About the service: Lyndon Croft accommodates up to 53 people in one adapted building. It provides residential care to people living with dementia over the age of 65. During our visit 43 people lived at the home. The home is located in Solihull, West Midlands.

People's experience of using this service:

¿ People felt safe.

¿Staff were recruited safely, and enough staff were on duty to meet people’s needs.

¿Staff received on-going support and training to be effective in their roles.

¿ Risk assessments supported staff to manage and mitigate risks.

¿Staff followed good infection control practices and the building was clean.

¿Medicines management was safe.

¿People were supported to access healthcare professionals when needed.

¿People's needs were assessed before they moved into Lyndon Croft.

¿People received information in a way they could understand and chose how to live their lives.

¿People's nutritional and hydration needs were met. Staff understood people's dietary needs.

¿Staff were kind to people and were responsive to their needs.

¿Care plans supported staff to provide personalised care.

¿People’s privacy was respected, and their dignity was maintained.

¿People were supported to be independent.

¿People's end of life wishes were documented and respected.

¿People enjoyed the social activities and had opportunities to maintain links with their community.

¿ People and relatives spoke positively about the leadership of the service.

¿Complaints were being managed in line with the provider's procedure.

¿ Systems to monitor the quality and safety of the service were effective. Feedback from people, their relatives and staff was used to drive forward improvement.

¿Lessons were learnt when things had gone wrong. The provider shared learning across the organisation to drive continual improvement.

¿At this inspection we found the evidence supported a rating of 'Good' in all areas.

More information in 'Detailed Findings' below.

Rating at last inspection: At our last inspection in November 2017 we rated the service as 'Requires improvement' overall.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission scheduling guidelines for adult social care services.

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

At the last inspection in January 2016, the service was rated 'Good' overall. At this inspection we found this had not been sustained and improvements and required. We rated the service as Requires Improvement.

Lyndon Croft is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Lyndon Croft provides care and accommodation for up to 53 people with dementia. There were 51 people living in the home at the time of our visits.

The service is required to have a registered manager in post. 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 and associated Regulations about how the service is run. At the time of our visit the registered manager had been in post for seven years.

Ineffective risk management at the home had placed people at unnecessary risk. Risk assessments were in place to reduce and manage the risks associated with people's care. Staff were knowledgeable about the risks however, we saw not all staff always effectively manage risk in line with best practice. Some people required close observation from staff to make sure they were safe. However, we saw records did not always clearly detail the frequency of checks people required.

People felt safe living at Lyndon Croft. There were enough staff on duty to support people’s care needs and we saw the management team worked alongside the staff team to support people. However, the deployment of staff required further development because the communication between staff when they needed to leave their allocated area of work was not always effective. The staffing levels were under constant review in response to people’s changing needs. A further review of the deployment of staff was planned to take place shortly after our visits.

The provider had taken action and ensured lessons had been learned when people had fallen at the home. They had sought and followed the advice of health professionals to manage falls. Relatives told us they were ‘happy’ with the action taken to prevent their family members falling again.

Procedures were in place to protect people from harm. Staff told us they had received safeguarding adults training and they knew to follow the provider’s procedures to protect people. Concerns of a safeguarding nature had been correctly reported and this meant any allegations of abuse had been investigated if required.

There were processes to keep people safe in the event of an emergency such as a fire. Regular checks of the building and equipment took place to make sure they were safe to use. People’s needs were met by the design and decoration of the home. Plans were in place to make continual improvements to the environment in-line with best practice.

The home was clean and well maintained. The staff team understood their responsibilities in relation to health and safety and infection control.

People and relatives told us they had no concerns about the way their medicines were managed and administered. Safe administration systems were in place and people received their medicines when they needed them.

People and their relatives confirmed they received effective care, support and treatment from health professionals. The provider worked in partnership and shared information with key organisations to ensure people received joined-up care which met their needs.

The provider's recruitment procedures minimised, as far as possible, the risks to people safety. New staff received effective support when they first started working at the home. Staff understood their responsibilities and had the skills and knowledge to care for people effectively. Staff fel

We carried out this inspection on 28 January 2016. The inspection was unannounced.

The home provides accommodation and personal care for up to 53 people. On the day of our visit there were 53 people who lived at the home. All of the people at the home lived with dementia.

A requirement of the service’s registration is that they have 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. A registered manager was in post and had been for five years.

Support was provided that met people’s individual needs and there were enough staff to care for people safely.

People’s health and social care needs were reviewed regularly. Staff referred to other health professionals when needed, so people were supported to maintain their health and wellbeing. Risk assessments were completed and plans minimised risks associated with people’s care.

People told us they felt safe living at the home. Staff knew how to safeguard people and what to do if they suspected abuse. People were protected from harm and systems ensured people received their medicines as prescribed, from staff trained to administer this. Some improvements were required around storage and disposal of medicines.

Checks were carried out prior to staff starting work at the service to make sure they were of good character and ensure their suitability for employment. Staff had training to do their jobs effectively in order to meet people’s care and support needs. Staff were encouraged to continue to develop their skills in health and social care. Staff told us they felt supported by the management team to carry out their roles effectively.

Staff understood the Mental Capacity Act 2005 (MCA), and Deprivation of Liberty Safeguards (DoLs) had been applied for where applicable. Staff gained consent from people before supporting them with care.

People’s nutritional needs were met, choice was offered and special dietary needs were catered for. People took part in some organised activities and day trips, and told us there was enough for them to do.

People told us they liked living at the home and that staff were friendly and kind. People were cared for as individuals with their preferences and choices supported. Staff treated people with dignity and respect when supporting them, and encouraged people to be as independent as possible. Relatives were encouraged to be involved in supporting their family members.

People were positive about the management team and the running of the home. Systems and checks made sure the environment was safe and that people received the care and support they needed.

The registered manager was responsive to people’s feedback in developing the service, and making continued improvements. People knew how to complain if they wished to, and these were addressed to people’s satisfaction.

We carried out this inspection to assess whether or not improvements had been made following our last inspection visit to the service in May 2014. At that inspection we found improvements were required in cleanliness and infection control. We set a compliance action in relation to these areas and received a report from the provider that told us what they had done to achieve compliance.

During our visit on 18 September we spoke with some people who lived in the home, the deputy manager, cleaning staff on duty and the laundry assistant. We also looked at records relating to hygiene and infection control. We found that the areas of non compliance identified at the previous inspection had been addressed and the service was compliant in cleanliness and infection control.

People we spoke with told us they home was, "Lovely and clean" and they had their rooms cleaned, "Every day." One person told us, "Cleanliness is next to godliness, and whilst they shall never achieve that, they do a very good job of trying."

Cleaning and laundry staff had been provided with training and supervision to ensure they were aware of the national guidelines for infection prevention. Appropriate cleaning equipment had been provided to minimise the risk of cross infection. Staff we spoke with told us the processes in place to prevent the spread of infection. During our visit we observed the processes staff had described being used.

This inspection was a scheduled inspection, however we also followed up on concerns we identified at the inspection in January 2014.

This inspection was completed by two inspectors. We spoke with three people and three relatives of people who used the service. We also spoke with the regional director, registered manager, deputy manager, three carers and two housekeeping staff. The evidence we collected helped us to answer five key questions; is the service safe, effective, caring, responsive and well led?

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

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

People we spoke with told us they felt safe. One person we spoke with said: “Oh yes, the staff are ever so kind”.

The staff we spoke with knew and understood the procedures they needed to follow to ensure people remained safe. Staff were able to tell us the different ways people might experience abuse that could place them at risk. Staff knew what their responsibilities were and what steps to take if they suspected abuse had taken place. We found staff had received training in safeguarding vulnerable adults and further training was planned.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Prior to this inspection we had received one DoLS application from the provider, however the person had since left Lyndon Croft. Staff were able to describe when an application should be considered and who should be involved in the process. We saw records that showed a number of staff had received training in mental capacity with further training booked for more staff.

The home was clean and tidy with no unpleasant odours apparent. We saw inconsistencies with the cleanliness of the home. We have asked the provider to send us an action plan informing us of how the inconsistencies will be addressed.

People told us if they needed anything repaired or replaced, this had been done with minimal delay. We saw maintenance records that confirmed repairs had been undertaken promptly.

We found equipment was maintained and regularly serviced. We found the provider carried out regular fire checks and ensured people and staff knew what to do in the event of an emergency.

Is the service effective?

People had an individual care plan which explained what their needs were. People and relatives told us they had been involved in the care assessment and their contributions were listened to. Risk assessments were reviewed and identified current risks.

People had access to health care professionals which supported their health care needs.

We found staff had received the necessary training that enabled them to provide suitable and appropriate care for people.

Is the service caring?

People were supported by staff that provided care at people’s preferred pace. Staff were kind and attentive and responded appropriately to people’s requests. Staff promoted individual choice and supported people who wanted to remain as independent as possible. We found individual wishes were taken into account.

We saw that a number of people did not have free access to their bedrooms. This was because they required a key to open their doors. The keys were carried by staff. Although this did not appear to be distressing to the majority of people, the provider may wish to consider this in light of a new ruling regarding the Deprivation of Liberty Safeguards (DoLS).

Is the service responsive?

People received help and support from other health professionals when required, such as doctors, dentists, occupational therapists and chiropodists.

People were supported to participate in activities inside and outside of the home. At the time of our inspection people participated in music and movement and a cheese and wine tasting event which were led by the care staff.

The service had systems in place to monitor the care provided to people. This included regular reviews with people and relatives. We found the provider held residents meetings to seek the views of people who used the service. We saw actions were taken when improvements had been identified.

People told us that concerns were listened to and acted on. People and relatives told us the staff and managers were very approachable.

Staff said they had a handover at the start of each shift to update them of any changes in people’s needs since they were last on duty.

We saw there were systems in place for people to alert staff if they required assistance. Call bells were installed in people’s rooms. People we spoke with said staff responded to call bells promptly.

Is the service well led?

The service worked alongside other health care professionals and agencies to make sure people received the care they required. We spoke with relatives who confirmed outside health professionals had provided care and support to their family members.

The service had an effective system in place that assured them of the quality of service they provided. The service completed regular checks and sought the views of people who used the service. The service also gained the views of staff and we found the service listened and acted upon these views.

People’s care records and other records were accurate, available and completed.

We carried out a responsive inspection at Lyndon Croft Care Home on 2 January 2014. This was because we had received concerns relating to the standards of care delivered by the service. We looked how people were being cared for at each stage of their care and treatment. We conducted a SOFI which is a short observational framework inspection to observe close interaction between people and staff. We looked how the service safeguarded people from harm and the environment. We also looked at staffing levels and staff training. We spoke to seven staff members and three people who used the service.

We observed staff interacting with people with kindness, one person told us” The staff are very kind here they are always pleasant”. We saw staff were attentive and patient when assisting people to eat.

We reviewed the care of four people with varying levels of need. We found not all risk assessments and care plans reflected their needs and were up to date.

We saw appropriate referrals were made to outside specialists for most people who used the service, for example, GP, dietician and Community Matron. However two people who were identified as high risk of falls had not been referred for a specialist assessments and supported with appropriate equipment.

We found fire procedures were not always adhered to. We saw that some parts of the environment were not clean.

One person who used the service told us,” Staff are nice here, but there’s not enough of them.”

On the day of our inspection there were forty eight people living at the home, with seven care staff on duty. Along with the manager and deputy manager, two housekeepers and two catering staff were also working in the home.

The improvements made following the last inspection had been continued. We could see that changes had been made throughout the home. For example, documentation and records were very well organised. Care plans had been written involving the individual and their families. Staff training and staff supervision was now taking place regularly.

The whole atmosphere in the home had changed for the better. Staff were professional and friendly, people living there were settled and engaged in conversations and activities, and visitors to the home were made very welcome.

People told us they were happy living at the home and were well cared for.

We had previously visited this home in May 2012 and found that although major improvements had been made, further work was needed.

These related to care and welfare of people using the service, meeting nutritional needs, cleanliness and infection control, staffing levels, staff training and monitoring quality assurance.

To check these we revisited the home to carry out a follow up inspection. We spoke with the manager of the home and other staff on duty. We looked at relevant records and observed the interaction between the staff team and the people living at the home.

From this we were able to confirm that improvements had been made across the board, and Lyndon Croft was now compliant with all outcome areas.

Since our last inspection we found there had been a major improvement in the service provided at Lyndon Croft.

Everyone we spoke to during our visit including relatives and people living at the home told us that the staff were very kind and helpful.

Comments included:

‘Nice improvements – well done Karen and all the staff’

‘Mum is happy and well cared for’

‘Mum looks content, and the staff are wonderful’

‘Mum has put on weight since the change in mealtimes’

‘Lovely refurb, the dining room looks lovely’

‘The change in meals is much better, residents being able to help themselves has improved mums appetite, and happily she has put on weight, a good move’

‘Things have improved greatly, the care is very good and the staff are lovely’

We saw good interactions between staff and people living at the home. However, further training is needed for staff to allow them to better communicate with people who have advanced dementia.

Nutrition and dietary input was much improved. People now received a full nutritional assessment, and their weights and food intake was monitored more closely.

On the surface the home looked clean; however some areas required a deep clean to bring them up to standard.

Quality assurance systems need further input to ensure concerns are dealt with promptly.

Records and care documentation were comprehensive and accurately maintained.

Significant improvements had been made across the board. The provider now needs to focus on bringing all areas up to standard and maintaining the service.

We visited Lyndon Croft on 21 March 2012. We reviewed the required improvements necessary for good medicine management.

Overall we found that medicines were still being stored in a place that was too warm. Arrangements for measuring the temperature had not taken into account how the thermometer should be accurately read.

Some people's medicines were allowed to run out and this could lead to people experiencing pain or discomfort.

We found that potential for medicine errors were increased by some practices. For example a person's medicines being poorly organised, not transcribing accurately information about medicines on to the medicine administration record and not ensuring that safety information about all medicines that were prescribed 'when required' had been updated.

We found there had been improvements in how drugs that required special storage and records had been stored and accounted for.

On 30 November 2011 a pharmacist inspector visited the home to look at the the home's compliance with regulations about medicines. They did not look at outstanding compliance actions for other regulations on this visit.

We found that the administration of medicines were not compliant with the regulations. Following our visit we received an action plan and met with the registered provider to discuss our concerns.

All of the people, relatives and professionals we spoke to told us that the staff were hard working and kind. We saw good staff interactions with people when we were visited the home.

Some people have behaviours that challenge and this impacted on other people living in the home. Improvements were needed to minimise the number of incidents. People looked well presented and relatives told us people were always assisted with their personal care.

Some people were unhappy with the meals provided. They told us: - "It doesn't taste of anything," " Its stone cold." Meal timings, assistance for people eating and monitoring people's weight was not good enough for people at risk of poor nutrition.

Relatives told us that the home was not as clean as it had been. We found the cleanliness of the building needed to improve.

The arrangements for monitoring the quality of the service needed to improve so that any improvements could be sustained.