This home is not registered to provide nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 60 people across three separate units, each of which have separate adapted facilities named the Villa Suite, Lymes Suite and Manor Suite. Staff and the people who live at the home refer to each unit as the Villa, Lymes and the Manor and we have done the same throughout this report. At the time of our inspection there were 24 people living at the home.

This focused inspection of Lyme Green Hall was undertaken following our receipt of a number of concerns raised by the local authority. We visited the home unannounced on the 19 April 2018 and requested further information in writing from the registered provider on the 25 April and 26 April 2018.

This location requires a registered manager to be in post. 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. There was no registered manager in post at the time of our inspection.

At the last inspection which we carried out between 31 October and 19 December 2017, we found the provider was not providing safe, effective, caring, responsive and well led services and was rated inadequate overall. The provider was not meeting the requirements of multiple regulations including regulations 9, 11, 12, 13, 14, 15, 16, 17, 18, and 19 of the Health and Social Care Act Regulations 2014 and regulation 18 of the Care Quality Commission (Registration) Regulations 2009. The service was put in special measures and we took enforcement action adding a condition to the provider’s registration restricting new admissions to the home until such time as the service was deemed safe, effective, caring, responsive and well led. This additional condition remained in force at the time of this inspection.

This inspection focused on two key questions only safe and well led. Whilst we could see that the provider had made some improvements we again found that the service was not safe or well led and people were at risk of receiving unsafe and ineffective care. We identified breaches of the regulations in respect of Person Centred Care, Safe Care and Treatment, Safeguarding service users from abuse and improper treatment, Good Governance, Staffing and Requirement as to display of performance assessments.

We found that people did not always receive care that was centred on their needs. The registered provider had failed to carry out an assessment of each person’s needs with the involvement of the relevant person and failed to develop plans of care designed to meet their needs and personal preferences.

Care was not being provided in a safe way. The registered person was not assessing the hazards presented to people or developing plans and effective arrangements for care to mitigate risk of harm.

Managers and staff failed to protect people from the risk of abuse. Poor communication in the home meant that managers were not always aware of incidents of abuse and on some occasions when they were made aware they failed to operate effective adult safeguarding procedures.

Whilst there were sufficient numbers of

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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.

Lyme Green Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. This home is not registered to provide nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 60 people across three separate units, each of which have separate adapted facilities named the Villa Suite, Lymes Suite and Manor Suite. Staff and the people who live at the home refer to each unit as the Villa, Lymes and the Manor and we have done the same throughout this report. At the time of our inspection started there were 49 people living at the home.

This comprehensive inspection of Lyme Green Hall was undertaken following our receipt of a number of concerns raised on behalf of people who used the service. We visited the home unannounced on the 31 October 2017 and carried out five further visits on the 01, 07 and 17 November and 04 and 19 December 2017.

At the last inspection on 16 August 2016, we found the provider was not meeting all the requirements of the regulations. Regulation 18 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Staffing) had been breached because the provider had failed to deploy sufficient numbers of suitably qualified and experienced staff.

Regulation 12 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Safe care and treatment) had also been breached because staff were not following policies and procedures on the administration and recording of medicines.

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This location requires a registered manager to be in post. A registered manager was in post 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. The registered manager resigned on the third day of our inspection and left without prior notice of her decision to leave.

At this inspection, we found that the provider was in breach of regulations 9, 11, 12, 13, 14, 15, 16, 17, 18, 19 and 18 of the Health and Social Care Act Regulations 2014 and regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

We found that the service was not safe, effective, caring, responsive or well led.

We found that there was an insufficient number of suitably trained and competent staff on duty to meet the needs of the 49 people who lived at the home. We found evidence of poor communication between the registered manager and staff, ineffective and inappropriate care practice, and a lack of knowledge regarding the requirements of the regulations designed to ensure safe and effective care. The registered manager responded ineffectively when we asked for information or highlighted concerns about people’s care and did not demonstrate that they had the necessary competencies to manage the home safely and effectively. Vulnerable people did not always have their needs assessed when their circumstances changed so they remained at risk of their needs not being met. Staff were found to be improvising when assisting people with their mobility in the absence of effective assessment, care planning, training, equipment and skill.

People who were identified as being at high risk of falls were not being reviewed following each fall to mitigate the risks of a reoc

The inspection visit at Lyme Green Hall took place on 16 August 2016 and was unannounced.

Lyme Green Hall offers accommodation for a maximum of 60 people who require nursing or personal care. The premises are set within its own grounds in a semi-rural residential location in Macclesfield. The home is subdivided into three distinct areas, each with individual bathroom facilities, communal lounges and dining rooms: Villa Suite, Lymes Suite and Manor Suite. Most of the bedrooms have en-suite toilet facilities and access between floors is by stairs or passenger lift. At the time of our inspection there were 54 people living at the home.

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 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 12 November 2013, we found the provider was meeting the requirements of the regulations inspected.

During this inspection, the provider did not ensure staff followed policies and procedures on the administration and recording of medicines.

This was a breach of Regulation 12 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Safe care and treatment.) You can see what action we told the provider to take at the back of the full version of the report.

We observed the provider failed to deploy sufficient numbers of suitably qualified and experienced staff throughout the home to keep people safe and meet their care and treatment needs.

This was a breach of Regulation 18 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Staffing.) You can see what action we told the provider to take at the back of the full version of the report.

Staff received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

Staff had received training to identify abuse and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.

People and their representatives told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People, who were able, told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

We found people had access to healthcare professionals and their healthcare needs were met. We saw the management team had responded promptly when people had experienced health problems.

Care plans were organised and identified the care and support people required. We found they were informative about the care people received. They had been kept under review and updated when necessary to reflect people’s changing needs.

People told us they were happy with the activities organised at Lyme Green Hall. The activities were arranged for individuals and for groups.

A complaints procedure was available and people we spoke with said they knew how to complain.

People and staff spoken with felt the registered manager was accessible, supportive and approachable.

The registered manager had sought feedback from people who lived at the home and staff. They had consulted with people and their relatives for input on how the service could continually improve. The provider had regularly completed a range of audits to maintain people’s safety and welfare.

When we visited the home we spoke with the manager, staff, relatives and people who lived at the home. We also had responses from external agencies including social services .This helped us to gain a balanced overview of what people experienced living at Lyme Green Hall.

During the inspection we looked at care planning, food preparation and complaints records. We also observed care practices during the day and talked with people and relatives about the home. Comments were positive and included, “The staff and manager are caring people I have no worries with my relative being here.” Also from a person living at the home, “The staff entertain us all the time. They do make sure people are able to do what they want within reason.”

We spoke with people who lived at the home. They told us they could express their views and were involved in making decisions about their care. They told us they felt listened to when discussing their care needs.

We spoke with people about their diet and how their nutritional needs were being met. They told us they were satisfied with the food and the quality and quantity. One person said, “The food is wonderful.” Another person said, “We are lucky to have good cooks who make homemade meals.”

There were a range of audits and systems in place to monitor the quality of the service being provided.

When we visited Lyme Green Hall we spoke with 11 of the people who lived at the home. Some of the people we spoke with were able to discuss the way their care was provided. We asked them about their experiences of how the service involved them and kept them informed. They told us that they were happy and very well looked after.

A visitor told us that they had been involved in a recent review of their relatives needs and found the process helpful, informative and reassuring. They told us that their relative needed support to make decisions and the manager had discussed the persons care plan with them and made amendments to it so they received care and support in a way that suited them.

We spoke with two people about the home’s medicines arrangements. Both people were happy for staff to manage their medicines. One person confirmed that they could have their painkillers at the times they needed them.

All the people we spoke with made positive comments about the staff praising them for their kindness and care. One person said “the staff are very good, I have no complaints”. Another person said “I am very happy and well looked after”.

A visitor told us that they had seen a significant improvement in the staff team and were impressed by them. They said “the staff are well trained, dedicated, tender and caring”.

When we visited Lyme Green Hall we spoke with nine of the people who lived at the home. Some of the people we spoke with were able to discuss the way their care was provided. We asked them about their experiences of how the service involved them and kept them informed. They told us that they were treated with respect and were always involved in making decisions about their care and support.

Several people made positive comments about the staff and the standard of care provided. One person said: “The staff were very good, there is enough of them, and they do things the way I want them done”. They told us how they valued their independence and gave an example as to how the staff had helped them to bathe with minimal intervention, so as to enable them to do things for themselves and preserve their dignity and self respect. They said “overall the home is comfortable and they are well looked after so it is really very good”.

Another person who was supported to answer our questions by a visiting relative told us that the home had improved since the beginning of the year and they felt at ease and relaxed in the home’s environment. Their visitor told us that they too had seen significant improvements in the standard of care provided and would now rate the home as “good to excellent”. They told us about the relatives meetings they had attended and how positive the most recent meeting had been. They told us that they had been invited to attend a review meeting and had seen their relatives care plans. They told us that they had every confidence in the manager who had listened to their views and had acted on them.

People we spoke with during our visit told us that they felt safe and well cared for living at Lyme Green Hall. A visiting relative told us that they had every confidence in the management team. They said they had no doubt that their relative was safe.

People told us that they found the home to be clean conformable, well decorated and well furnished throughout.

Some people living at Lyme Green Hall were unable to directly express their views about their medication due to a variety of complex needs. One person told us that they were happy that staff looked after their medicines as they would be worried about doing their own.

We carried out this review of compliance because a number of people contacted the commission and raised concerns about the standard of care provided at the home. Relatives of two people who lived at the home told us that standards of care were deteriorating and they were concerned for the welfare of their relatives. They told us that there were not enough staff on duty to meet the needs of all the people who live at the home and this had meant there were times when their relatives’ needs had not been met.

When we visited Lyme Green Hall we spoke with thirteen of the people who lived there and five of their visiting relatives. All the people we spoke with told us that the staff were always kind and courteous. All the relatives spoken with told us that they were happy with the standard of care provided.

One group of people living in the home told us that there is often only one member of staff on duty. They said “the staff are very nice but they can’t cope with all of us”. They told us that there were not enough staff on duty, so when they needed a drink or assistance to use the toilet or bathe they had to wait. Another person told us that there was not enough going on; they said that they could entertain themselves but others needed support and encouragement that not available.