Lyndon House 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. They are registered to provide accommodation and personal care to 32 older people some of whom may live with dementia. At the time of our inspection there were 26 people living at the home.

There was 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.

When we last inspected the service on 09 September 2015 we found them meeting the required standards. Previously when we carried out a comprehensive inspection at Lyndon House on 09 September 2015 we found that the service was Good. At this inspection we found that they continued to maintain a good service and further improve in some areas. This inspection was carried out on 15 March 2018.

People told us they were feeling safe in the home and enjoyed a comfortable and happy life in Lyndon House. Staff were enthusiastic and knowledgeable when they talked to us about the people they supported. They told us about safeguarding processes and how they reported concerns to the registered manager or local safeguarding authorities. They demonstrated a good understanding of people`s needs likes, dislikes and preferences.

People told us staff were extremely caring, patient and respectful when they helped them with their care. People felt that they were enabled to live the life they wanted by staff who were appropriately trained and knew their needs and preferences. Relatives told us they were extremely happy with the care and support people received and they felt included in their loved one`s care by staff who were always welcoming and listened to them.

People were supported by sufficient numbers of staff who responded to people when they required assistance. Staff were knowledgeable about risk management and how to mitigate risks to keep people safe.

People were encouraged to socialise, pursue their hobbies and interests and try new things. There was a strong culture within the service of treating people with dignity and respect. People and the staff knew each other well and these relationships were valued by people who used the service.

People and their relatives where appropriate were involved in the development and the review of their care and support plans. Care plans captured people’s support needs as well as their preferences regarding the care they received. Care plans were updated every time a change occurred which influenced the way people received support. People were supported to make decisions about their care and be independent.

People were supported to have sufficient food and drinks. People had access to healthcare professionals such as their GP as and when required. People received appropriate support from staff to take their medicines safely.

The manager and the provider carried out a regular programme of audits to assess the quality of the service, and we saw that these were capable of identifying shortfalls which needed to be addressed. Where shortfalls were identified, records demonstrated that these were acted upon.

This inspection was carried out on 9 September 2015 and was unannounced.

Lyndon House is a residential care home that provides accommodation and personal care for up to 32 older people, some of whom live with dementia. At the time of our inspection there were 26 people living at the home.

There was 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.

When we last inspected the service on 16 May 2014 we found them not meeting the required standards in management of medicines. At this inspection we found that they had met the standards. People were encouraged to manage their own medicines and where this was not possible staff ensured people received their medicines in accordance with the prescriber’s instructions.

Staff were kind and caring and people’s privacy and dignity was promoted. Staff were knowledgeable about people`s needs and they provided care which was tailored to individuals and their preferences. Staff had received appropriate training and supervision.

People’s safety was promoted and there were risk assessments in place to maintain this. However people were encouraged to be as independent as possible. Care plans and care practices were reviewed regularly and people were involved to ensure their needs were met the way they wanted.

The management team recently started monitoring the accidents and incidents in the home and where any trends were identified actions were in place to minimise the likelihood of reoccurrence.

Staff knew how to recognise and respond to allegations of abuse.

People were offered a choice of nutritious food in accordance with their needs and preferences.

People had access to activities that complemented their interests and hobbies. There were several areas in the home used for entertaining people with different interests. The service had strong links with the outside community and a volunteer group who organised fund raising events which benefitted the people living at the service.

Health and social care professionals were very positive about the staff team at Lyndon House and the service they provided.

Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. We found that people had their mental capacity assessed and if they lacked capacity the manager has submitted DoLS applications to the Local Authority. The manager and staff were familiar with their role in relation to MCA and DoLS.

We received positive comments about the management team from people who used the service, their relatives, staff team and health care professionals. The management team closely monitored and sought feedback about the service provided from people and relatives to identify areas for improvement and drive forward improvements in the home.

We consider 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 safe?

•Is the service effective?

•Is the service caring?

•Is the service responsive?

•Is the service well led?

This is a summary of what we found.

Is the service safe?

People’s care plans reflected their individual needs. All care plans we looked at had risk assessments that included: Moving and handling, falls and safeguarding. The care plans were reviewed on a monthly basis. All staff received handovers at the start of their shift. This ensured staff were kept up to date with any changes to people’s needs.

We looked at medication and we saw that staff did not reconcile medication that was dispensed, for example: PRN medication is given when required and recorded on the individual MAR sheet. There is no reconciliation of what has been dispensed and what should be left. That meant medication could go missing and would not be noticed.

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs had been met. It was clear from our observations and from speaking with staff that they had a good understanding of people’s care and support needs.

People had signed consent forms in their care plans. Staff we spoke to understood the importance of consent. One member of staff said, “They can choose what they want and when they want to do it.” One person said, “Staff always knock on my door even when it is open. They always communicate what they are doing, and they support me to do what I can.”

Staff supervision had been completed but appraisals had not been started. Training was now being sourced. Staff had recently received training for moving and handling and medication. There were planned dates for safeguarding of venerable adults and health and safety training.

Is the service caring?

People were supported by kind attentive staff. They spoke to people in a polite and respectful way. We observed good interaction between staff and people who used the service. One person said, “Staff are very caring.” Another person said, “You are cared for and I am really happy here.”

Is the service responsive?

All service users had pre-assessments to ensure the home could meet there needs. Their care plans were regularly reviewed and people’s needs were assessed and documented. The care plans we saw were all person centred. There were lots of activities for people that included: Bingo, scrabble, flower arranging, table games and quizzes.

Is the service well led?

There was no registered manager at Lyndon house. The temporary manager at the date of our inspection was still the registered manager of another location in Richmond.

There had been no feedback surveys sent out to relatives, advocates, staff or healthcare professionals such as GPs and nurses since October 2011. This meant people’s views had not been sought.

Monthly resident meetings and staff meetings had been started in April 2014. We spoke to some staff who said they did not feel supported by the manager and that communication was poor.

All care plans we looked at had relevant information and risk assessments, and these were reviewed monthly.

We carried out a responsive review of compliance following the receipt of some concerning information which was sent to The Care Quality Commission. The information alleged that the management of the home was poor, inappropriate decisions were made around the care of people who used the service. There were allegations of staff being bullied by management.

During our visit we observed people who used the service and they looked comfortable in their home.

We observed good staff interaction with people who used the service.

We spoke to a selection of staff who were on duty at the time of our inspection and they raised a number of concerns about the management and support of staff who worked at Lyndon house. We asked staff about individual supervision, team meetings and support arrangements. There were gaps in the supervision and support arrangements and none of the staff we spoke to could remember when they last had supervision with their manager.

During our visit, on 26 November 2012, we spoke with nine people who lived at Lyndon House, visitors and staff.

The people we spoke with were all positive about the service and the staff who supported them. People told us that the staff were kind and caring. One person told us that the staff "do things for you" and gave an example of the extra lengths a member of staff had gone to. They said they liked "the freedom" the service provided, enabling them to do what they wanted. Another person, who liked to spend time in their room, told us it was "wonderful" and like ' living in my own flat'. We noted that there was a varied activity programme and people felt free to choose what to take part in. For some people the spiritual aspects of this service and the availability of a chaplain was very important to them. One person told us the best thing about the service was the "good atmosphere".

People confirmed that staff treated them with respect and dignity. Individuals' commented on their appreciation of the cleanliness and decoration of the service and their ability to add their own possessions and furnishings to their rooms. People commented on the freshly ironed bed linen and ironed clothing, which all added to their feelings of dignity.

We confirmed that people had good access to community health services.

The provider needed to take action to review some of the health and safety checks being carried out to ensure people's safety.

We carried out a responsive review of compliance over two days, following the receipt of some concerning information which was sent to The Care Quality Commission. However we found people to be well cared for and people looked happy and relaxed in their surroundings. People were dressed appropriately and we observed people had drinks and snacks provided in the lounges or in their bedrooms. We observed people participating in a number of activities throughout the home.

We observed good staff interaction and people spoke positively about their experiences at Lyndon house. We spoke to staff about safeguarding people from abuse and noted staff were aware of the process should they have any concerns.

We looked at staff supervision and appraisal records and noted that there were some gaps in the frequency of the supervision arrangements and appraisals had not been completed yet for any staff.