The inspection took place on 07 June 2018 and was unannounced. At the last inspection of the service in May 2017, the provider was rated as Requires Improvement in all five key questions. At this inspection, we found that while some regulations had now been met, there continued to be concerns in all areas and further breaches of regulation were identified.

Lyndon Hall 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 Hall is registered to provide care, nursing and accommodation to a maximum of 80 older people, some with a diagnosis of Dementia. At the time of the inspection, there were 77 people living at the home.

There was no registered manager in post, but a new manager had been recruited and they were planning to apply to become registered. 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.

Administration and recording of medicines given was not always done safely. Medicines were not always stored at the correct temperature required to keep the medicine at it’s optimum potency. Staff were not always available to keep people from harm. Staff understood the procedures they should follow if they witnessed or suspected that a person was being abused or harmed. Accidents and incidents were responded to appropriately.

Staff did not always have the skills and knowledge required to support people effectively. Staff did not always have a clear understanding of the Mental Capacity Act and how best to support people in line with it’s principals. People did not always like the food provided and staff were not always supportive when people required assistance to eat. Staff gained people’s consent before assisting or supporting them. Staff received an induction prior to them working for the service and could access ongoing training to assist them in their role. Staff could access supervision and felt able to ask for assistance from management should they need it. Staff supported people’s healthcare needs.

Staff were not always caring towards people and their dignity was not consistently maintained. People were encouraged to retain an appropriate level of independence and choices were given to people were it was appropriate.

Care plans were in place, but it was not always clear if people had been included in compiling them and they were not always detailed. People were not consistently offered a stimulating environment. People’s preferences for how they wished to receive support were known and considered by the care staff. People knew how to raise complaints.

There had been a lack of consistency in management and some people remained unsure of the management status of the home. There was a high turnover of staff, which had had a negative effect on some people. The environment was not always conducive to people’s wellbeing. Meetings were held where people were able to contribute. Quality assurance audits were carried out, but these did not identify concerns in all areas. We did not always receive notifications as required.

You can see what action we told the provider to take at the back of the full version of the report.

This unannounced inspection took place on 19 and 25 May 2017.

The home is registered to provide accommodation, nursing or personal care to a maximum of 80 people. On the day of our inspection 73 people were using the service. The service is divided into four units and people who live there have a range of conditions related to older age and dementia.

The previous ratings inspection of the service took place on 24 February 2015 and at that inspection we found the service was Good overall with a rating of requires improvement in the area of Safe. This was because we found issues with recruitment practices as there were gaps in employment history and appropriate references had not been analysed. We saw that these concerns had been addressed.

The service did not 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. There was an acting manager in place who was covering in the absence of a registered manager whilst recruitment was in progress.

People were not always turned appropriately to ensure that skin viability was maintained. People and relatives told us that there were not enough staff to keep people safe. Risk assessments were in place and were in the main followed. Medicines were given appropriately. People told us that they felt safe. Staff recruitment was carried out safely.

People had some concerns around how they received food and drink. Information was not always passed between staff correctly in the form of effective handovers. Staff received an induction prior to them working for the service and they felt prepared to do their job. Staff could access on-going training and regular supervision to assist them in their role. Staff knew how to support people in line with the Mental Capacity Act 2005 and gained their consent before assisting or supporting them.

There were concerns around the amount of time that people spent in their bedrooms.

Where possible people were able to make some decisions for themselves. Staff provided dignified care and showed respect to people. People were encouraged to retain their independence with staff there ready to support them if they needed help.

There were concerns around lack of stimulation and limited involvement in activities for people. There was a lack of consistency with regards to people and relatives understanding of the complaints procedure. People had been involved in their care plans where possible.

Not everyone knew who the acting manager was and not all staff felt supported in their roles. People and their relatives were not always aware that meetings to discuss the service were taking place. Audits were carried out in order to assist staff to take action where any concerns arose, but these were not always done consistently. We received notifications of accidents or incidents that had occurred, which the provider is required to do so by law.

This unannounced inspection took place on 24 February 2015. At our last inspection in April 2013 the service were meeting the regulations of the Health and Social Care Act 2008.

Lyndon Hall Nursing Home is registered to provide accommodation, nursing or personal care for up to 80 people, on four separate units. Both Poppy and Sunflower units provided general nursing care. Rose Unit provided residential and Bluebell Unit nursing care for people experiencing a dementia type illness. At the time of our inspection 64 people were using the service. People using the service may have a range of needs related to dementia, older people and younger adults.

The service had 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.

There were systems in place to protect people from abuse and harm. Staff had a clear knowledge of how to protect people and understood their responsibilities for reporting any incidents, accidents or issues of concern. The registered manager was able to demonstrate learning and changes to practice from incidents and accidents that had occurred within the service.

People and their relatives told us they felt confident that the service provided to them was safe and protected them from harm. We observed there were a suitable amount of staff on duty with the skills, experience and training in order to meet people’s needs.

Recruitment practices within the service were not always effective. We saw in some records that appropriate last employer references were not in place and that gaps in staff employment history had not clearly been discussed and reasons for these documented.

People’s nutritional needs were monitored regularly and reassessed when changes in people’s needs arose. We observed that staff supported people in line with their care plan and risk assessments in order to maintain adequate nutrition and hydration.

The staff worked closely with a range of health and social care professionals to ensure people’s health needs were met, for example physiotherapists and chiropodists.

We found that a number of people in the service were subject to a Deprivation of Liberties Safeguard (DoLS). Staff were able to give an account of what this meant when supporting these people and how they complied with the terms of the authorisation. However, documentation in relation to people’s resuscitation status was not always fully completed.

We spent some time observing people and the activities available to them on Bluebell unit. The environment had not been adapted, decorated or furnished to the needs of people with Dementia. The provider had plans in place to refurbish Bluebell Unit in the coming weeks to suit people’s specific needs and in line with the work already partly or fully completed on the other units.

We saw staff responded to people’s needs and protected their dignity. Staff spoke with people in a friendly and encouraging way to support people with their independence.

People were routinely provided with written information including how to make a complaint. Information regarding how to access local advocacy services was clearly displayed. Staff were aware of how and when to access independent advice and support for people.

Activities within the home had been somewhat limited. Recent recruitment of additional activities staff and training of staff meant that an increased availability and variety of activities was being planned.

People and their relatives were involved in the planning of care and staff delivered care in line with peoples preferences and wishes. Staff supported people to access support for their spiritual or cultural needs.

People, relatives and professionals spoke positively about the approachable nature and leadership skills of the registered manager. Structures for supervision allowing staff to understand their roles and responsibilities were in place. Staff we spoke with were clear about the how they could access and how they would utilise the providers whistle blowing policy.

Nursing staff, the registered manager and the provider undertook regular reviews and analysis of the quality and safety of the service. Spot checks were performed regularly in order to check that the care being delivered was safe and of high quality.

There were 30 people living there on the day of our inspection. No one knew we would be inspecting that day.

All people spoken with were satisfied with the care and overall service provided. One person said, “I really like it here. The staff are so kind”. Another person told us,” It is a very nice place”. One relative said, “The home is comfortable and the staff are good. We are happy with everything”. Another relative told us, “My relative looks well cared for. They were in three other homes before they came here and this one is the best they have lived in”.

We saw that people's needs had been assessed which ensured that their health, personal care, and safety needs would be met.

We saw that people were offered food and drink that they liked and were supported and encouraged to eat and drink sufficiently to prevent their ill health.

Medicine systems were adequate and medicines were given to people as prescribed by their doctor.

People and staff spoken with said that there were enough staff to meet people’s needs and keep them safe. One person told us, “We do not usually have to wait if we call the staff”. We found that staff had the training and support they needed to help them to meet people’s needs and keep them safe. One relative told us, "The staff are polite and approachable".

Records sampled and people spoken with confirmed that systems were used to monitor how the service had been run to benefit the people who lived there.

We carried out this responsive inspection as we had been told about a number of concerns by external health professionals and Sandwell Council staff. These concerns included care planning, health monitoring, weight monitoring and management, bed rail safety and dementia care provision.

During our inspection we spoke with seven people who were living at the home. All of those people were complimentary about the care that they received and the staff. One person said, “I do like it here. I cannot grumble. The staff are very nice”. Another person told us’ “I have not stayed anywhere else like this before but I would say that it is first class here”.

We found that people’s needs had not always been identified, planned for, or met. We found that staff had not always taken action to prevent certain conditions re-occurring and had not always responded in a timely manner when action was needed to prevent risk.

We found that record keeping concerning care delivery and fluid intake were not always adequate which meant that some risks had not been identified and managed and some needs had not been met.

People living at the home had confidence in the staff. We observed that staff were available at all times and that they were kind and caring.

We found that activity provision could be better. However, staff were aware of this and were taking action to improve in that area.

This home was taken over in November 2011 by a new provider called HC-One Limited.

Prior to November 2011 we had identified non-compliance at Lyndon Hall across a number of regulations including medication management, safeguarding and care and welfare. To date the new provider HC-One Limited does not have a contract with Sandwell Council. Birmingham Council has a contract with this provider and is making placements. Walsall Council has a contract with this provider but at present is not making any new placements.

At the time of our April 2012 inspection only the two ground floor units which are called Rose and Bluebell were in use for people to live in. We spent time on both of these units speaking to people who lived on them and observing routines and engagement between people and staff. We arrived at this home early so that we could meet and speak to the people who live there. We used a number of different methods to help us understand the experiences of people using the service.

We spoke with five people who told us that they liked living at the home. Comments made by these people were positive about the care and support they received and included; “Oh yes it is good here, they look after me”.“Yes it is good here”. “The staff are nice and kind”. “It is lovely here. I am very happy. The staff are so good and friendly. They have asked me if I like it here and I do very much. I don’t have to ask for anything they know what I want and get it”.

Evidence that we gathered during the course of our inspection process showed that improvements had been made where we had previously identified non-compliance with regulations. This means that the 16 people living at this home at the time of our inspection were receiving the care that they needed and were safe.

The provider for this location HC-One Limited is newly registered. They took over the management and responsibility for Lyndon Hall following their registration with us in November 2011.

Prior to November 2011 we had identified non compliance at Lyndon Hall across a number of outcome areas including medication management, safeguarding and care and welfare. External contractors also had concerns. Due to these concerns the ‘host authority’ Sandwell suspended placements at Lyndon Hall from 2009 and in the autumn of 2011,due to the lack of sustained improvements and a number of safeguarding alerts,terminated their contract with the previous provider. To date HC-One Limited does not have a contract with Sandwell Council.

Our December 2011 inspection visit was undertaken to assess compliance with a number of high risk outcome areas including medication safety, staffing and care and welfare. Our evidence showed non compliance in these areas.

The location is registered to provide accommodation nursing and personal care to a maximum of 80 people. There were 18 people living at the location at the time of our inspection.

We arrived at Lyndon Hall at 08.20 hours so that we could indirectly/ directly observe or sample routines and care delivery from early morning. During our inspection we spoke with a number of staff and managers and five people living at Lyndon Hall. Below are a few examples of what people living at Lyndon Hall said to us;

“I do like living here. It is my home”.

“I like coming here. The staff are nice”.

“They look after us”.

A relative we spoke with told us;” Lyndon Hall used to be ok then things went downhill. Recently we have noticed that things are getting better. It looks better and the smell is cleaner”.

Although people made positive comments about Lyndon Hall in general and the service they received, our inspection findings showed that improvements in staffing numbers, medication safety and management, care planning and delivery are needed to make sure that people’s needs are met in a safe, consistent and personalised way.