About the service:

¿ Lynwood Lodge Residential Care Home (known as Lynwood) is a residential care home registered for 24 people. Lynwood was providing personal care to 16 people aged 65 and over at the time of the inspection.

¿ Lynwood is a large Victorian building, with 20 single rooms and two shared rooms. Some rooms have en-suite facilities. There is lift access to the two main floors, with stair lift access to other areas of the home.

People’s experience of using this service:

¿ All the people and their relatives we spoke with were complimentary about living at Lynwood Lodge and were positive about the staff team. They said the staff knew them and their needs well, always treated them with respect and new how to maintain their privacy and dignity.

¿ The staff said they enjoyed working at the home and they received the training and support they needed. Staff were safely recruited.

¿ Care plans were in place that assessment the support people needed and the risks they may face. All care plans were reviewed each month. People and / or their relatives were involved in agreeing the care plans.

¿ People received their medicines as prescribed from trained staff.

¿ People enjoyed the meals and said they always had a choice.

¿ People’s health needs were being met. Referrals to medical professionals were made as required.

¿ A quality assurance system was used by the registered manager to monitor the service. All incidents and accidents were recorded and reviewed by the registered manager to ensure actions were taken to reduce the chance of a re-occurrence.

¿ No one was receiving end of live care at the time of our inspection. We saw evidence of the service working with district nurses, GPs and other professionals when supporting people at the end if their lives.

¿ The home was clean throughout. Clear infection control procedures were in place for supporting three people who had hospital acquired infections.

¿ Staff arranged activities within the home and an external exercise instructor visited twice per week. Some people said they did not have chance to go out, for example to the pub, as much as they used to.

¿ There was a formal complaints policy in place. No formal complaints had been made since our last inspection. People and their relatives told us they spoke directly to the staff team or registered manager about things and they were then sorted out.

¿ Lynwood Lodge was well decorated, however dementia friendly signs to assist people to orientate themselves within the home were not used. A notice board contained old pictures and paper clippings to aid reminiscence.

Rating at last inspection: Good; report published 2 November 2016

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on the 21 and 22 September 2016 and was unannounced. The service was previously inspected in September 2014 and was found to be compliant with the regulations reviewed at that time.

Lynwood Lodge is registered to provide personal care and accommodation without nursing for up to 24 older people. At the time of our inspection there were 23 people living at the home. The home is a large Victorian property located in its own grounds close to Sale town centre. There are 20 single rooms and two shared rooms. Most rooms have en-suite facilities. The home has lift access to the main floors and chair lift access to other areas of the home. There are two lounges on the ground floor, with dining facilities spread between the two lounges and a small galley area.

The service had a registered manager in place. 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 we spoke with, and their relatives, were complimentary about Lynwood Lodge. They said they felt safe, the staff knew their needs a well and there were enough staff on duty to meet their needs. We observed the home had a calm and relaxed atmosphere. Staff were positive about their role.

Staff had received training in safeguarding adults and knew the correct action to take if they witnessed or suspected abuse. Staff were confident that the registered manager would act on any concerns raised.

Care plans and risk assessments were in place with guidance for staff in how people wanted to be supported and the tasks they were able to complete independently. These were written in a person centred way and had been regularly reviewed and updated when people’s needs changed. Care plans were in place for the support people wanted as they came to the end of their lives.

People we spoke with told us that the staff at Lynwood House were kind and caring. During the inspection we observed kind and respectful interactions between staff and people who used the service. Staff showed they had a good understanding of the needs of people who used the service and had received appropriate training in order for them to meet people’s needs. The recruitment process was robust and all required checks were in place prior to staff commencing work. Staff received regular supervisions and said they felt well supported by the registered manager.

Medicines were administered and stored safely. Senior care workers had received training in the administration of medicines. However we found the two people had not received their medicines as prescribed as there was a discrepancy in the number of tablets currently held for these two people. The service had procedures in place when an error in administration was made. Weekly audits of medicines meant the registered manager was able to action any errors found.

Systems were in place to help ensure people’s health and nutritional needs were met. Records we reviewed showed that staff contacted relevant health professionals to help ensure people received the care and treatment they required.

We found the service was working within the principles of the Mental Capacity Act (2005). Capacity assessments and best interest decisions were made where required. Applications for Deprivation of Liberty Safeguards (DoLS) were appropriately made. Staff offered people day to day choices about their care and sought their consent before providing support.

All areas of the home were seen to be clean. Procedures were in place to prevent and control the spread of infection. Systems were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and gas supply. Regular checks were in place of fire systems and equipment.

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We found the care plans respected the person's right and that of the family to be involved in making decisions about how the service should be provided.

We found people had the opportunity to express their views about the services provided and the home fully engaged with relatives or representatives when decisions were made about the care needs of the people who used the service.

We found care was planned and delivered in a way that was intended to ensure people’s safety and welfare.

One person who used the service told us; “I think it is very nice, the staff are very kind. The food is satisfactory, I have no concerns.” Another person who used the service said “I’m very grateful for what they have done for me. I’ve been very happy here.”

During the inspection we reviewed how medication was administered, recorded and stored. We found medicines were safely administered and people who used the service received their medicines in the way they had been prescribed.

We spoke with five members of staff who told us they all felt supported in their roles. One member of staff told us “The manager does supervision every two months, they are very good on training which the manager arranges.”

We found that the provider had system in place to monitor the quality of the service they provided.

We found that the provider had system in place to monitor the quality of the service they provided.

Four care plans provided evidence that people had been asked to consent to the personal care and support they received. One person said, "If I wanted something to be done differently, I would speak to the carers or the manager. It is always flexible here."

Care plans and risk assessments had been regularly reviewed and consistently updated to reflect changes in people's wellbeing.

People living in the home received varied and nutritionally balanced diets.

An effective system was in place to safeguard people living in the home from abuse. One of the people accommodated told us, "Yes, I feel safe living here. Sometimes people have disagreements, but the staff are on hand to calm things down."

The home's environment was found to be clean and hygienic. We found two concerns relating to fire safety. When we shared our concerns with the manager they took immediate action to make the required improvements.

Sufficient staff had been deployed to meet the needs of the people accommodated. One person told us, "The staff are very good. Nothing is too much trouble for them. You only have to ask and it's done."

We saw that Lynwood Lodge had an effective system in place to investigate and respond to complaints made by people using the service and their representatives. One person living in the home said, "I would be confident in raising any issues I had with the manager, or any of the staff. They are all approachable."

People told us that they were able to decide how their care needs were met and how care staff supported them.

People told us that daily routines were flexible and they could decide what time they got up in the morning, what time they went to bed and they had a choice about how they spent their day.

One person complained that there wasn’t enough going on in the home and said that all they had to do was watch the TV.

People said that the manager and care staff were very good and if they were ill GP's and district nurses were contacted.

People said that care staff were very good and helpful.

One person told us they were,” Very happy, it’s brilliant living here.”

Another person said, “Nothing’s too much trouble”, for care staff.

One person said of the menus, “too many sandwiches” and someone else told us, “Supper, you are lucky if you get something.”

People told us they felt safe living at Lynwood Lodge

The inspection was carried out by one inspector. 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 to people's needs?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them, the manager and the podiatrist. We also spoke with the Director of Operations and the Director of Care. We looked at records relating to people’s care and the management of the service. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Lynwood Lodge provides support for up to 24 people with varying personal care needs which include people who are living with dementia. The premises are located in a quiet residential area of Sale. The building is a large Victorian detached house that has been converted from two semi-detached houses.

A maintenance person was responsible for the day to day maintenance of the home.

The premises had recently undergone a full electrical re-wire; therefore a redecoration and refurbishment programme; such as replacing carpets was in progress.

The home was odour free and those areas that had been refurbished were clean, tidy and well presented.

Training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) took place which ensured that people who were not able to make decisions or choices were protected and kept safe. The manager had recently submitted two DoLS applications. Best interest meetings and any other legal requirements such as applications to DoLS or Court of Protection were completed in conjunction with other health care professionals such as social workers and IMCA’s (Independent Mental Capacity Advocate).

We saw people had received an assessment of their care needs and that these had been discussed with the person concerned.

There were a sufficient number of people in the staff team to ensure that people were supported with their care needs.

Is the service effective?

Recruitment and selection procedures were in place. There was a probationary period of 12 weeks which included induction to ensure that that the people who lived at Lynwood Lodge had their needs met by staff who had the right skills.

The recruitment and selection was undertaken by the Director of Operations and the Director of Care. We discussed with them the need to ask on the application form that people include their complete work history from leaving school or full time education and explain any gaps. This is to ensure as far as possible only suitable people are employed.

We saw from looking at the care plans that people had received an assessment and that there was a good understanding of the person's needs and the support they required.

The people we spoke with said that they were happy with the care they received. They also spoke well of the staff team and had no complaints.

Is the service caring?

We spoke with five people who used the service and three family members. The family members told us "The staff are very nice and the manager is very approachable.” Another person told us “The staff are really nice; very patient and kind.”

The people who lived at the home told us “I could tell the staff if I was not happy with anything”; “I have a good relationship with all the staff and I go into the office and have a chat with the manager most days.”

People's preferences were recorded in the care plan and they were able to express their views and opinions through talking to members of the staff team, taking part in reviews and focus groups. The focus groups were held every three to four months and family members were also invited. The groups discussed such areas as food, outings and forth coming events.

Is the service responsive to people's needs?

We saw that people's needs were assessed before they were offered a place at Lynwood Lodge Residential Care Home.

A hand and foot massage therapist and a person who conducted movement to music exercises were commissioned by the organisation to provide a service at Lynwood Lodge.

We saw that people were referred to other healthcare professionals as and when necessary; these included GP, dietician, district nurse and podiatrist.

Is the service well led?

Lynwood Lodge is one of three residential care homes which are part of Trinity Merchants Limited.

Surveys were conducted after the first six weeks of the person’s admission to the home and replies were analysed in order to improve the service provided.

There were quality and monitoring systems in place. The manager completed a check list to monitor such areas as the care plans and health and safety. These reports were sent to head office. The Director of Operations and the Director of Care also visited the home to complete checks. These visits could take place at any time of day or night and were unannounced.

The systems in place helped to keep the people who lived and worked at Lynwood Lodge safe.