This inspection took place 23 January 2019 and was unannounced. This inspection was completed due to a safeguarding incident.

We had previously carried out an unannounced comprehensive inspection of this service on 23 August 2018, where one breach of legal requirement was found. After the inspection, the provider wrote to us, with an action plan, to say what they would do to meet the legal requirement in relation to their governance practices.

At this inspection, we checked whether the provider had followed their action plan to determine whether they now met legal requirements. Although some action had been taken, we found the provider was still not meeting the legal requirements for governance. We also found two further breaches of legislation relating to safeguarding and the management of risk.

Lymehurst is registered to provide accommodation and personal care to up to 35 people. At the time of the inspection 29 people were using the service.

Lymehurst is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager in post but they were not present for 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 overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

The registered manager had failed to escalate safeguarding concerns in line with local safeguarding protocols. When the provider was made aware, they acted quickly to ensure everyone living at Lymehurst was kept safe from the risk of abuse.

When people had accidents, their care was not reviewed to show it continued to meet their needs. Incidents were not investigated or followed up. There were no records of people being referred to specialist teams when they had a high incidence of accidents.

The registered manager had not fully implemented new quality systems, despite the provider introducing these. The provider had not ensured sufficient management oversight in the running of the home.

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This unannounced inspection took place on 23 August 2018. At our previous inspection in December 2015 we had rated Lymehurst as good.

Lymehurst is registered to provide accommodation and personal care to up to 35 people. At the time of the inspection 31 people were using the service.

Lymehurst is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager 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.'

At this inspection we found that there were no effective governance systems in place to monitor and improve the quality of the service. We found there was a breach of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken to the end of the report.

People's needs were not always met in a timely manner due to the deployment of staff. Risks associated with some staff employed by the service had not been minimised.

People's risks were assessed, however their risk assessments did not always contain the most up to date information. There was no system in place to learn from accidents and incidents when things had gone wrong.

Infection control procedures were followed by care staff. However the kitchen hygiene measures put people at risk. Oral medicines were stored and managed safely, however external creams were not signed for when administered.

The registered manager followed the local safeguarding procedures, however some staff had not received training in safeguarding policies and procedures.

People's needs were not fully assessed to ensure their diverse needs were identified and met and they were not supported by staff who had been trained and assessed competent in their roles.

People were offered sufficient amounts of food and drinks, however they were not offered a choice of food or involved in the menu planning.

Staff at the service worked with other health and social care agencies and people had access to health care when they were unwell or their needs changed.

The principles of the Mental Capacity Act 2005 (MCA) were being followed, however some people required accessible information to be able to consent to their care.

People were not always treated with dignity and respect and they were not always supported to make decisions about their care and support.

People's right to privacy was not always maintained.

People were not receiving personalised care that met their individual needs as information about their diverse needs had not been gained.

People did not have access to the complaints procedure in an accessible format and their complaints were not always acted upon.

People's end of life wishes had been gained.

This inspection took place on 2 December 2015 and was unannounced.

Lymehurst is a care home registered to provide accommodation with personal care and support for 35 older people some of who may be living with dementia. At the time of our inspection they were providing care and support for 25 people.

There is a registered manager 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.

People were protected from harm and abuse because they were supported by staff that identified any risks to people and took action to minimise harm. Staff did not start work at the home until appropriate checks had been made to make sure they were suitable to support people.

Staffing levels and the skill mix of staff were sufficient to meet the needs of people who lived in the home and to keep them safe.

Medicine was stored securely. People were prescribed medication that had to be administered ‘as and when required’ and the procedures for this were in place.

People were involved in the planning and reviewing of their care. The provider encouraged people to raise any issues and people were confident that action would be taken by the management team to resolve any issues.

Staff obtained consent from people before they provided care and support. The management and staff had an understanding of providing care to people who lacked the capacity to make their own decisions. This meant that people had their rights protected.

People were assisted to eat and drink enough to keep them healthy. People were supported to access a variety of healthcare professionals to ensure their physical and mental healthcare needs were met. People were assisted to see their GP as and when required.

People living at the home considered that staff were caring and kind and promoted their privacy and dignity. People were supported to maintain their independence where possible. Staff had developed positive working relationships with the people they supported. People were encouraged to make their own choices and decisions and felt listened to and respected.

Staff were aware of the activities people enjoyed and what was of interest to them. People were supported to take part in activities both in the home and in the community. Activities were planned on a regular basis and people were encouraged to tell staff what they would like to do and efforts were made to accommodate these requests.

Staff received induction and on-going training in order for them to provide care. Staff were supported by the management team and received regular feedback on their performance.

People knew how to make a complaint if they needed. The provider had daily contact with people and observed staff practice to ensure standards of care were maintained. People’s views were sought on a regular basis by survey or meetings and any areas for improvement were identified and acted upon. People were aware of who the management team were and felt they were approachable and listened to them.

This was a follow up inspection to ensure the provider had completed actions as a result of our last inspection on 27 June 2013.

During our inspection we found the provider had made improvements.

The registered manager was not present during our inspection but was on call. We spoke with them over the telephone. They provided us with an overview of progress that had been made since our last visit. One of the providers was present to assist us with our inspection.

People told us they felt safe in the care of the staff. Staff spoken with knew how to protect people against the risk of abuse.

The provider had a system in place that ensured staff were supported and their training was kept up to date.

Not all the people we met were able to speak with us about the care they received and their experience of living in the home. Therefore we observed how staff interacted and supported people. This helped us to make a judgement on how their needs were being met.

People who used the service and their representatives told us they were happy with the care and support they received.

Since our last visit all care plans had been updated and reviewed and provided much more detail about individual’s needs.

People who used the service were not protected from the risk of abuse because the provider had not taken reasonable steps to ensure staff were trained to recognise the signs of abuse and act appropriately. This meant people may be at risk of harm.

Staffing levels had improved since our last visit. People told us there always appeared to be enough staff on duty.

The provider had undertaken some staff performance appraisals since our last visit and was working towards completing the remainder. A training needs analysis had been undertaken for all staff. However, there were some gaps where training had not been identified as a requirement. This was discussed with the provider at the time of our visit.

We were informed the manager spends two days a week at the home and performed on call cover each night. The duty rota did not reflect this information and it was evident that the reduced presence of the registered manager was having an impact on the overall quality of the service people received.

People shared mixed experiences of the care and support they received. Comments included, “They look after me well” and, “The care is good but it could be better”. People’s health needs were closely monitored by the staff and visiting health professionals.

The lack of detail in care plans did not support the delivery of personalised care. They did not inform staff about how to deliver safe and effective care to support people in a way that they preferred.

People were not always adequately supervised to ensure their safety or wellbeing. Managers could not show that they had carried out a needs analysis and risk assessment as the basis for deciding sufficient staffing levels based on people’s changing needs and the layout of the home.

Staff told us they had attended a range of training courses to equip them with the knowledge and skills to effectively carry out their duties. However, staff had not had the opportunity to regularly meet with managers to share any issues or concerns or to review their practice and address any training and development needs.

Records were not effectively maintained to ensure the safety of the people living at the home or the safe running of the service.

We spoke with 13 of the 30 people who were living at the home. People shared positive experiences of the care and support they received. Comments included, “It’s absolutely marvellous. We couldn’t be better looked after.” “The carers are excellent, they are good fun and we can have a laugh with them.”

People told us they enjoyed living at Lymehurst and felt involved in their care. They said they were offered choices in their daily living for example when to get up and retire, a choice of food and some activities. People said staff respected their privacy and dignity and always knocked on their door before entering.

People said they felt safe living at the home. One person commented, “The staff treat me well.” Staff told us they had received training in keeping people safe. They demonstrated an understanding of the different forms of abuse and knew the procedure to follow if they suspected abuse or observed poor practice.

People told us staff were kind and caring. One person said, “You can’t fault the staff, they are lovely.” Staff told us they had attended a range of training courses to equip them with the knowledge and skills to carry out their duties and meet people’s needs.

People said they were satisfied with the service they received. They told us they felt listened to and were confident in raising any concerns. A number of people said they would welcome more residents’ meetings to share their views.

This inspection took place on 9 and 10 December 2014 and was unannounced.

Lymehurst provides accommodation and personal care for older people and people living with dementia for a maximum of 35. There were 30 people living at the home when we inspected.

The home had a registered manager in post; both the manager and one of the providers were present for 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.

We found that the management of medicines had not ensured people received their prescribed medicines. Records indicated that a person had not received their treatment for eight days.

People told us that they felt safe living in the home. We found that staff had a good understanding of the importance of keeping people safe. Staff were also aware of their responsibility of sharing concerns of poor care practices with the registered manager.

People told us that staff were always nearby to support them with their care needs. We observed that people did not have to wait long for support when needed. We found that the provider’s recruitment procedure was robust to ensure that staff were suitable to work in the home. Discussions with staff and the records we looked at confirmed that safety checks were carried out before people started working in the home.

We found that the provider had a good understanding when it was necessary to carry out a Mental Capacity Act assessment and when Deprivation of Liberty Safeguards (DoLS) should be put in place. However, some improvements were required to find out if DoLS that had expired needed to be reviewed and extended. We saw a number of ‘do not attempt cardio pulmonary resuscitation’ forms in place. However, best interest meetings had not been carried out to ensure that decisions made were in the person’s best interest.

Although staff supervisions were infrequent, staff told us that they felt supported and had access to routine training. Staff told us that they were happy working at the home.

People told us that they were happy with the meals provided and we found that the cook was able to cater for people’s specific dietary needs. People had access to drinks at all times and staff were always nearby to assist people with their meals when needed. People told us that they were happy with the care and support they had received. Although people were unaware of their care plan. They told us that they had discussions with the manager about changes to the care and their support needs.

People told us that they were confident that if they had any problems the manager would sort them out. Complaints were recorded and showed what action had been taken to resolve the concern. We found that quality assurance audits in place were not robust. For example, there were no audits in place to monitor accidents and to take action to reduce the risk of them happening again. The audit in place for the safe management of medicine was not effective to ensure that people received their prescribed medicines.

Arrangements were in place to enable people to tell the provider about their experiences of using the service. People had access to regular meetings that gave them the opportunity to have a say in the running of the home. The people we spoke with and staff were aware of the management structure. We saw that staff were supported by the management team during our inspection to ensure people’s care and support needs were met.