About the service:

Lymewood Court Nursing Home provides both nursing and personal care in one building for up to 46 people, some of whom live with dementia. When we inspected 34 people lived at the service.

People’s experience of using this service:

The providers processes for checking on the quality and safety of the service were not always effective in identifying and mitigating risk to people. The provider did not have sufficient oversight of the service to ensure consistent leadership and the delivery of safe care. There was a lack of partnership working with external agencies which delayed a safeguarding investigation.

The provider reflected on the concerns raised prior to the inspection and our findings. They advised us after our inspection that they had implemented a series of changes to their systems and approach to governance to bring about the required improvements.

We have made a recommendation about infection prevention and control. People were not fully protected from the risk of the spread of infection and risks to their health and safety. Clinical waste was not safely managed, and equipment used for people was not kept clean and hygienic. Action was taken at the time of the inspection to mitigate the risk of the spread of infection.

We have made a recommendation about the safe use of medicines. The management of medicines had improved in response to concerns raised by the Clinical Commissioning Group (CCG) and following our first day of inspection, however further improvements were required. Medication administration records (MARs) lacked information about prescribed creams and how they were to be used. There also needed to be a consistent approach to ensuring the safe management of medicines.

Safe recruitment processes were followed to ensure staff were suitable to work with vulnerable adults. There was enough suitably skilled and experienced staff on duty to safely meet people’s needs.

A full description of our findings can be found in the sections below.

Why we inspected: This inspection was prompted by information of concern which we received from partner agencies about people’s safety. As a result, we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to the key questions we ask is the service safe and well-led. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lymewood Court Nursing Home on our website at www.cqc.org.uk.

Rating at last inspection: Good (Published 20 November 2018). The service has a revised rating of requires improvement.

Enforcement: The provider was in breach of regulation 17 because the governance of the service was not effective. You can see what action we told the provider to take at the back of the full version of the report.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. We will work alongside the provider, local authority and clinical commissioning group (CCG) to monitor progress. If any concerning information is received, we may inspect sooner.

What life is like for people using this service:

Improvements had been made since the last inspection to the way medication was managed. Medication was managed safely and people received their all their prescribed medication on time. People were protected from abuse and the risk of abuse because staff understood their role and responsibilities for keeping people safe from harm. People and their family members told us the service was safe. Risks people faced were identified and measures put in place to minimise the risk of harm occurring. People were protected from the risk of the spread of infection because staff followed good infection control practices. The premises and equipment were well maintained, kept clean and they underwent regular safety checks. People’s needs were met by the right amount of staff who were suitably skilled and experienced.

Improvements had been made to the environment since the last inspection. Adaptations had been made to the environment to better meet people’s needs. People’s needs and choices were assessed and planned for. Care plans identified intended outcomes for people and how they were to be met in a way they preferred. People told us they received the right care and support from staff who were well trained and competent at what they did. People were supported to maintain good nutrition and hydration and their healthcare needs were understood and met. People who were able consented to their care and support. Where people lacked capacity to make their own decisions they were made in their best interest in line with the Mental Capacity Act.

Improvements had been made since the last inspection to how people were cared for. People were treated with kindness, compassion and respect. People told us that staff were kind and respectful of their privacy, dignity and independence. Staff used techniques to help relax people with positive outcomes. Family members and other visitors to the service were made to feel welcome at the service.

Improvements had been made since the last inspection to how people’s needs were responded to. People received personalised care and support which was in line with their care plan. People, family members and others knew how to make a complaint. They were confident about complaining should they need to and felt their complaint would be listened to and acted upon quickly.

Improvements had been made since the last inspection to the leadership of the service. There was a positive culture that was person centred and inclusive. People, family members and staff all described the management team as supportive and approachable. They told us many improvements had been made to the service since the last inspection and that they were fully engaged and involved in the running and development of the service. Effective systems were followed to check on the quality and safety of the service which lead to improvements being made.

More information is in Detailed Findings below

Rating at last inspection: Requires Improvement (report published on 08 December 2017)

About the service: Lymewood Court Nursing Home is a residential care home that provides personal and nursing care for up to 46 people, some of whom are living with dementia. At the time of the inspection 44 people lived in the service.

Why we inspected: This was a planned inspection based on the rating at the last inspection. We saw improvements had been made since our last inspection and that the service has improved to good.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The inspection took place on 07, 08 and 15 November 2017. This first day of the inspection was unannounced.

Lymewood Court is a purpose built service, all bedrooms and communal areas are located on the ground floor. The service is registered to accommodate 46 people, there were 41 people living at the service at the time of this inspection.

A registered manager was in post at the time of the inspection visit. They were registered with the Care Quality Commission in July 2017. 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 last inspection of the service was carried out in March 2017 and found that the service was not meeting all the requirements of Health and Social Care Act 2008 and associated Regulations. We asked the registered provider to take action to make improvements in relation to people’s safety, dignity and respect, management of medicines and quality monitoring systems. We received an initial action plan and subsequent actions plans outlining actions completed to date and those that were ongoing. At this inspection we found that the provider had made improvements however we found further improvements were required to become fully compliant with the Fundamental Standards of Quality and Safety.

We have made a recommendation about the management of some medicines. Improvements had been made to the management of medication, however further improvements were required. Some prescribed medication not safely stored and administered in line with national guidance.

People received their prescribed medication on time and medication administration records (MARs) had been signed to indicate this. Where medication was not administered the circumstances for this was recorded. Medication such as eye drops were labelled on opening and used within the expiry date. Handwritten entries made on MARs were signed by two staff to ensure the accuracy of the information recorded.

Improvements had been made to the safety of the environment. People were protected against the risk of fire. Repairs had been carried out on fire doors and automatic closure devices were used for holding fire doors open. Pathways to external fire doors were clear from obstructions and regular checks were carried out to ensure this was maintained.

Improvements had been made to minimise the risk of the spread of infection. Cleaning schedules had been put in place and followed for the cleaning of equipment used by people to help with their comfort and mobility. Each person had their own hoist sling which was stored in their bedroom.

Improvements had been made to the recruitment of staff, however further improvements were required. The required checks on applicant’s criminal background had been carried out before they were allowed to started work at the service. However references obtained for some staff employed since the last inspection had not been obtained in line with the providers recruitment procedure.

Improvements had been made to the system for communicating people’s needs, however further improvements were required. Wound care provided to one person was not effectively communicated making it difficult to establish the actual care provided. Agency nurses were still heavily replied upon to ensure people were supported by the right amount of suitably skilled staff. However the same nurses who were familiar with people’s needs were blocked booked well in advance thus improving communication and consistency of care for people. In addition two permanent nurses had been recruited since the last inspection and further appointments were in the process of being made.

Improvements had been made to assessments, care plans and supplementary care records so that

The inspection took place on 28 February and 01 March 2017. This first day of the inspection was unannounced.

Lymewood Court is a purpose built service, all bedrooms and communal areas are located on the ground floor. The service is registered to accommodate 46 people, there were 45 people living at the service at the time of this inspection.

A registered manager was in post at the time of the inspection visit. They were registered with the Care Quality Commission in June 2016. 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 was absent from work at the time of our inspection. However in February 2017 an interim manager was appointed to manage the service in the absence of the registered manager.

The last inspection of the service was carried out in September 2016 and found that the service was not meeting all the requirements of Health and Social Care Act 2008 and associated Regulations. We asked the registered provider to take action to make improvements in relation to people’s safety, dignity and respect, management of medicines and quality monitoring systems. We received an action plan which showed all actions would be completed by 31 December 2016. However at this inspection we found that the registered provider had not met these legal requirements and we found further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

CQC are now considering the appropriate regulatory response to the concerns we found. We will publish the actions we have taken at a later date.

The management of medication was unsafe. Some people did not receive their prescribed medication because stocks had run out and other people did not receive their medication on time. Medication administration records (MARs) for some people had been signed to indicate they had received prescribed medication which was not given. One person had been administered eye drops which had passed their use by date. Handwritten MARs had not been signed by two staff to ensure the accuracy of the information recorded. There was a lack of advice sought from healthcare professionals about the possible effects on people when they did not receive their prescribed medication. This put people’s health safety and wellbeing at risk.

Although some improvements had been made to the environment there were ongoing concerns which put people’s safety at risk. Some remedial work had been carried out on fire doors; however they did not provide people with full protection in the event of a fire. Some failed to close properly, others were damaged and a fire door to a bedroom which was occupied was held open with boxes. Trailing wires and equipment obstructed pathways to external fire doors. We alerted the Fire Safety Authority about our concerns following the inspection.

Equipment used to help people with their comfort and mobility was not clean which increased the risk of the spread of infection.

The recruitment of staff was not safe and thorough. The required checks had not been carried out on staff before they started work at the service. Staff were allowed to start work without some of the appropriate checks having been obtained on their character and suitability to work with vulnerable people.

There was a high use of agency nurses at the service. Agency nurses were called upon to ensure that people were supported by the right amount of suitably skilled staff. However the system for communicating people’s needs onto agency nurses was inadequate which lead to people receiving ineffective care and support.

Assessment’s carried out to plan people’s care were not always reflective of people’s needs. Charts which were in place to monito

The inspection took place on 02, 07 and 12 September 2016. This inspection was unannounced.

Lymewood Court is a purpose built service, all bedrooms and communal areas are located on the ground floor. There is a car park to the front of the building and gardens to the rear. There were 45 people using the service at the time of this inspection.

A registered manager was in post at the time of the inspection visit. They were registered with the Care Quality Commission in 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 last inspection of the service was carried out in May 2014 and we found that the service was meeting all the regulations that were assessed. However this was the first inspection under the current provider who was registered in June 2016.

At this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People’s health and safety was put at risk because parts of the environment were unsafe. Pathways were uneven and had pot holes and a build-up of moss which posed a slip trip and fall hazard. Items of equipment which were stored in communal areas obstructed fire exits and people’s access to areas of the service. Staff removed the equipment after we raised our concerns with them. Some fire doors to people’s bedrooms failed to close properly putting people‘s safety at risk in the event of a fire. The fire doors had been repaired by the second day of our inspection.

The management of medication was not always safe. An open medication trolley was left unattended on a corridor and people who use the service and visitors could have accessed the content of the trolley. Medication administration records (MARs) were not always signed at the right times. Medication for one person was pre dispensed and placed in a pot half an hour before they were due to be administered to the person. Handwritten entries made on some people’s MARs had not been countersigned to check the accuracy of the record made.

Food items were not always safely stored and foods which had exceeded their use by date were kept. Pureed foods were put in the freezer without a label displaying what the content was and without dates to show when it was stored and a use by date. The system for labelling pre prepared foods which were put in the fridge was unreliable because staff were unclear about the information provided. Sauces in the dining room and other food items which were kept in the food stores had passed the use by date. All unlabelled food items and out of date food had been disposed of by the second day of our inspection.

People’s confidentiality, dignity and privacy were not always respected. Some people’s bedrooms could be viewed from the car park at the front of the building. Although bedrooms were fitted with curtains there were no nets curtains or blinds which could be used to promote people’s privacy when they occupied their rooms with their curtains open. People in bed could be seen from the car park outside. The doors to offices where care plans and other personal records belonging to people were stored were left open. In addition staff communication books and monitoring records detailing personal information about people were stored in communal areas.

Although there were systems in place for checking on the quality of the service they did not always identify areas for improvement. When areas of improvement were identified the registered provider failed to act upon them to ensure the health and safety of people who used the service and others. Action plans developed in conjunction w