Lyndhurst Residential Care Home is registered to provide personal care and accommodation for up to 42 people. It caters for both long term and respite stays. There were 36 people accommodated at the home at the time of the inspection. The home is located in Middleton, and has a variety of shops and other amenities close by. It is close to local transport links.

At the last inspection of June 2015 the service did not meet all the regulations we inspected and were given requirement actions. The service sent us an action plan to show us how they intended to meet the regulations. At this inspection we saw the improvements had been made and the regulations were met. This unannounced inspection took place on the 05 and 06 January 2017.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff we spoke with were aware of how to protect vulnerable people and had safeguarding policies and procedures to guide them, which included the contact details of the local authority to report to.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow. Their competency was checked regularly.

The home was clean and tidy. The environment was maintained at a good level and homely in character. We saw there was a maintenance person to repair any faulty items of equipment.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities to help protect their health and welfare.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies.

People were given choices in the food they ate and told us it was good. People were encouraged to eat and drink to ensure they were hydrated and well fed.

Most staff had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of her responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed there were good interactions between staff and people who used the service. People told us staff were kind and caring.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and they were regularly reviewed. Plans of care contained people’s personal preferences so they could be treated as individuals.

People were given the information on how to complain with the details of other organisations if they wished to go outside of the service.

Staff and people who used the service all told us managers were approachable and supportive.

Meetings and supervision with staff gave them the opportunity to be involved in the running of the home and discuss their training needs.

The manager conducted sufficient audits to ensure the quality of the service provided was maintained or improved.

There were sufficient activities to provide people with stim

This was an unannounced inspection which took place on 09 June 2015. The service was last inspected on 23 September 2013 when we found it to be meeting all the regulations we reviewed.

Lyndhurst Residential Care Home provides accommodation for up to 33 people who have personal care needs, including those with dementia. There were 31 people living in the service on the day of our inspection.

The service had a registered manager in place 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.

During this inspection we found some risk assessments were in place for people who used the service. However we found that not all necessary risk assessments were in place.

The service only had one environmental risk assessment in place and this was in relation to fire safety. No other risks within the service had been assessed.

People who used the service, staff members and relatives felt that there was not enough staff on duty during certain times of the day and sometimes people had to wait a long period of time before they received the support they needed. The registered manager did not undertake dependency level assessments to ensure adequate staffing levels.

Medicines were not always managed safely. We have made a recommendation about the storage of controlled drugs.

Infection control was not always managed safely. Staff did not always wear the correct Personal Protective Equipment (PPE) when entering the kitchen area. Communal toiletries were being used and dirty linen and clinical waste was placed in bags on the floor of a bathroom.

Fresh fruit and water/juice was not readily available for people who used the service and people who required support to eat their meals were not always supported in a timely manner.

The carpet in the main corridor was torn and uneven and posed a trip hazard for people who used the service, staff members and visitors.

People we spoke with told us they did not get the opportunity to look at a menu. This meant that people who used the service did not know what was on offer for their meal.

We noted there was a lack of appropriate signage for people with dementia throughout the service. This included a lack of pictorial signs to identify toilet and bathroom facilities as well as a lack of photograph’s or other identifying features on bedroom doors. We have made a recommendation about dementia friendly environments.

We did not see any evidence of dementia friendly resources, such as memory boards, sensory and tactile items or adaptations in the communal lounges, corridors or bedrooms. We have made a recommendation about resources being available for people with dementia or those that lack capacity.

We found some health and safety concerns that could have been identified by the service if robust monitoring systems had been in place.

All the staff we spoke with told us they had received safeguarding training and were able to tell us what they would do if they had concerns about the safety of people who used the service.

The service had a whistleblowing policy in place which gave staff clear steps to follow should they need to whistle blow (report poor practice).

We found that people who used the service had a Personal Emergency Evacuation Plan (PEEP) in place in place to ensure they were safely evacuated in an emergency situation.

Communal areas provided a comfortable environment and were in keeping with the features and character of the building. The bedrooms that we looked at were clean, tidy and personalised.

Staff spoken with and records examined showed that an induction was completed when they commenced work at the service.

People who used the service told us they thought staff were trained and able to meet their needs.

Staff we spoke with told us they had received training in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Records we looked at showed that people who used the service had access to external health care. This included podiatrists, dentists, bladder and bowel services, dieticians, opticians and district nurses.

We observed interactions from care staff that were kind, patient and sensitive.

Records we looked at showed that two senior staff members had undertaken further training in end of life care. Staff we spoke with told us that this had improved the care people received.

None of the people we spoke with who used the service had ever made a formal complaint but told us they felt confident enough to speak with staff and management if they had a problem or concern.

The religious needs of people who used the service were addressed with the offer of Holy Communion once per week for those people who were Catholic and a Church of England service the last Thursday in the month.

Most of the people we spoke with knew who the manager was and felt they had a very visible presence in the service.

We saw a range of policies, including safeguarding, whistleblowing, infection control, medicines management and recruitment.

Records we looked at showed that staff meetings were held on a monthly basis.

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.

We found that people’s care needs were assessed and their care plans were regularly reviewed. We found people who use the service, or their representatives were involved in planning their care. All the people we spoke with about the service were positive about the care received. One person said “You would be hard pressed to find anything wrong here”. During our visit we observed staff caring for people in a way that supported their needs, wellbeing and safety.

The provider had an effective system in place for engaging other health professionals in people’s care. We spoke with a visiting health professional who said staff had been “very observant” and said staff had requested health support from them appropriately when it had been needed. We spoke with people who use the service who told us they were visited by health professionals.

We found that the provider had an effective recruitment system in place and staff underwent an induction period before they started working independently.

We found that the provider had an effective complaints policy in place and that complaints information was available to people. We found that staff understood the process.

During our visit to Lyndhurst Residential Care Home we spoke to five people using the service and to two relatives. They were all very complimentary about the staff and the care provided.

We were told that they felt there was enough staff on duty to care for them, the food was good and they were given their medicines on time.

Some of their comments were:

“I am well looked after”.

“Very happy with the care”.

“I would recommend this home to anybody”.

“They are all lovely; good girls”.

“I have every confidence in them”.