This inspection took place on 26 and 27 March and the first day was unannounced. At the last inspection, the service was rated Good. At this inspection, we found the service was Requires Improvement. We found four breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Lynwood 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.

Lynwood House accommodates up to ten people in one adapted building. The people who live in the home have learning disabilities. Some people also have profound physical needs. At the time of the inspection, seven people were living there.

There is 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 2008 and associated Regulations about how the service is run.

Although there were sufficient numbers of staff to keep people safe, staff were not always providing the one to one hours as detailed in people’s care plans to ensure their needs were met.

Suitable measures were not always taken to reduce the risk of harm to people, although a range of risk assessments had been put in place. Staff assessed people for the use of bed rails, although they had not been trained. One person’s bed rails were set incorrectly. There was no guidance for staff about pressure relieving mattress settings where people were at risk of pressure ulcers. Not all staff could consistently describe how they would know a person was in pain.

Medicines were not always managed safely and some staff did not have their competency to administer medicines assessed in line with the provider’s policy. The suitability of giving medicines in food had not been checked with a pharmacist and storage temperatures were incorrect.

Staff did not have guidance or training about how to support some people’s specific complex needs and not all necessary training had been completed by staff.

People’s records lacked detailed information to support personalised care in some specific areas. These included dietary needs, communication and specific complex needs. Not all health checks could be confirmed as completed. Where one person required staff support with exercises, these were not always done as directed by the physiotherapist.

The provider did not have effective systems in place to monitor the quality of care and support that people received. Audits had not identified the shortfalls we found during this inspection.

Staff knew how to safeguard people from potential abuse and understood how to raise concerns and report accidents.

People were supported in line with the requirements of the Mental Capacity Act 2005 and people were only deprived of their liberty lawfully.

People responded well to staff who understood their communication needs. However we did not see the specific methods of communication being used with people as described by staff. People told us they were happy and looked relaxed with the staff.

Staff felt well supported by the manager, attended regular meetings to discuss their work and monthly staff meetings to discuss wider issues about the service.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back this report.

This inspection took place on the 12 March 2016 and was announced. 48 hours’ notice of the inspection was given because the service is small and we needed to be sure that a senior member of staff would be available. When the service was last inspected in November 2013 there were no breaches of the legal requirements identified.

Lynwood House is registered to provide accommodation and personal care for up to ten people. At the time of our inspection there were ten people living at the service. The people who live at the service have learning disabilities. Some people also have profound physical needs.

A registered manager was in post at the time of inspection. 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.

People’s rights were being upheld in line with the Mental Capacity Act 2005. This is a legal framework to protect people who are unable to make certain decisions themselves. We saw information in people’s support plans about mental capacity and the Deprivation of Liberty Safeguards (DoLS). DoLS applications had been applied for appropriately. These safeguards aim to protect people living in homes from being inappropriately deprived of their liberty.

People had their physical and mental health needs monitored. All care records that we viewed showed people had access to healthcare professionals according to their specific needs.

People were encouraged to maintain contact with their family and were therefore not isolated from those people closest to them.

Staffing numbers were sufficient to meet people’s needs and this ensured people were supported safely. Staff we spoke with felt the staffing level was appropriate. People were supported with their medicines by staff and people had their medicines when they needed them.

People received effective care from the staff that supported them. Staff were caring towards people and there was a good relationship between people and staff. People and their representatives were involved in the planning of their care and support. Staff demonstrated and in-depth understanding of the needs and preferences of the people they cared for.

Support provided to people met their needs. Supporting records highlighted personalised information about what was important to people and how to support them. People were involved in activities of their choice.

There were systems in place to assess, monitor and improve the quality and safety of the service.