At our last inspection in July 2017 the overall rating for this service was Requires Improvement. We rated Safe, Caring, Responsive and Well-Led as Requires Improvement because the provider did not have suitable arrangements to protect people against the risks associated with the management of medicines. We found that not all medicines were administered safely and the stock control checks of medicine were not always correct. We observed and we received feedback from staff and relatives that there were insufficient numbers of staff to care for and support people to meet their needs. The provider did not have effective systems to assess, review and manage risks to ensure the safety of people. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Caring, Responsive and Well Led to at least good.

At this inspection on the 19 June 2018 we found the provider had followed their plan with regard to the breaches of regulations in safe care and treatment and staffing. The provider and staff were managing and administering medicines in a way that was safe. Staffing levels had improved and the provider recognised this would need to be monitored weekly to ensure people received the care they required.

We have not changed the rating for Safe from Requires Improvement to Good as the provider needs to show they can sustain and improve on the changes they have made over a longer period of time. We have changed the rating for Caring, Responsive and Well-Led to Good and the overall rating to Good.

Lynton Hall is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. There were 43 older people, some of whom had Dementia, using the service at the time of our inspection.

The home was based on two floors, the ground floor for people with nursing care needs and the first floor for people living with dementia. There were bedrooms, bathrooms and communal rooms on both floors.

The home had a registered manager. A registered manager is a person who has registered with the 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.

People were safe at the home. Staff could explain to us how to keep people safe from abuse and neglect. People had suitable risk assessments in place. The provider managed risks associated with the premises and equipment well.

There were enough staff at the home to meet people's needs; however, management said they would assess this weekly to ensure sufficient staff were on duty to meet people’s caring needs. Recruitment practices remained safe.

Medicines were now administered safely. The checks we made confirmed that people were receiving their medicines as prescribed by staff qualified to administer medicines.

People were cared for by staff who received appropriate training and support. Staff had the skills, experience and a good understanding of how to meet people's needs. We saw that staff encouraged people to make their own decisions and gave them the encouragement, time and support to do so. Staff were providing support in line with the Mental Capacity Act (2005).

People were supported to eat and drink sufficient amounts to meet their needs. People had access to a range of healthcare professionals.

The staff were caring. The atmosphere in the home was calm and friendly. Staff took their time and gave people encouragement whilst supporting them. Throughout the inspection we saw that people had the privacy they needed and were treated with dignity and respect by staff.

People's needs were assessed before they stayed at the home and sup

We undertook an unannounced inspection on 18 July 2017. At our previous inspection in 5 March 2016 the service was rated as Good.

Lynton Hall Care Home provides accommodation and nursing care for up to 57 older people. There were 43 people living at the home when we visited. The home was based on two floors, the ground floor for people with nursing care needs and the first floor for people living with dementia. There were bedrooms, bathrooms and communal rooms on both floors.

The home had a manager at the time of the inspection, who was in the process of registering with the CQC. 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.

The provider did not have suitable arrangements to protect people against the risks associated with the management of medicines. We found that not all medicines were administered safely and the stock control checks of medicine were not always correct. Staff did not follow the National Institute for Health and Care Excellence [NICE] guidelines for the recording of medicines taken or refused. Medicines were stored securely and staff received annual medicines training.

We observed and we received feedback from staff and relatives that there were insufficient numbers of staff to care for and support people to meet their needs. People had to wait for staff to help them with their personal care. We observed one person waited 50 minutes to transfer from their wheelchair to a comfortable chair in the lounge area. We saw that the provider's staff recruitment process helped to ensure that staff were suitable to work with people using the service.

At this inspection we found the provider did not have effective systems to assess, review and manage risks to ensure the safety of people. Although the home conducted a variety of audits they were not effective in that they had not identified the inconsistencies we found in relation to the management of medicines. We saw that regular checks of maintenance and service records were conducted to ensure these were up to date.

The provider took appropriate steps to protect people from abuse, neglect or harm. Training records showed staff had received training in safeguarding adults at risk of harm. Staff knew and explained to us what constituted abuse and the action they would take to protect people if they had a concern. Staff were familiar with risks people faced and knew how to manage these.

Staff had the skills, experiences and a good understanding of how to meet people's needs. Staff spoke about the training they had received and how it had helped them to understand the needs of people they cared for.

The service had taken appropriate action to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. DoLS were in place to protect people where they did not have capacity to make decisions and where it is deemed necessary to restrict their freedom in some way. We saw and heard staff encouraging people to make their own decisions and giving them the time and support to do so.

Detailed records of the care and support people received were kept. People had access to healthcare professionals when they needed them. People were supported to eat and drink sufficient amounts to meet their needs.

People were supported by caring staff and we observed people were relaxed with staff who knew and cared for them. Personal care was provided in the privacy of people's rooms.

People's needs were assessed and information from these assessments had been used to plan the care and support they received. People had the opportunity to do what they wanted to and to choose the activities or events they would like to attend.

The provi

We carried out a comprehensive inspection of this service on 4 August 2015 at which a breach of legal requirements was found. The provider had not ensured that people who use services were protected against the risks of inappropriate care and treatment by means of the planning and delivery of care to meet the service users’ individual needs and to ensure the welfare of the service user. After the inspection the provider wrote to us with a plan of how they would meet the legal requirements in relation to these breaches.

We undertook this unannounced comprehensive inspection of Lynton Hall Nursing Centre on15 and 17 March 2016. We checked the provider had followed their plan and made the improvements they said they would make to meet legal requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Lynton Hall Nursing Centre on our website at www.cqc.org.uk.

Lynton Hall Nursing Centre provides accommodation and nursing care for up to 57 older people. There were 43 people living at the home when we visited. The home was based on two floors, the ground floor for people with nursing care needs and the first floor for people living with dementia. There were bedrooms, bathrooms and communal rooms on both floors.

The home had a registered manager at the time of the inspection. 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.

At this inspection, we found the provider had followed their action plan, and legal requirements had been met. People's care plans and risk assessments were completed and comprehensive. The provider had a monthly schedule of checking care plans for accuracy and actions plans to deal with any errors.

People were safe at the home. The provider took appropriate steps to protect people from abuse, neglect or harm. Training records showed staff had received training in safeguarding adults at risk of harm. Staff knew and explained to us what constituted abuse and the action they would take to protect people if they had a concern. We saw that the office door was open and people could speak to the registered manager or deputy at any time.

Care plans showed that staff assessed the risks to people's health, safety and welfare. Records showed that these assessments included all aspects of a person’s daily life. Where risks were identified, management plans were in place. Records showed that incidents or accidents were thoroughly investigated and actions put in place to help avoid further occurrences. We saw that regular checks of maintenance and service records were conducted.

We observed that there were sufficient numbers of qualified staff to care for and support people and to meet their needs. We saw that the provider’s staff recruitment process helped to ensure that staff were suitable to work with people using the service.

People were supported by staff to take their medicines when they needed them and records were kept of medicines taken. Medicines were stored securely and staff received annual medicines training to ensure that medicines administration was managed safely.

Staff had the skills, experiences and a good understanding of how to meet people’s needs. Staff spoke about the training they had received and how it had helped them to understand the needs of people they cared for.

The service had taken appropriate action to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. DoLS were in place to protect people where they did not have capacity to make decisions and where it is deemed necessary to restrict their freedom in some way, to protect themselves or others. We saw and heard staff

At our last inspection on 15 December 2014 we found a number of breaches of legal requirements. At the time, we judged two breaches of legal requirements were serious enough, that we served two warning notices on the provider and told them to make the necessary improvements by 3 April 2015. This was because the provider did not carry out sufficient risk assessments of the premises and individual risk assessments for people and did not have an effective system to regularly assess and monitor the quality of services provided and did not submit a Provider Information Return to CQC in a timely manner. We undertook a focused inspection on the 6 May 2015 to check that the provider had met the legal requirements for these two breaches and found the necessary improvements had been made. During this inspection we looked to see if the provider was continuing to demonstrate good practice against these breaches of regulation.

Also at the inspection on the 15 December 2014, we found another seven breaches of legal requirements. These were in relation to the condition of the premises, the management of medicines, the standard of cleanliness of the premises and the level of support given to people who required help to eat and drink. Care plans for the support people required were not detailed enough to describe how to meet people’s individual needs and the provider had not taken the correct actions to ensure that the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. These safeguards ensure that a service only deprives someone of their liberty in a safe and correct way, when it was in their best interests and there was no other way to look after them.

The provider sent us an action plan and told us they would make the necessary improvements by the end of May 2015. We undertook a comprehensive unannounced inspection on 4 August 2015 to check that they had followed their plan to confirm that they now met legal requirements and to review the rating of the service.

Lynton Hall Nursing Centre provides accommodation and nursing care for up to 57 older people. There were 41 people living at the home when we visited. The home was based on two floors, the ground floor for people with nursing care needs and the first floor for people living with dementia. There were bedrooms, bathrooms and communal rooms on both floors.

The new manager at Lynton Nursing Centre had transferred from another BUPA home and had applied to the CQC to be the registered manager at this location. 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.

At this inspection we found the provider had made progress towards improving the safety of the home for the people who lived and worked there and for visitors. We saw communal bathrooms that were previously congested with equipment and emergency pull cords that were not within reach were now more accessible. This meant that people could use the bathrooms independently and safely and that equipment did not have to be stored in the corridors when a person wanted a bath or shower.

We saw that a new medicines room had been built on the ground floor, which was locked and only accessible to staff. These improvements meant risks associated with medicines storage were being mitigated.

We observed that the home was clean and free from malodours. Bathrooms were adequately equipped to promote people’s independence. There was a cleaning schedule of the kitchen area which was being followed. Risks to people and others from poor infection control practices were therefore minimised.

We saw the sluice rooms were locked and cleaning products and chemicals were safely stored within these rooms. This meant people no longer had access to dangerous substances.

We looked at the care records for six people and the accident/ incident records. The care plans we looked at identified a high risk of falls but this had not prompted staff to develop a falls action plan to address the matter. The manager stated this was something that was being developed with staff and was part of their on-going improvement of the service.

The service had contracts for the maintenance of equipment used in the home, including the lift, fire extinguishers and emergency lighting. Records showed that these items of equipment were being maintained as required.

The service helped protect people from abuse. Staff were aware of what constituted abuse and the actions they should take to report it.

Throughout the inspection we saw staff were available, visible and engaging with people. Staffing levels had improved since the last inspection. The provider now employed their own bank staff who were familiar with the service, rather than using agency staff.

We saw the correct procedures had been followed before staff were employed. New staff now had a statutory six month probation period built into the job. These checks and processes helped to ensure that people were cared for by people suitable to the role.

We observed a medicines administration round and the practices used were safe. We looked at medicine administration record (MAR) charts and saw that they were correctly completed and up to date. The checks we made confirmed people were receiving their medicines as prescribed by staff qualified to administer medicines.

We found that staff had a general understanding of the Mental Capacity Act 2005 and the need to assess a person’s capacity before taking any decisions. However we also saw there were restrictions around the home for the use of the lift or to access the doors leading to the stairs between floors because these were operated with the use of a key code pad. There were no assessments as to how these could restrict people’s freedom and how the risks could be mitigated. We have made a recommendation in relation to this.

There were sufficient staff during meals times to help people who require assistance with their meal. People could choose their meal from a variety of food on offer or if they wanted something else this would be made for them. These improvements have helped people to have a better experience at meals times.

People were cared for by staff who received appropriate training and support. Staff had the skills, experiences and a good understanding of how to meet people’s needs. Staff told us the training had enabled them to do their work to a good standard. The frequency of supervision for staff had improved and was now a more supportive and helpful discussion time with their manager.

People were supported to maintain good health and have appropriate access to healthcare services. Appointments people had with health care professionals such as dentists or chiropodists were recorded in their health care plan.

People were looked after by staff who were caring. Our observations found the interactions between staff and people were positive. We saw that staff showed people care, patience and respect when engaging with them. The atmosphere in the home was calm and friendly. Staff took their time and gave people encouragement whilst supporting them.

The main entrance hall had a notice board that gave people and visitors a variety of information so they knew what was happening in the home. This included information about events taking place, activities, important phone numbers and the minutes of the home meetings that all people and relatives were invited to.

We saw people had the privacy they needed and they were treated with dignity and respect. Staff used the correct procedures and equipment when moving people from their wheelchair to a lounge chair and people’s dignity was retained while they did this.

People’s needs were assessed before they moved into the home and improvements had been made to the details within care plans but more detailed information was still needed to make sure staff were clear about how to meet people’s needs. The care plans we looked at had been generated within the last six months.

Care plans covered the activities of daily living but we did note for some people there was a lack of personal history. The manager said they were gradually adding information to the care files to help staff understand who a person was through their background.

There was a programme of activities and it was noted in people’s daily records if they had attended. The home employed two full time activity co-ordinators and records showed they had regular contact with people and what activities were offered to them.

We reviewed the records relating to complaints or concerns. We noted the received complaints had been investigated and a record of statements and actions taken were retained, all within a timely manner.

Weekly, monthly and quarterly audits were carried out, including audits of medicines’ records and storage, care plans and infection control. A new cleaning checklist had been devised for domestic staff to follow and we saw this was being followed.

Staff told us the new manager was doing a good job and cited several improvements they had made. Staff said they could approach the manager with any issue and regular staff meetings had been started. Staff said these were a helpful way of sharing information and having an understanding of the improvements the home needed to make.

The manager had an understanding of their role and responsibilities. They understood their legal obligations with regard to CQC requirements for submission of notifications and these had been submitted in a timely manner.

The provider continued to ask people and staff for their opinion of the service through the annual survey. People and staff were able to give their opinions on the service through the staff meetings, the house meetings and having easier access to speak to the manager and deputy manager. This helped to ensure that people’s opinions were heard in a timely fashion and any concerns dealt with promptly.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations Act 2014. The actions we have asked the provider to take can be found at the back of this report.

We carried out an unannounced comprehensive inspection of this service on 15 and 16 December 2014. Several breaches of legal requirements were found and the Care Quality Commission issued two warning notices for breaches of Regulations 10 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond to Regulation 17 and 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they have met the requirements of the warning notices. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lynton Hall Nursing Centre on our website at www.cqc.org.uk.

Lynton Hall Nursing Centre provides accommodation and nursing care for up to 57 older people. There were 43 people living at the home when we visited, one person was in hospital. The home was based on two floors, the ground floor for people with nursing care needs and the first floor for people living with dementia. There were bedrooms, bathrooms and communal rooms on both floors. Each person has their own room.

The home had a registered manager who was on leave at the time of the inspection. The home was being supported by a registered interim manager from another local BUPA home. 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.

We found that the doors to both sluice rooms were locked and individual risk assessments were updated. Staff explained to us the schedule for ensuring how they would assess people most at risk based on the level of risk they faced. We saw that a behaviour observational chart was in use for people who had behaviours that challenged. Plans were now in place to monitor accidents and falls and evaluate why they had occurred. These included measures to mitigate further risk of accidents or falls.

The provider continued to conduct monthly reviews of the service and an action plan was developed. The outcomes of the action plan were monitored more robustly than during our previous inspection and evidence compiled that the areas for improvement were being addressed and these were signed off when completed.

People were able to participate in making decisions regarding their care or treatment and were treated with consideration and respect.

Over the lunch period in the ground floor dining room and saw that interactions between staff and people were positive. People were asked if they would like to wear a clothes protector and what they would like for lunch. We saw that staff spoke kindly to people before helping them and engaged people in conversations during the lunch period.

The care we saw that was given to people was good and an improvement on our last observation. The area manager said there was still more work to be done. We saw that staff now had dedicated lunch and break times. This ensured there was always sufficient staff to help people, especially after meal times. We saw that people who choose to stay in their rooms had a call bell near to them and staff came within a very short time, less than three minutes when the bell was pressed.

We heard staff speaking to people throughout the house in a positive and friendly manner and engaging people in conversations. People confirmed they were treated with respect and dignity and could have a bath or shower when they wanted to.

People in the first floor were engaged in an activity and quiet music was play in the background. Staff were talking to people and helping one person who was restless on a one to one basis and this appeared to calm them.

We saw that medicines waiting to be returned to the pharmacy were kept securely in a locked cupboard. There was a monthly schedule for updating care plans and staff confirmed our observations that this was happening.

The area manager said they had engaged people in making changes to the lounge areas. We saw the changes meant people and staff could speak to one another while activities were taking place and other people could go into a quieter area of the lounge.

We saw that the majority of food and fluid charts were now completed correctly.

People who live in this home, who are known as residents, were generally happy with the care they were receiving. They told us “it’s alright here”, “staff are nice and friendly, they do their best” and “I can’t complain it’s not bad”.

Others told us told us “staff usually do things how I like them”, and “I can tell them what to do”.

One person did complain that, although she had told them, staff did not address her in the way she preferred, calling her ‘darling and love’. Others said that they didn’t mind that.

Comments that we received about the food served in the home were mixed. Some residents told us “it’s quite good”, “I like it” while others complained “its not as good as it was”, “sometimes it’s quite cold”, “it’s not to my choice”, and “it’s not what I like”.

This unannounced inspection took place on 15 and 16 December 2014. Lynton Hall Nursing Centre provides accommodation and nursing care for up to 57 older people. There were 43 people living at the home when we visited. The home was based on two floors, the ground floor for people with nursing care needs and the first floor for people living with dementia. There were bedrooms, bathrooms and communal rooms on both floors. Each person has their own room with en-suite toilet and some have a bath or shower.

The last inspection on 9 and 22 January 2014 was part of a themed inspection programme specifically looking at the quality of care provided to support people living with dementia to maintain their physical and mental health and wellbeing. We found the service was meeting the regulations we looked at.

The home had a registered manager at the time of the inspection. 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.

People were not safe at the home because the provider did not have suitable arrangements to ensure there were adequate staffing levels in the home. People and relatives’ feedback suggested that this was more evident during weekends.

We saw that the provider did not always ensure the safe storage of chemicals and medicines. We found that cupboards used for their storage were left unlocked. This meant that people’s health and wellbeing were put at risk. We observed a medicines administration round and the practices used were safe.

Communal bathrooms we looked at were dirty and there were other areas that we found where the standard of cleanliness was not good. Some bathrooms were used to store equipment, including hoists, walking frames, laundry bins and wheelchair parts. Emergency pull cords were not within reach and in some cases tied up. This made it difficult for people to use the bathrooms safely and independently.

The provider had taken appropriate steps to protect people from abuse, neglect or harm. Training records showed that the majority of staff had received recent training in safeguarding adults at risk. Regular checks of maintenance and service records were conducted.

Although the provider ensured there was training for staff, people did not feel that staff had the skills and knowledge to know their needs and preferences. The home had a dementia champion; they had received training on dementia awareness and were responsible for training the other staff on this subject.

Records showed that supervision of staff was conducted every three months. But staff we spoke with said that one to one supervision was not occurring frequently. One staff member said they had not had supervision for more than nine months, another said not recently and another staff member that they had never had supervision. We were unable to look at staff supervision files, so could not verify what staff were telling us.

The provider ensured that people received a variety of meals to meet their needs and choices. People especially liked their breakfast

Some people and their relatives were pleased with the care but other people did not think they were always looked after by staff who were caring. We observed a number of staff engagements with people that were not positive.

People’s needs were assessed prior to admission to the home. The care plans overall were to a variable standard. We found few that were comprehensive and had considered who the person was and how they would like to be cared for. Other care plans did not have this detail of information. Some of the care plans we looked at were more than a year old and had not been reviewed monthly as per the provider’s policy on reviewing care plans.

There were two part time activities co-ordinators and a programme of activities, including arts and crafts, board games and outings so that people had a range of occupational activities to choose from.

The service was led by a registered manager; they were supported by a deputy manager. The manager had not submitted notifications to the CQC as they are required by law. They had not notified CQC of any Deprivation of Liberty Safeguards (DoLS) applications and the decisions taken. These safeguards ensure that a service only deprives someone of their liberty in a safe and correct way, when it was in their best interests and there was no other way to look after them.

People and relatives were aware of the complaints procedure and those who have raised concerns felt that these had been listened to and things had improved. The provider Bupa Care Homes (ANS) Ltd conducted monthly reviews of the service; we saw that recommendations made had not been actioned. The provider’s monitoring systems were therefore not effective.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond to the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The actions we have asked the provider to take can be found at the back of this report.