The inspection took place on 7 November 2018 and was unannounced.

Lynden Hill Clinic is a care home with nursing. It is registered to provide a service for up to 28 people and provides respite, rehabilitation, therapies and nursing care. At the time of our inspection 13 people were receiving personal care, nursing and complimentary therapies provided by the service.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the overall rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were safeguarded from the risk of abuse. Potential risks to people had been assessed and managed to help them to stay safe. There were sufficient staff to provide people with their care safely. People received their medicines as required, from trained and competent staff. Staff ensured people were protected from the risk of acquiring an infection during the provision of their care. Processes were in place to ensure any incidents were reflected upon and relevant changes made for people's future safety.

People were cared for by staff who had received appropriate training, support and supervision in their role. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were supported to eat and drink sufficiently for their needs. Staff supported people to see a range of healthcare professionals in order to maintain good health and wellbeing.

People consistently reported they were treated in a caring and kind manner by staff. People were supported by staff to express their views and to be involved in decisions about their care. Staff ensured people's privacy and dignity were upheld and independence promoted during the provision of their personal care. People’s human rights were respected and supported.

People received personalised care which was responsive to their needs. People's concerns and complaints were encouraged, listened to and relevant action taken in line with the providers policy and procedures. The provider did not offer end of life care so we could not inspect this area.

The provider had effective governance processes in place. People and staff were encouraged to be actively involved in the development and continuous improvement of the home. The provider had robust quality assurance systems which operated across all levels of the service. Staff had worked effectively in partnership with other agencies such as GPs, pharmacies and therapists to promote positive outcomes for people.

The inspection took place on 14 and 15 April 2016 and was unannounced. We last inspected the service in May 2014. At that inspection we found the service was compliant with all the essential standards we inspected.

Lynden Hill Clinic is a care home with nursing. It is registered to provide a service for up to 28 people and provides respite, rehabilitation, therapies and nursing care.

The home is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.

At the time of the inspection the registered manager was on long term leave. The Care Quality Commission (CQC) had been made aware of this and the arrangements for managing the service in their absence. A new manager had been appointed and had begun the application process to register with CQC to become a registered manager. They assisted with the inspection.

People felt safe using the service. Staff understood their responsibilities to safeguard people and were familiar with the procedure to follow to raise concerns. Risks to people’s safety were assessed and measures were taken to reduce them. Staff were recruited safely and there were sufficient numbers of staff to provide a safe service.

Medicines were managed safely and people received them when they needed them.

People had access to effective healthcare from a GP and other healthcare professionals when required.

People were provided with nutritious food tailored to their choice and tastes. When necessary people’s food and fluid intake was carefully monitored.

People felt staff were competent and well trained. Staff received induction and training in core subjects but we found not all training was up to date. The manager agreed to address this.

Staff sought people’s consent before offering care. However, not all staff had received training in the Mental Capacity Act 2005 (MCA). Therefore we could not be assured people’s rights to make decisions were always protected. We have made a recommendation about staff training on the MCA.

The service had a relaxed and positive atmosphere. People told us they were happy using the service. People had been involved in drawing up their care plans. The care plans were focused on the individual and recorded their personal preferences. Staff were aware of how people liked to receive care.

People’s privacy and dignity was respected and staff enabled people to regain their independence and maintain it whenever possible. People were treated with kindness and compassion by friendly and attentive staff.

Complaints were investigated and responded to appropriately. The quality of the service was monitored and audits were conducted regularly by the management team. Feedback was encouraged from people and used to make improvements.

At the time of our inspection there were 25 people using the service. Four people required long term care and treatment. The other 21 people required short term rehabilitation care to help them return to their own homes.

We spoke with five people who use the service and one person’s relative, and observed interactions between staff and the people they care for. We spoke with the service’s registered manager, clinical nurse manager, a physiotherapy assistant, three care workers, two registered nurses and the housekeeping supervisor. We looked at records and documents held by the service, and requested further information to be sent to us to clarify information we saw.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found.

Is the service caring?

One person described the service as “A haven, the care is absolutely incomparable. I’ve been here before so I knew everything would be alright. The physiotherapy is out of this world, it’s amazing what they can do for you”. We observed staff were respectful and caring. People were not rushed with their care and support. When people requested support this was provided promptly and discreetly.

Is the service responsive?

We observed staff understood people’s care and support needs. An initial assessment identified people’s needs on arrival. We saw care plans were updated to reflect people’s changing needs as their rehabilitation progressed. For people who received long term care, plans were reviewed monthly to ensure people were supported in accordance with their needs and wishes.

We observed staff communicated effectively to ensure any concerns were addressed promptly. For example, we saw a concern raised by a relative to a nurse was resolved immediately. Other staff were informed of the actions taken and follow up actions required at staff handover later the same day.

Is the service safe?

People told us they felt safe with staff, and were supported to promote their independence safely within the grounds and local community. Staff ensured people were protected from the risk of healthcare associated infections and cross contamination through the use of effective infection control methods. All staff were trained in infection control. The service was clean, and staff followed the provider’s policies to maintain good hygiene practices.

People’s care was planned and risk assessed to ensure people were supported safely. Actions and equipment to support people to rehabilitate safely were promoted, such as the use of walking aids and appropriate footwear. Physiotherapy developed people’s ability to mobilise safely, and gave them confidence to return to their homes when it was safe to do so.

The provider had an effective recruitment process to ensure people were supported by suitable staff. All checks required by the Regulations, such as verification of an applicant’s identity, reference to good character and criminal records checks, were completed before staff were offered employment. The provider checked evidence of claimed qualifications and registrations.

Is the service effective?

One person we spoke with said “Staff discuss your care with you. It’s an ongoing thing”. Another told us staff “Respect my wishes”. We saw care plans reflected people’s wishes and preferences. Staff had training to understand the Mental Capacity Act 2005, and were able to explain to us what this meant to them. One nurse told us they always discussed care and treatment with people. They said “It’s their choice, we can’t force them”.

We saw people’s mental health was assessed on admission to the service. Staff understood when it was appropriate to conduct best interest decision meetings, and were supported with guidance and policies available from the provider.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to this service. The DoLS are a legal process supported by a code of practice to ensure that people who lack mental capacity to make decisions are not deprived of their liberty, other than in accordance with the law. The manager told us they had not needed to apply for DoLS for any of the people who use the service, but they were aware of the process to follow.

We saw multi-disciplinary meetings were held daily to ensure care and treatment was understood by all staff. This promoted people’s health and wellbeing. Staff told us communication was effective, and promoted the sharing of knowledge and understanding of people’s progress or any concerns. This meant care and treatment was provided consistently and effectively to meet people’s rehabilitation and care needs.

Is the service well led?

All the people we spoke with told us they were pleased with the care they received. Staff told us they felt supported, and all staff worked together as a team.

Policies and procedures ensured staff understood the standards expected by the provider, and staff followed good practice guidance. The provider sought feedback from people and staff to monitor the quality of the service provided. We saw feedback was complimentary. Where suggestions or concerns were raised, senior management responded promptly to address issues identified.

Internal audits were scheduled and completed to ensure required standards were met. For example, we saw notes from an infection control audit completed in April 2014. Issues identified were promptly addressed. Senior staff conducted spot checks to ensure staff displayed appropriate actions to reduce the risk of cross contamination, for example, through the use of personal protective equipment such as gloves and aprons, and conducting good hand washing technique.

We met with four people receiving care; one visitor and six members of staff.

People using the service were all complimentary about the quality of care that they received. People told us that "staff are exceptional" and one person said that the clinic had been a "life saver". Some people had chosen to return to the clinic and other had recommended it to their family and friends.

Staff were described as "kind" and "always happy" and people appreciated the environment, especially the cleanliness and quality of furnishings. We saw that the clinic was well maintained, warm and welcoming.

We saw that people's care needs were regularly reviewed but noted that the care records for people receiving longer term support lacked the same level of rigor as the records for people admitted for a short period of time.

People felt safe and staff felt supported. Staff described the clinic as a "unique place" and all seemed proud to work there and were motivated.

People felt involved in their care and were able to make choices. They appreciated the range of therapies and treatments available to support them in their rehabilitation.

People's views were taken into account in the way the service was delivered.

During the inspection, we spoke with seven people using the service (three people lived at the service and four people were 'short stay patients'). We also spoke with seven members of staff.

People using the service were very complimentary about the care and services provided. One person described the service as 'exemplary'; another person said 'I would highly recommend it to anybody and don't want to go home.'

Staff were described as 'kind', 'very respectful' and having a 'perfect manner.' People said that they were involved in their care and were able to 'stay in control'.

Peoples' healthcare needs were assessed and regularly evaluated. Staff had a holistic approach to care and supported the 'whole person.'

Staff were aware of safeguarding procedures and had received appropriate training.

Staffing levels were very good. People using the service described prompt responses to their requests. Staff were supported and motivated to provide high quality care.

Comprehensive systems were in place to monitor the quality of care and services provided. Peoples' views were listened to and acted upon. The service was committed to continuous improvement.