Lyndon Hall Nursing Home

Lyndon Hall is a 'care home’ providing personal and nursing care. The care home accommodates 78 people across four separate wings, each of which has separate adapted facilities. Two of the wings specialise in providing residential or nursing care to people living with dementia. At the time of the inspection, there were 68 people living at the home.

People’s experience of using this service and what we found

People were kept safe as staff knew how to identify and report any concerns of abuse. Risks to people’s safety were managed well. Staff had been recruited safely and there were enough staff to meet people’s needs. Medicines were given in a safe way, and people had a clean environment to live in.

People were supported by staff who had received appropriate training. People’s needs had been assessed and their dietary needs were met. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The décor of the premises needed improvement to meet people’s specific needs. People had access to healthcare services where required.

People were supported by staff who knew them well and with whom they had positive relationships. People had access to some recreational and social activities, but these needed to be further developed. There was a complaints procedure in place and people knew how to raise complaints.

Everybody felt the service was well managed and that the registered manager was approachable and supportive. The registered manager had a visible presence around the service. There were effective systems in place, which were used consistently to monitor the quality of the service. People were given opportunity to provide feedback about the service.

Rating at last inspection The last rating for this service was requires improvement (published 03 August 2018) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lyndon Hall on our website at www.cqc.org.uk.

Follow up

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

Lyndon Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Lyndon Hall is registered to provide care, nursing and accommodation to a maximum of 80 older people, some with a diagnosis of Dementia. At the time of the inspection, there were 77 people living at the home.

There was no registered manager in post, but a new manager had been recruited and they were planning to apply to become registered. 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.

Administration and recording of medicines given was not always done safely. Medicines were not always stored at the correct temperature required to keep the medicine at it’s optimum potency. Staff were not always available to keep people from harm. Staff understood the procedures they should follow if they witnessed or suspected that a person was being abused or harmed. Accidents and incidents were responded to appropriately.

Staff did not always have the skills and knowledge required to support people effectively. Staff did not always have a clear understanding of the Mental Capacity Act and how best to support people in line with it’s principals. People did not always like the food provided and staff were not always supportive when people required assistance to eat. Staff gained people’s consent before assisting or supporting them. Staff received an induction prior to them working for the service and could access ongoing training to assist them in their role. Staff could access supervision and felt able to ask for assistance from management should they need it. Staff supported people’s healthcare needs.

Staff were not always caring towards people and their dignity was not consistently maintained. People were encouraged to retain an appropriate level of independence and choices were given to people were it was appropriate.

Care plans were in place, but it was not always clear if people had been included in compiling them and they were not always detailed. People were not consistently offered a stimulating environment. People’s preferences for how they wished to receive support were known and considered by the care staff. People knew how to raise complaints.

There had been a lack of consistency in management and some people remained unsure of the management status of the home. There was a high turnover of staff, which had had a negative effect on some people. The environment was not always conducive to people’s wellbeing. Meetings were held where people were able to contribute. Quality assurance audits were carried out, but these did not identify concerns in all areas. We did not always receive notifications as required.

You can see what action we told the provider to take at the back of the full version of the report.

The home is registered to provide accommodation, nursing or personal care to a maximum of 80 people. On the day of our inspection 73 people were using the service. The service is divided into four units and people who live there have a range of conditions related to older age and dementia.

The previous ratings inspection of the service took place on 24 February 2015 and at that inspection we found the service was Good overall with a rating of requires improvement in the area of Safe. This was because we found issues with recruitment practices as there were gaps in employment history and appropriate references had not been analysed. We saw that these concerns had been addressed.

The service did not have a registered manager. 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 an acting manager in place who was covering in the absence of a registered manager whilst recruitment was in progress.

People were not always turned appropriately to ensure that skin viability was maintained. People and relatives told us that there were not enough staff to keep people safe. Risk assessments were in place and were in the main followed. Medicines were given appropriately. People told us that they felt safe. Staff recruitment was carried out safely.

People had some concerns around how they received food and drink. Information was not always passed between staff correctly in the form of effective handovers. Staff received an induction prior to them working for the service and they felt prepared to do their job. Staff could access on-going training and regular supervision to assist them in their role. Staff knew how to support people in line with the Mental Capacity Act 2005 and gained their consent before assisting or supporting them.

There were concerns around the amount of time that people spent in their bedrooms.

Where possible people were able to make some decisions for themselves. Staff provided dignified care and showed respect to people. People were encouraged to retain their independence with staff there ready to support them if they needed help.

There were concerns around lack of stimulation and limited involvement in activities for people. There was a lack of consistency with regards to people and relatives understanding of the complaints procedure. People had been involved in their care plans where possible.

Not everyone knew who the acting manager was and not all staff felt supported in their roles. People and their relatives were not always aware that meetings to discuss the service were taking place. Audits were carried out in order to assist staff to take action where any concerns arose, but these were not always done consistently. We received notifications of accidents or incidents that had occurred, which the provider is required to do so by law.

All people spoken with were satisfied with the care and overall service provided. One person said, 'I really like it here. The staff are so kind'. Another person told us,' It is a very nice place'. One relative said, 'The home is comfortable and the staff are good. We are happy with everything'. Another relative told us, 'My relative looks well cared for. They were in three other homes before they came here and this one is the best they have lived in'.

We saw that people's needs had been assessed which ensured that their health, personal care, and safety needs would be met.

We saw that people were offered food and drink that they liked and were supported and encouraged to eat and drink sufficiently to prevent their ill health.

Medicine systems were adequate and medicines were given to people as prescribed by their doctor.

People and staff spoken with said that there were enough staff to meet people's needs and keep them safe. One person told us, 'We do not usually have to wait if we call the staff'. We found that staff had the training and support they needed to help them to meet people's needs and keep them safe. One relative told us, "The staff are polite and approachable".

Records sampled and people spoken with confirmed that systems were used to monitor how the service had been run to benefit the people who lived there.

During our inspection we spoke with seven people who were living at the home. All of those people were complimentary about the care that they received and the staff. One person said, 'I do like it here. I cannot grumble. The staff are very nice'. Another person told us' 'I have not stayed anywhere else like this before but I would say that it is first class here'.

We found that people's needs had not always been identified, planned for, or met. We found that staff had not always taken action to prevent certain conditions re-occurring and had not always responded in a timely manner when action was needed to prevent risk.

We found that record keeping concerning care delivery and fluid intake were not always adequate which meant that some risks had not been identified and managed and some needs had not been met.

People living at the home had confidence in the staff. We observed that staff were available at all times and that they were kind and caring.

We found that activity provision could be better. However, staff were aware of this and were taking action to improve in that area.