The inspection took place on 25 April 2017 and was unannounced. Lyngate Care Home is registered to provide accommodation for up to 41 adults requiring personal care. At the time of the inspection there were 26 people using the service. The home is situated on a busy main road in the Deane area of Bolton. There are car parking facilities to the rear of the building and there is good access to local amenities.

The last inspection was undertaken in August 2016. During that inspection we found multiple breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 with regard to staffing, safe care and treatment, meeting nutritional and hydration needs, need for consent, dignity and respect, person centred care and good governance.

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 a registered manager in place, but they were currently on sick leave and had given their notice. The service were planning to advertise the post internally. In the meantime the operations manager and care manager were undertaking all management duties.

People we spoke with said they felt safe at the home. Staffing levels were sufficient to meet the needs of the people who used the service and they were now using a dependency tool to calculate staffing levels based on need. There were medication systems in place to ensure that people who used the service received their medicines as prescribed and medicines were ordered, stored and disposed of safely.

The service had a robust recruitment system which helped ensure people employed were suitable to work with vulnerable people. Safeguarding procedures were in place and staff had undertaken training in this area and were able to demonstrate a good understanding of the issues.

The latest infection control audit had highlighted areas which were below standard and required improvement. The service was working on an improvement plan to help raise standards.

The induction programme was appropriate and staff received training and shadowing experience. Staff spoken with confirmed they had opportunities for training and development and we saw an on-going programme of training. A new supervision schedule had been implemented and supervision sessions were being completed on a regular basis.

People’s nutritional needs were recorded and met appropriately. There was a good choice of food and drink and we observed friendly, respectful interactions when meals were being served.

The service were working within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS).

We saw that staff were kind and courteous with people who used the service. Staff were clear about their roles and demonstrated a good understanding of the people they cared for.

People’s dignity and privacy was respected and they were encouraged to be involved in care planning and reviews. Residents and relatives meetings were held and this gave people further opportunities to be involved in aspects of the service delivery, such as menu choice and activities.

Care plans were person-centred and included a range of information around people’s health and personal preferences, background and interests.

There were a range of activities on offer and the service were considering suggestions from people who used the service for future outings.

The complaints procedure was clearly displayed and concerns and complaints dealt with appropriately. The service had received a number of compliment cards from relatives of people who used the service.

The management team were described as approachable and supportive by staff. However, the operations manager was a new addition to the staff team and a ne

The unannounced inspection took place on 10 August 2016. The last inspection was undertaken on 25 July 2014 when the service was found to be meeting all requirements reviewed at that time.

Lyngate Care Home is registered to provide accommodation for up to 41 adults requiring personal care. The home is situated on a busy main road in the Deane area of Bolton. There are car parking facilities to the rear of the building and there is good access to local amenities. On the day of the inspection there were 34 people using the service.

There was a registered manager at the service. 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 multiple breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 with regard to staffing, safe care and treatment, meeting nutritional and hydration needs, need for consent, dignity and respect, person centred care and good governance.

Staffing levels were inadequate to meet the needs of the people currently using the service. There were some safety hazards, such as a long trailing buzzer cord and a call buzzer which was out of reach of people who used the service. Individual risk assessments were not always meaningful in terms of actions required to minimise the risk and the information in people’s care files was not always completed.

The staff recruitment and induction processes were satisfactory and staff training was not up to date but there were plans in place to rectify this. Supervisions and appraisals were not carried out on a regular basis.

There was a safeguarding policy in place and staff were able to explain how they would recognise and report any concerns. Safeguarding issues raised had been followed up appropriately.

All health and safety processes, such as electrical and gas safety, fire equipment maintenance and checks and environmental maintenance and checks were in place at the service. There were systems in place to help ensure medicines were ordered, stored, administered and disposed of safely.

There was a lack of choice with regard to meals and food and fluid charts were not always completed. People’s preferences, choices, likes and dislikes were not consistently recorded and people were often unable to have their choices respected due to the low staffing numbers.

Some people who used the service were poorly presented and records indicated they were not being supported to have baths and showers on a regular basis. The building was over three floors and was difficult for people to navigate around without support.

Staff had a basic understanding of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) but information in care files was not robust in regard to these issues. There was a complaints policy in place and no complaints had been received recently. No staff meetings where staff could voice their opinions or raise concerns were taking place.

The registered manager was not visible around the home and staff said they would raise any concerns or issues with the deputy managers. We saw medication audits but there was no evidence of other quality audits. Regular surveys were completed with people who used the service and their relatives. Many of the policies at the service required updating.

We considered 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?

Lyngate Care Home was safe, clean and hygienic. Equipment was serviced and maintained regularly which helped ensure people who used the service were not put at any unnecessary risk.

We checked the staffing rotas and saw the required numbers of staff were on duty. One staff member accompanied a person to hospital and another staff member covered for them until they returned. This helped ensure the safety of people who used the service.

Deprivation of Liberty Safeguards (DoLS) become important when a person is judged to lack the capacity to make an informed decision related to their care and treatment. The provider told us no applications for DoLS had been made but knew the procedure to be followed if an application needed to be made.

Is the service effective?

We were told by the manager that before any person was admitted to the care home, they had undergone a pre-admission assessment. We saw care plans had been signed by the person or their representative which showed they had been involved in the creation of their care plans.

People who used the service and their families had been involved in regular surveys. The last one was completed in February 2014. We saw an action plan had been put together and any shortfalls had been addressed.

Is the service caring?

We saw there was a good interaction between staff members and people who used the service. Staff were patient with people and took their time to understand their needs.

We spoke with two people who used the service and one told us, "It`s home from home here. Really champion." A family member told us, "This is such a homely place and the staff are so approachable."

Is the service responsive?

We spoke with the activities co-ordinator who confirmed people completed a range of social activities both inside and outside the care home. The home had its own minibus which helped ensure people were kept involved around the local community.

People who used the service had their spiritual and religious needs met by the provider. Monthly services were held at the care home for all denominations. People who chose to could attend.

Is the service well-led?

We saw evidence in care plans and were told by the manager that the care home had a good relationship with other agencies. This helped ensure people received care and support when they needed it.

The provider had quality assurance procedures in place. Internal and external audits had been completed and we saw any shortfalls had been addressed. This helped ensure the quality of care and support people received continued to improve.

We carried out a responsive inspection at the service due to concerns raised to the local authority safeguarding team by a whistle blower.

Information of concern regarded the care and welfare of people who used the service in relation to staff getting people out of bed very early and the recruitment procedure when employing new staff.

We spoke with all the night staff on duty and some of the day staff and the manager.

We looked at the daily monitoring records of four people who used the service.

We sampled staff files of the last two members of staff to be recruited.

We found care files contained all relevant personal details. This made care plans more person centred. We saw risk assessments in place for all aspect of care including: personal care, nutrition, mobility, falls risks and general environmental risks. We found that all health professional visits and communication was fully recorded.

We spoke with four people who used the service they told us; "I had a look around the home first and was involved with my care plan when I entered the home". "I am very happy here” “I can’t complain” “Absolutely smashing here” “Staff are all very kind” “I recommend to anybody” “They listen to you” “The staff notice if anything is bothering me” “I’ve never heard anyone be cross with anyone”.

We found there was appropriate management of the nutritional needs of the people who used the service. When we sampled six care files we noted nutritional assessments had been undertaken. Weights were recorded on a monthly basis.

We found care was provided in an environment that was clean and well organised. Bedrooms and communal areas were free from any malodours. We saw staff had access to appropriate infection control and prevention guidance.

We found that Lyngate care home had a robust recruitment process and all required checks on new staff were completed.

Lyngate care home had appropriate systems in place to monitor the quality of the service provided. We found audits were undertaken by the registered manger and senior staff.

People told us that they were very happy at Lyngate Care Home.

Comments included:

“They know me and that’s important to me”.

“They (care staff) are on always on hand but if you don’t need them they don’t push it”.

“The staff here are lovely, I am very happy here”.

“There is always something going on if you want to join in”.

They look after me well; I have no complaints at all”.

“They have always looked after my X very well, she’s not been easy to look after but they are great here”.