This comprehensive inspection of Lyndale Residential Home took place on 7 November 2018. The inspection was unannounced. This meant that the provider and staff did not know we were coming.

Lyndale Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. We regulate both the premises and the care provided, and both were looked at during this inspection. The service supported people who were living with mental health issues. People living at Lyndale received help with their all aspects of their care, including their well-being and positive mental health.

The home is in Tavistock near the town centre. It has been converted from two three-storey houses which are linked through communal areas. There are bedrooms on all three floors of the home.

At our last inspection we rated the service Good. There was no evidence or information from the current inspection and ongoing monitoring that demonstrated any serious risks or concerns. All five domains (Safe, Effective, Responsive, Caring and Well-Led) remain Good. This means the service is still rated Good overall.

Why the service is rated Good

The provider and registered manager were experienced at delivering care and support to people living with a mental illness. Both of them worked together, as well as with staff and professionals, to ensure they delivered care which really reflected the person’s needs.

There was a clear vision for the service which was developed by and shared with people and staff to ensure that it was agreed and understood. The vision described how the service was empowering for people, person centred and inclusive. People’s achievements were recognised and celebrated. Care records including risk assessments and support plans clearly described how the person was supported to be as independent as possible. People’s ambitions and preferences were recorded which ensured that staff had information to support people both when they were well and when their mental or physical health deteriorated.

Feedback from people using the service, visitors and professionals was all very positive. People described how they loved living at Lyndale and felt very well supported by the registered manager and staff.

The home was clean, comfortable and well maintained. People described Lyndale as “their home” and were clearly at ease and comfortable both in communal areas and their bedrooms which they had personalised.

Health professionals were very complimentary about the service and described how the staff were very professional, caring and effective. They also described how staff always ensured they proactively contacted and worked with health professionals to support people to maintain their health and wellbeing.

People were encouraged to stay healthy both physically and mentally. Staff supported them with this while recognising the rights of people to choose. Staff spent a lot of time encouraging people to consider their physical health, including their diet and exercise.

Staff were very skilled at supporting people who live with mental illness. Staff anticipated and supported people when they became mentally unwell to minimise the risks of a significant episode of mental illness.

Staff encouraged people to take part in social activities both inside and outside the home. Staff were innovative about engaging people in new ideas and experiences, such as food from around the world and a “Pride” event.

People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

There were sufficient staff to support people safely. Staff had been recruited safely and undertook training to ensure they had the necessary skills and knowledge. Health professionals said staff really got to know people well and were knowl

The inspection took place on 27 April 2016 and was unannounced. The home had previously been inspected June 2014 and had met all the regulations.

Lyndale Residential Home provides accommodation with personal care for up to 15 people living with a mental illness. When we visited the home, there were 15 men and women living there, most of whom had been resident for a number of years.

The home is located in Tavistock, a market town on the edge of Dartmoor, approximately 15 miles from the city of Plymouth. There are frequent bus services from the town to Plymouth.

The home had been adapted from two large semi-detached houses and includes a self-contained flat for one person living in the home, as well as single occupancy bedrooms for 14 other people. The two houses are interconnected and provide three lounges, a dining room and a large kitchen all on the ground floor. There is also a self-contained conservatory in the back garden, which provides a smoking area for people.

The home has a manager, who had worked there for over 20 years and had been registered with the Care Quality Commission since 2011. 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 were treated with kindness and dignity. They were involved in and chose their preferences when supported with care. Staff respected people’s rights and helped them to be as independent as possible whilst feeling safe.

Staff supported people to become more independent and develop their skills, both inside and outside the home. This included increasing people’s ability to undertake personal care tasks and to develop household skills as well as interpersonal and social skills.

Staff understood their responsibilities in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, relatives as well as health and social care professionals were consulted and involved in decision making about people in their 'best interest’.

There were detailed risk assessments in place for each person with actions identified to reduce risks as much as possible. People received their medicines safely and on time. Staff had a good knowledge of people’s communication, care and health needs. They also had an indepth knowledge of their mental health and social needs.

Staff received training when they started working at Lyndale. There were regular updates of training considered to be mandatory for staff. Staff were also provided training in specialist areas including Support Time and Recovery (STaR) training. Staff received regular supervision and an annual appraisal. Staff were supported to develop their skills through undertaking nationally recognised qualifications in care.

People’s care records were well maintained and up-to-date. The records provided detailed information about how to support each person. Care plans had been developed with the person, and those close to them.

The home was well maintained and provided people spaces to be with others or on their own, when they preferred.

Staff encouraged people to eat a well-balanced diet and make healthy eating choices. People had been encouraged and supported to lose weight. People were also supported to do exercise which had increased their well-being.

Staff worked with healthcare professionals including the person’s GP, specialist medical staff and members of the local community mental health team team.

Staff had completed safeguarding training and knew how to recognise signs of potential abuse. Staff knew how to report any concerns they had.

The provider had a written complaints policy and procedure. Although no formal complaints had been received, the manager kept

We gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We gathered information from people who used the service by talking with them.

This is a summary of what we found-

Is the service safe?

At the time of the inspection the service was safe.

During our inspection we observed staff supported and spoke with people in a respectful manner.

We spoke with people who lived at Lyndale Residential Home. Everyone we spoke with was complementary of the care and support provided by the staff and management. People we spoke with told us of how staff supported and enabled them to be as independent as possible. One person told us, “I go out a lot” and “I don’t know what I would have done without this place over the past 12 years”.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. People who lived at Lyndale Residential Home told us that “they could come and go as they pleased”. The manager was aware of the DoLS legislation and had in the past submitted an application. This demonstrated that the manager had knowledge about the legislation and of the responsibilities associated with it.

There was a safe and robust recruitment process in place which ensured people who lived at the care home were not at risk.

Is the service effective?

At the time of the inspection the service was effective.

People’s health and care needs were assessed and individual care plans were in place to guide and direct staff to meet a person’s health and social care needs.

From our observations and from speaking with people who lived at Lyndale Residential Home, staff encouraged people to do things for themselves as much as possible.

From our conversations with the manager and provider they promoted positive mental health and encouraged people where possible to move on from Lyndale Residential Home, to living independently within the community.

Is the service caring?

At the time of the inspection we found the service to be caring, one person told us, “the staff look after me, excellent every one of them”.

We observed staff speak to people in a caring and supportive manner. One person told us, “I don’t know what I would have done without this place over the past 12 years”.

We saw staff engaged in friendly conversation with people. One member of staff told us, we try our best to not be an ‘institution’, keep it personalised to the individual”.

Is the service responsive?

At the time of the inspection we found the service to be responsive.

The provider told us that the ethos of Lyndale Residential Home was to “provide stability” for people.

People told us that external health care professionals were involved in their care, such as GPs, and psychiatric nurses (CPN).

During our inspection we observed staff responded to people’s needs when requested and staff took an individual approach when working with a person.

Is the service well-led?

At the time of the inspection we found the service to be well-led.

The service had a manager who was registered with the Care Quality Commission.

People who lived at Lyndale Residential Home also told us that they were confident in the management of the home. One person described the manager and told us, “She’s my favourite”.

Staff we spoke with all told us that they were confident in the management of the home and would speak with the manager or provider if they had any concerns. One member of staff told us, “She [the manager] is probably the best I’ve had, easy to approach, firm but fair”.

During our inspection the manager and provider were both present; we observed that they were visible, that they took time to speak with people and were fully involved in the running of the home.

We found the provider had systems in place to monitor the quality of the service being provided.

There were 15 people living in the home on the day of our visit. We met with most of the people during our visit and respected the privacy of those that did not want to speak with us. We had meaningful conversations with seven of the people.

The home had a friendly and homely atmosphere. One person told us "it's not institutionalised here - we're a family". Throughout our visit we saw that people who lived at the home appeared comfortable and at ease with the staff who supported them. Comments included "staff are very nice", "staff are lovely" and "staff are good to me".

Each person had a plan of care in place which was regularly reviewed.

We saw that people chose their own meals and had a menu which was based on their favourite foods.

Staff demonstrated that they understood the signs of abuse and how to report any concerns. The home followed the correct procedure in cases of suspected abuse.

People lived in a home that was safe and suitable to their needs, choices and lifestyle.

People were not protected from possible harm, or inappropriate care, because the necessary employment checks had not always been undertaken before staff began work.

People at the home told us that they did not have any complaints but that if they did they would speak with the manager.

We carried out this inspection to check on the care and welfare of people using this service. The inspection was unannounced which meant the provider and the staff did not know we were coming.

We found that people's care was reviewed regularly and their needs were met. People contributed to the development of their own care records and were central to any care review.

People using the service were able to participate in activities in the community with support where needed. People told us they were able to join in local community activities according to their interests.

We saw the staff were friendly and professional in their approach and interacted confidently with people. There was a relaxed atmosphere in the home, and people were happy with the support they received. One person told us, “The staff are always available if we need them and help us. They also know when to let us do things on our own, so we can be independent.”

The staff told us that they received appropriate training and support in order to provide positive outcomes for people using the service.

We checked records were stored safely and correctly and systems were as required. This was to ensure people’s confidential information was stored appropriately.

We conducted an unannounced visit to Lyndale Residential Home on 24 January 2012 and a second visit, with short notice of our arrival, on 31 January 2012. Both visits were part of a planned inspection of the home.

Each person using the service had the opportunity to talk to us. We spoke to three people in depth and several in passing. We observed staff interacting with people and had conversation with four staff, the manager and the provider. We also contacted a health care professional with good knowledge of the home.

People who used the service spoke highly of the manager and provider. They also commented on the good level of support they received from their individual key support workers. We were told: "Nice homely little home", "Absolutely fantastic", "You can please yourself what you do" and "Very settled and happy". A care worker said: "There is lots of choice and freedom, with encouragement".

People told us that their health care needs were understood and met and that support, both emotional and practical, was provided for appointments and activities when needed.

People told us about the various activities available to them in the town and how they spent their time. We saw that when a person wanted one to one time with a care worker it was immediately provided. Staff we spoke with had a good knowledge of people's needs and how to care for them. They understood risks to people's welfare and knew how to reduce the risk. People told us that the staff knew what they were doing. A health care professional spoke highly of the service provided.

People told us that they felt safe at the home and named staff they would talk to if they did not feel safe. However, we found that the safeguarding arrangements at the home did not fully protect people. Also, that there was some training not being provided at all, or within a reasonable timescale.