The inspection of Lyndale took place on 22 and 23 August 2018 and was unannounced on the first day. The previous inspection in April 2017 had found two breaches of the Health and Social Care Act 2008 Regulations in relation to safe care and treatment and good governance. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, safe, effective, responsive and well led, to at least good. We received this and checked on this inspection to see if improvements had been made.

Lyndale 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. Lyndale accommodates 18 people in one adapted building. On the days of the inspection there were 17 people living at Lyndale, two of whom were on respite. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in post and they were available during the 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.

People were safe as staff knew them very well, and there were detailed, individualised risk assessments in place. The staff team was stable with an in-depth knowledge of people living at the home and they were able to describe and show how they supported people in their preferred manner.

Medication administration was safe and followed all required guidance, and infection control practice was also proficient. There were few incidents within the home but where these had occurred, there was evidence of reflection and analysis to minimise the likelihood of reoccurrence.

The registered manager and senior management team demonstrated understanding of key regulation and guidance, and supported people to be as independent as possible. 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 supported this practice.

People needing assistance with nutrition and hydration received this from competent staff and staff also were vigilant in observing for the smallest of changes in people’s wellbeing, requesting extra support where necessary. Staff received supervision and training and were competent in supporting people effectively. Staff were also very clear this was people’s home and they were there to enable. They worked well as a team.

There had been a considerable programme of environmental improvements since the last inspection and this had resulted in a usable, accessible outdoor area for people to use independently and also internally building work ensured easier access for those becoming physically frailer.

People were comfortable and affectionate towards staff and we observed some very positive interactions between people. Emotional support was offered to people who were feeling low in mood in a sensitive and discreet manner. Records showed people took an active role in choosing what and how they did things. Privacy was respected at all times and people encouraged to change clothing or seek support with personal care when needed.

Care was delivered as people requested it. People had choice as to how to spend their days and every effort was made to accommodate their wishes. People were keen to share their po

The inspection was carried out on 11 and 18 April 2017 and was unannounced. Lyndale provides accommodation and support for up to 18 people with learning disabilities. There were 17 people living in the home at the time of the inspection, with some people using the service for occasional respite care. The home was over two floors with communal areas where people could spend recreation time. The previous inspection of the service was in March 2016 and was rated 'requires improvement'. The inspection found the provider had taken some measures to address the issues of the previous inspection, although not all actions had been thoroughly addressed.

A registered manager was 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 of the Health and Social Care Act 2008 and associated regulations about how the service is run.

Staff understood how to safeguard people from abuse and they knew the procedure to report any concerns.

The premises were in need of refurbishment and there was a planned programme in place. The provider responded promptly to safety issues in the premises highlighted on the first day of the inspection

Individual risks to people were not always robustly identified, assessed or mitigated to ensure people’s safety.

People received their medicines when they needed them, although there were weaknesses in the management of medicines and how these were recorded.

Staffing levels were supportive of people’s needs and training opportunities for staff had improved since the last inspection. There were clear processes for the induction and support of new staff.

People were enabled 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 supported this practice. The provider had taken steps to ensure applications were made to ensure Deprivation of Liberty Safeguards (DoLS) were in place for people where necessary. However, staff were not all confident about DoLS or the Mental Capacity Act (2005) (MCA) and how it may impact on the day to day aspects of people’s care.

Mealtimes and the provision of food and drink was very supportive of people’s individual needs, preferences and rights and there were referrals made to dieticians of other professionals as necessary to support people’s health.

People had good relationships with staff who respected their privacy and dignity, and knew each person very well.

Care plans were person-centred, although some information lacked detail and information was not always in place.

People were involved in a range of activities at the home and on outings organised by the provider and they chose whether they wished to participate.

People were confident to approach staff to discuss any aspect of their care. We saw there were no complaints recorded since 2003, although there was evidence not all matters of concern raised were recorded as complaints.

The home was well established and people knew who was in charge. People, relatives and staff felt the home was managed well. Quality assurance systems were in place although these were not robust and there was no clear accountability for key responsibilities.

We inspected the service on 4 March 2016. Lyndale provides accommodation and support for up to 18 people with learning disabilities. There were 17 people living in the service at the time of our inspection with a number of other people regularly using the other room on a respite basis. The home was spread over two floors with communal areas where people could spent time as well as an enclosed garden.

A registered manager was 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.

People told us they felt safe in the home. Staff told us they were confident people were safe and that they had not seen anything of concern whilst working in the home. Safeguarding procedures were in place which were understood by staff.

Risks to people’s health and safety were assessed by the service and risk assessments which were in place were well understood by staff.

There were sufficient quantities of staff to ensure people were kept safe and ensure they had opportunities to participate in a varied programme of activities. Safe recruitment procedures were in place to ensure staff were of suitable character to care for vulnerable people.

Medicines were safely managed. People received their medicines as prescribed and clear records were kept.

The service was not compliant with the Deprivation of Liberty Safeguards (DoLS). The service had not taken steps to assess the restrictions placed on people and put in DoLS assessments where appropriate.

People and relatives told us that staff had the right skills and knowledge to care for them. ;;Staff had access to a range of training. However training was not always provided in a timely manner to some staff.

People were supported appropriately to eat and drink and maintain a healthy lifestyle.

The service supported people to access a range of healthcare services to help ensure their healthcare needs were met.

People and relatives said staff were kind and caring and treated people with a high level of dignity and respect. During observations of care and support we saw people were treated well by staff. It was clear staff had developed strong relationships with people and knew them well.

People’s needs were assessed by the service and plans of care put in place to help staff deliver appropriate care. People’s care and support needs were reviewed on a monthly basis which helped ensure the service stayed responsive to people.

The service helped people develop and maintain their independence by encouraging them to assist with daily life within the home.

People had access to a range of activities and social opportunities. People were encouraged to go out into the community on a daily basis to undertake meaningful activity.

Staff told us morale was good and they felt the management team was supportive of them. People and relatives we spoke with also praised the way the service was run.

Key information was not always present within people’s care and support plans to demonstrate that the service had fully assessed people’s needs and provided the required care and support. For example in one case, records of fluid intake were not fully completed and other documentation was out of date and no longer relevant.

Systems were in place to assess and monitor the quality of the service. For example people were asked for their views on the service through quality questionnaires. The management team undertook a range of audits and checks. However there was a lack of structure to this with audits and checks taking place at inconsistent intervals.

We found two breaches of the Health and Social Care Act (2008) Regulated Activities 2014 Regulations. You can see what action we asked the provid

The environment in which people lived promoted their privacy and dignity and supported their rights to choose and retain a level of independence. Each person using the service either had their own bedroom or shared a room with another person. One member of staff said that people had a choice as to whether they shared a room or not.

Care records recorded information on people’s daily routine. They described what time people liked to get up, what they liked to eat and drink, and how they liked to spend their day. There was a weekly activities document which had information on the social activities people like to get involved in.

We spoke to three people who use the service and two relatives. We observed the care and treatment of people living in the home. One person said “ I like it here”. People were observed being involved in various activities and were spoken to in a kind and caring way by staff.

One relative said “I am very happy with the care that my relative is getting. I can go into the home anytime and it is always the same. It is good”. Another relative said “ My relative appears happy, he is not presenting with any problems. He comes to me regularly so I would be able to tell if he had any concerns”.

People’s needs were assessed and care and treatment was planned in line with their individual care plan. We looked at three care records and saw that records recorded information on people’s communication and dressing skills, personal care, mobility and personal safety.

All of the staff we spoke to during out visit was familiar with safeguarding procedures. When asked what constituted abuse one member of staff said “ It can be anything, verbal, physical, sexual even something like when someone asks for something you don’t give it to them”.

We looked at three staff records which demonstrated that effective recruitment and selection procedures were in place. We did note however, that one record did not have a photograph of the member of staff. The deputy manager said that she would rectify this.

The deputy manager said that they had not had any complaints for a number of years. We saw that the last record of a complaint was recorded in 2003. The manager did say however, that they did document any “grumbles” that people had in the daily diary.

We used a number of different methods to help us understand the experiences of people using the service including talking to people and observing the care provided. We spent time with people and we observed staff being friendly and warm towards people. We observed that staff and people who lived at the service had positive relationships. People appeared relaxed and comfortable with their surroundings; with staff and the activities they were engaged in. We saw that staff supported people to make choices about their daily living.

We spoke with people who used the service and they told us that they had been included in decisions about what care and support they received. One person told us "It’s a good place to live. I decided how my bedroom was decorated and where I went on holiday." Another person said "The staff are lovely. We all decide what meals we have".

We spoke with four members of staff who were able to demonstrate a good understanding of the needs of the people who lived at Lyndale. They told us that they were well supported by managers of the home and there were good opportunities for training.