Lyndhurst Lodge Residential Home 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.

Lyndhurst Lodge Residential Home is located in a residential area of Ashby-de-la-Zouch and is registered to provide accommodation and personal care for up to 19 older adults. At the time of our inspection, there were 19 people living at the service, some of whom were living with dementia.

At our last inspection in May 2016, the service was rated as Good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going 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.

Staff had a good understanding of how to protect people from the risk of abuse and safeguarding procedures to be followed. Risk assessments were in place to manage potential risks for people and staff were clear on the measures they needed to take.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out which helped ensure that suitable staff worked at the service. There were sufficient numbers of staff deployed to keep people safe and their needs were met in a timely manner.

Staff had the skills, knowledge and support they needed to meet people's needs. Staff demonstrated that they knew people well.

Staff received regular support and supervision. This helped them to reflect on their practices and identify areas of personal and professional development.

People were supported to have enough to eat and drink and people had access to healthcare to enable them to maintain their health and well being.

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 were treated with kindness, dignity and respect. Staff spent time getting to know people and their specific needs and wishes.

People and, where appropriate, their relatives, were involved in care planning and were able to contribute to the way in which care was provided. Information in care plans supported staff to provide personalised care and was regularly reviewed to ensure it reflected people's current needs.

A process was in place which ensured people could raise any complaints or concerns. These were acted upon promptly and used to drive improvements in the service.

The provider had systems in place to monitor the quality of the service. People, relatives and staff were supported to share their views about the service and this feedback was used to develop the service to ensure people received good care.

We inspected this service on 23 May 2016. The inspection was unannounced.

The service was last inspected on 2 December 2014. During the last inspection the provider was found not to be meeting five regulations. These were in relation to assessing and monitoring the quality of the service, meeting people’s nutritional needs, involving people in the service, staffing and ensuring that people had consented to care and treatment. We asked the provider to implement changes to ensure that they met the regulations. At this inspection we found that the necessary action had been completed and improvements had been made.

Lyndhurst lodge is a 19 bedded residential home for older people, some of whom have dementia. One the day of our inspection there were 17 people using the service.

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.

People were protected from harm. People told us they felt safe and that there were enough staff available to meet their needs. There was a recruitment policy in place which the registered manager followed. We found that all the required pre-employment checks were being carried out before staff commenced work at the service.

Risks associated with people’s care were assessed and managed to protect people from harm. Staff had received training to meet the needs of the people who used the service. People received their medicines as required and medicines were managed and administered safely.

People’s independence was promoted and staff treated people with dignity and respect. People were supported to follow their interests and engage in activities.

People were supported to make decisions about the care they received. People’s opinions were sought and respected. The provider had considered their responsibility to meet the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The registered manager was clear of their role in ensuring decisions were made in people’s best interest.

The registered manager had assessed the care needs of people using the service. Staff had a clear understanding of their role and how to support people who used the service as individuals.

Staff knew people well and treated them with kindness and compassion.

People enjoyed the meals provided and where they had dietary requirements, these were met.

Systems were in place to monitor the health and wellbeing of people who used the service. People’s health needs were met and when necessary, outside health professionals were contacted for support.

People were supported to follow their interests. Information about planned activities were displayed within the home.

Staff felt supported by the registered manager. The registered manager supervised staff and regularly checked their competency to carry out their role. People who used the service felt they could talk to the registered manager and were confident that they would address issues if required. Relatives found the registered manager to be approachable.

This inspection took place on 2 December 2014 and was unannounced.

Lyndhurst Lodge Residential Home provides care and support for up to 19 older people who require personal care. At the time of our inspection there were 17 people using the service. The majority of the people using the service were living with dementia. The service is located in Ashby de la Zouch in Leicestershire and accommodation is provided over two floors.

At the last inspection on 2 June 2014, we asked the provider to take action to make improvements in relation to how they ensured people were protected from the risk of infection, how people’s consent to care and treatment was obtained, staff training, record keeping and the arrangements in place to monitor the quality of the service and cleanliness of the service.

The provider sent us an action plan outlining how they would make improvements.

At this inspection we found that some of the required improvements had been made. However, we found that some further improvements were needed and additional concerns were identified.

There was a registered manager 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.

We found further concerns during this inspection in relation to staffing levels at the service and how people’s individual needs were being met. All of the people we talked to were positive about the staff who cared for them but many of them told us there were not enough staff to meet people’s needs. We observed people having to wait for assistance and people being left to eat without support. We found that there was an insufficient number of staff working at the service.

We found that the service was failing to respect the privacy of some people using the service and that, at times, people’s dignity was compromised. However we observed that staff treated people with kindness and we observed positive interactions between staff and people using the service. We saw that staff understood people’s individual needs.

Staff had received further training since our last inspection and staff told us that they felt adequately trained and well supported by the registered manager. However, staff supervisions were not being carried out regularly at the service.

We found that the service did not consistently offer a choice of nutritious meals to people and that people were not always supported to eat as they may have required. We found this to be having an impact on people using the service.

People’s consent was not being obtained. We found that current legislation in relation to people’s mental capacity was not being followed. Although mental capacity assessments had been carried out where needed, no best interest meetings and decisions had been documented. People’s care plans did not document their consent or the agreement of their representative on an on-going basis.

There were systems in place to monitor the quality of the service being delivered. These were carried out by the registered manager and identified any shortfalls in relation to infection control, the premises and care planning. However, the quality of care at the service was not being monitored consistently and further improvements were needed in relation to ensuring quality care was being delivered to meet people’s individual needs.

We found that people were now protected from the risk and spread of infection at the service. The registered manager had implemented a number of improvements to the systems in place to ensure the service was clean.

We found that people’s medication was being managed safely.

People felt safe and staff understood how and when to report any safeguarding concerns. Risks to people had been assessed and documented in their care plans and guidance was in place for staff to help them minimise those risks to people.

We found that Deprivation of Liberty Safeguards (DoLS) had been applied for appropriately at the service and that the registered manager had a good understanding of when these should be considered to protect people using the service from being unlawfully deprived of their liberty.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

An inspector and an inspection manager took part in this inspection. As part of our inspection we spoke with three people who used the service, the relatives of two people using the service, a visiting professional and five members of staff working at the service, including the manager.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We found that although nobody using the service was under a Deprivation of Liberty Safeguard (DoLS) at the time of our inspection, appropriate applications had been made by the service in the past. However, people’s mental capacity was not being considered by the service.

We found that people were being cared for in premises which were being maintained to ensure their safety. We found the premises to be safe and secure for people. However, we did not find the premises to be in a clean and hygienic state at the time of our inspection.

People's risks associated with their care were being managed effectively and people were being cared for by adequate numbers of staff.

Is the service effective?

People were involved in their care planning and delivery on an on-going basis. People’s individual likes and dislikes were detailed within their care plans and staff understood people’s care needs. However, care plans did not always contain the relevant information and accurate records were not being held for people.

People’s health needs were being monitored and the relevant health professionals were involved in their care.

People told us that they liked living at the home. One person told us, “I’m happy with everything.” Another person said, “The food is beautiful.”

Staff did not have adequate training to effectively meet the needs of people using the service. There were gaps in staff training in relation to safeguarding vulnerable adults and infection control, amongst others.

Is the service caring?

We observed staff to treat people with respect and maintain their dignity. Staff were kind and compassionate towards people. Staff knew the people they were caring for and we saw that people’s personal histories were detailed in their care plans.

People were able to express their views about how the service was run through regular meetings and people were asked about how they wanted their care to be delivered to them. One person using the service told us, “Anything you want them to do they’ll do it for you.”

Is the service responsive?

There had been no mental capacity assessments carried out for people who may have lacked the capacity to consent to their care. People’s consent was not being obtained at the service and therefore it was not clear how people were agreeing to their plan of care.

People had access to some activities and did not appear to be at risk from social isolation. There were systems in place to obtain people’s views about how the service was being run.

People’s individual needs were assessed on a regular basis, however, some people’s care records were in need of review and updating and some records held for people were not being adequately kept.

Is the service well-led?

There had been a recent change of manager at the home and the current manager had submitted an application to us, the CQC, to become registered at the service. The service was found to be continuing to fail to meet the requirements detailed in this report. We have asked the current manager to make the required improvements within a short timeframe due to continued failings at the service.

We found that although some quality assurance processes were now in place and being carried out effectively, staff training and infection control was not being monitored and addressed at the service. Staff required training in a number of areas and the home was not found to be clean or hygienic at the time of our visit.

Staff, relatives and a visiting professional spoke positively about the new manager in place at the service and told us that this had made a positive difference to how the service was being run.

We carried out this inspection to check whether the provider had made the required improvements since our inspection in September and October 2013 in relation to the standards within this report.

We spoke with the registered manager, the provider and three members of staff working at the home as part of our inspection.

We saw that care plans were in the process of being revised and that they had been updated to reflect any risks associated with people's care. However, some of the staff we spoke with told us that they were not familiar with the content of these care plans. The care plans did not always reflect what was being delivered in practice.

We found that some action had been taken to minimise the risks associated with infection, however, further improvements were required in the recording and management of this.

We found that improvements had been made in relation to the premises in which people were living. We found that there was a lack of management checks in place at the home and that there were no systems in place to ensure the premises were safe or that people were protected from the risk of infection on an ongoing basis.

Staff had been recruited in line with legal requirements.

We carried out this inspection due to concerns in relation to people's care and welfare, the premises people were living in, and in relation to the food and drink offered at the home.

We visited the home on two separate occasions in order to assess the service. During the two days we spoke with five people who used the service and six members of staff working at the service, including the registered manager. We also spoke with a visiting health professional and the relatives of two people who used the service.

Most of the people using the service were happy with the care they received at the home. One person told us that they were concerned about the levels of cleanliness and said staff did not have time to meet people's needs. They said: "They're all over-worked. They've not got time to see to you."

Staff told us there were not enough staff working at the service. One staff member said: "We've told the owners we don't have enough staff but they've said they don't have the money to pay for them." The staff we spoke with said they did their best to meet people's care needs.

We found further concerns during our visit in relation to infection control at the home and found there to be insufficient checks carried out by the registered manager to ensure the quality of the service.