This inspection visit took place on 4 January 2018 and was unannounced.

Lyons Court 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. Lyons Court accommodates up to 50 people in one adapted building providing nursing care and support for people living with dementia including those who may experience behavioural disturbance or distress and younger adults. At the time of our inspection visit there were 36 people using the service. Lyons Court is divided into five separate units including a specialist behaviour unit called Raby and a general nursing unit called Windsor.

The service now had a registered manager in place who had been registered since August 2017. 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 last inspected the service in November 2016 and rated the service as ‘Requires Improvement.’ At that visit we found breaches of regulations in relation to staffing levels, medicines management, the safety of some fixtures and fittings and cleanliness and checks in relation to infection control. There was no registered manager in post. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective and Well-led to at least good. The provider sent us an action plan in which they set out how they would meet the regulations. At this visit we saw improvements had been made and the service was meeting all regulations at this time.

The service was now safe. People, staff and relatives we spoke with told us they felt safe at Lyons Court. Staff and people were aware of procedures to follow if they observed or were aware of any concerns. Accidents and incidents had been appropriately recorded and monitored and risk assessments were in place for people who used the service and staff.

Staffing levels were appropriate and a consistent staff team was in place. The service has implemented a recruitment drive for nursing and bank staff which had been successful and also ensured annual leave and sickness was managed more proactively resulting in much lower agency staff usage.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. Medicines were stored in a safe manner.

Appropriate health and safety checks had been carried out on the building and the home was clean and well maintained. We saw that infection control measures were now well embedded and a recent external audit by the infection control nursing team was positive.

The service was now effective. Staff were now suitably trained and received on-going training and support. Staff received regular supervisions and appraisals and told us they felt supported. We saw staff were supported by debrief sessions to review any incidents that took place at the service and staff members told us they were able to speak up and learn from these meetings.

People’s day to day health needs were met by the staff and the service had good relationships with external healthcare professionals. Care records showed that people’s needs were assessed before they started using the service and they were supported to transition to the service as smoothly as possible.

The provider was working within the prin

This inspection took place on 23 and 24 November 2016 and was unannounced, meant the staff and provider did not know we were visiting. We visited the service earlier than originally planned in response to concerns raised about the registered provider and additional specific concerns about this location.

Lyons Court Care Home is registered to provide accommodation and personal care with nursing to up to 50 people and at the time of the inspection 45 people were living in the home. Everyone living at the home required varying levels of support with their personal care: 27 of these people had additional conditions which also required nursing care.

The home is divided into five separate areas referred to by staff as “units” and we were told by the home manager that these consist of an eight person unit supporting people with “behaviours of concern”, a nine person residential unit, a nine person unit support people with dementia, a 12 person unit supporting people with dementia and nursing needs and a 12 person nursing unit. Each unit has a name for example the “Auckland Unit.”

At the last inspection on 16, 17 and 21 July 2014, and it was compliant with CQC regulations inspected at that time. At this inspection we rated the home as ‘Good’ overall but as ‘Requires Improvement’ in relation to being ‘Well-led’. This was because we identified that quality assurance systems were failing to maintain continuous improvement.

At the time of our inspection visit, the home did not have a registered manager in place and there had not been a registered manager at this home since 29 January 2016. 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, however, a manager in post who has worked in the home since June 2016 and who now intends to apply to be the registered manager.

Although we observed staffing to be sufficient at the time of the inspection people who used the service, their relatives and staff told us they had concerns about staffing levels. We also found that the home had failed to recruit sufficient staff to ensure cover for staffing contingencies and maintain adequate management oversight of the home. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that medicine management arrangements were not always clear or consistent and found this had led to medicine errors being made. We found examples of where people had received too much or too little medicine. We found examples where there was no documented evidence that topical medicines had been administered because records were inaccurate or did not exist. The acting manager agreed that they could not discern from the medicine containers that these had been administered appropriately or at all. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that cleaning in the home and checks of the home were not sufficient to ensure good infection control practices and reduce the risk of the spread of infections. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that fixtures and fittings were not always maintained and secured so as to ensure people’s safety. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found staff understood what actions to take if they thought people at risk of abuse.

There was a process for managing accidents and incidents to ensure the risks of any accidents re-occurring would be reduced.

Staff employed by the registered provider had undergone a number of recruitment checks to

We used a number of different methods which included observation to help us understand the experiences of people using the service, because some of the people using the service had complex needs which meant they were not able to tell us their experiences.

During our observation we saw people were treated with consideration and respect. All people we spoke with said they were respected by staff. Comments include: "My privacy is respected at all times".

We reviewed care records and saw that people's preferences and care needs had been well documented. Staff were knowledgeable about people's care needs and what they should do to support them. We found people experienced care, treatment and support that met their needs and protected their rights.

We saw staff were very busy as they provided care and support to people who used the service. We spoke to people who lived at the home who told us staff were kind and helpful but they were kept very busy. One person said;" The girls are marvellous." Another person said;" They'll do anything for you but they're very busy." Other comments included "I can't grumble." Another person said; "On the whole I have no complaints."

We found the building was suitably designed for the needs of people who used the service.

There were not enough qualified, skilled and experienced staff to meet people's needs.

People were protected from the risks of unsafe or inappropriate care and treatment because the care records reflected the care provided.

We spoke to several people who lived at Lyons Court Care Home and they told us that the staff were very friendly and helpful. One person said “the staff are very good, very obliging”.

People said they were happy with the staff and the care they provided. One person said “the staff are very kind, it’s alright here”.

We also spoke to some relatives and visitors, they told us that the home was well run and they felt able to approach the staff or manager with any concerns they had.

We talked with some of the people who lived here and with some visitors. Many of the people who live here could not express their views because of their dementia care needs.

All the people and visitors we spoke with felt that the service at Lyons Court was good. Their comments included:

“It’s very nice.”

“We’re well looked after”

“It’s better than other places I’ve been in.”

“The manager and staff are very friendly.”

People described the help that they received from care staff. One person said, “The staff help me with my medication and baths.”

Other people commented on the activities and meals. One person said, “There’s a girl who helps us with dominoes and other games. We can just see the local football pitch from the upstairs lounge window.”

One person said, “We very well looked after. We get well fed and the food is very nice so I’ve put weight on.”

People said that they were happy with the accommodation. One person said, “It’s a nice place. It’s not my home but they make it very comfortable for us.”

One person told us, “We’re very comfortable. I’ve got lots of my own things in my bedroom. I can spend time in my own room watching telly whenever I want and looking out across the fields.”

One person said, “It’s very nice. I’ve got a lovely room with my own toilet. I prefer to use my own toilet for privacy.”

People told us that that they get “good help” from the staff.

A visitor told us, “The manager and staff are very friendly. My relative knew some of the staff before moving here so they feel very settled here.”

The people we spoke to during this review were generally satisfied with the service at the home and some felt that they were able to make some of their own decisions. However none felt that they had been involved in their own care planning.

When we visited the home people had not been given their medication on time. This made some people very anxious as they relied on having their medication at set times.

Overall people said that they were happy with the standard of their accommodation. People were pleased to have their own bedroom and their own private toilet. One person said, "My room's in a good place for me to come and go by myself."

People commented "staff are very nice" and "staff are very caring". During the visit we saw that staff were respectful and helpful towards the people who lived here.

Most people were unable to tell us whether they thought staff were well trained, but we saw and heard from staff that they felt untrained and uncertain about how to support some people’s dementia needs.

The people we spoke to commented that there was no manager. One person said, "There doesn't seem to be any control over things.”

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

We inspected Lyons Court Care Home on 16, 17 and 21 July 2014 and the inspection was unannounced. Our last inspection took place on 19 and 27 December and we found the service was meeting all essential standards.

Lyons Court Care Home is registered to provide accommodation and nursing care for up to 50 older people some of whom may be living with dementia. The accommodation for people who lived in the home is arranged over three floors linked by a passenger lift. On the day of inspection 44 people were living in the home.

The home had a Registered Manager who had been in post since January 2012. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider. However the manager has had long periods of absence since December 2013 and was not present during our visit and therefore the provider had appointed an acting manager until the return of the registered manager.

Relatives and staff gave us positive comments about the management team such as “The staff know what they are doing; they have been here quite a while. They just get on with it” We did not receive any negative comments from people who use the service, their relatives or health professionals involved in people’s care.

On the day of our visit we saw people looked well cared for. We saw staff speaking calmly and respectfully to people who lived in the home. Staff demonstrated that they knew people’s individual characters, likes and dislikes.

We spoke with one health care professional who told us, “The service is much better than it has ever been. We think of Lyons Court Care Home as a learning service in that they try really hard to get things right for people”. We found during our visit there were some areas for improvement such as maintaining people’s care plans and ensuring staff were aware of people’s changes in needs.

People who used the service and their relatives spoke very positively about the new acting manager as well as the registered manager. However staff told us they could be more included and feel more valued within the service. Staff explained they often did not feel listened to particularly when they raised issues regarding staffing levels.

We saw people who lived in the home were engaged in a variety of activities during our visit and were kept stimulated and occupied for example the where engaged in reading magazines and arts and crafts. People were able to choose where they spent their time for example on the ground floor there was a quiet room and a busier lounge area as well as a large outdoor space where people could sit.