This was an unannounced inspection that took place on 27 and 31 January and 1st February 2017.

Lynde House is a care home registered to provide accommodation and nursing and personal care for up to 76 people who require personal care and may also have dementia. The service is located in the Twickenham area.

The home had 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 and associated Regulations about how the service is run.

In November 2014, our inspection found that the service required improvement regarding staffing levels under the safe question and we made a recommendation accordingly. At this inspection the home met the regulations.

People and their relatives said that this was a nice place to live and staff provided good support and care that was delivered in a respectful way. People were given the opportunity to choose what they wanted to do and joined in the activities provided if they wished.

The home had a welcoming atmosphere and during the inspection visitors told us that they were always made welcome. The home was well maintained, clean and provided a safe environment for people to live and work in.

There were thorough up to date records kept, including care plans that contained clearly recorded, fully completed, and regularly reviewed information. This enabled staff to perform their duties appropriately.

Staff knew people using the service well, including their likes, dislikes, routines and preferences and addressed them in the way they preferred. During our visit everyone received the same attentive service and were treated equally. Staff had appropriate skills, qualifications and were focussed on providing individualised care and support in a professional, friendly and compassionate way. Whilst professional they were also accessible and listened to people using the service and their relatives. Staff said they had access to good training, support and career advancement.

People were protected from nutrition and hydration associated risks with balanced diets that also met their likes, dislikes and preferences. They said the choice of meals and quality of the food provided was very good. People were encouraged to discuss health needs with staff and had access to community based health care professionals, if they required them.

People using the service said the manager and management team were very approachable, responsive to requests made or concerns raised, frequently encouraged feedback and acted upon it. The manager and management team consistently monitored and assessed the quality of the service provided and encouraged all staff to put forward ideas that may improve the quality of life of people using the service. Staff were also enabled to utilise their talents in areas that would not normally come under the remit of their roles, such as the maintenance person running very popular current affairs discussion sessions with people using the service. The home also involved the local community by putting on open days, provided the opportunity for local school students to complete their Duke of Edinburgh Award by visiting the home and gave students from the local six form college an opportunity to do placements to increase their knowledge of adult social care.

This was an unannounced inspection over four days and took place on 11, 12, 13 and 14 November 2014.

Lynde House is a care home registered to provide accommodation and nursing and personal care for up to 76 people who require personal care and may also have dementia. The service is located in the Twickenham area.

During the visit, we spoke with 14 people using the service, nine relatives, 12 care and nursing staff and the 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 and associated Regulations about how the service is run.

In March 2014, our inspection found that the service did not meet the regulations in two areas we inspected, involving people in decision-making and records. At this inspection the home met these regulations.

Some people using the service, relatives and staff told us that they didn’t think there were enough staff at times during the day, they were struggled to meet people’s needs and sometimes it was difficult to find staff. They were concerned that there were not always enough staff to meet people’s needs in a timely way. Other people using the service, relatives and staff thought there were enough staff to meet needs.

We recommend that the home reviews its staffing numbers and the method used to calculate the number of staff required.

People said they were happy living at Lynde House, with the service they received, the staff who delivered it and way it was delivered. They told us staff cared, responded to their needs and the home was well managed. This matched most of our observations during the inspection visit. Some relatives felt the service provided was good, although others thought people spent too much time in bed and in their rooms unnecessarily.

People using the service told us they held the staff in high regard and that they met people’s needs in a caring and understanding way. Most relatives said the staffs was compassionate, caring and carried out their duties well, although some were more so than others.

The staff we saw and spoke with had appropriate skills and training, were familiar with people using the service, generally understood people’s needs and care and support was given in a professional, supportive and compassionate way.

There were a number of group activities that took place during the inspection, although we didn’t see many individual activities in the communal areas. Some people told us there was plenty to do whilst others said there weren’t enough activities.

We saw that the home provided a safe environment for people to live and work in. It was clean, well-maintained and furnished.

We looked at nine care plans from different areas of the home that were clearly recorded, fully completed, regularly reviewed and underpinned by risk assessments. The staff at all levels of seniority were well trained, knowledgeable, professional and generally accessible to people using the service and their relatives.

Fourteen people told us, we saw and records showed that the management team and organisation were approachable, responsive, encouraged feedback from people who use the service and their relatives. They consistently monitored and assessed the quality of the service provided. Staff said they felt well supported by the management team and organisation. Some relatives said the manager was not always approachable.

During our inspection we saw staff involving people in activities and life at Lynde House. We spoke with sixteen people living at Lynde House and eight relatives of people living at the home. We asked people how they were involved and included in life at the home. One person said "we have a variety of activities we can join". We looked at activity plans and read twenty-two different activities available across the week. Examples included, bible study and music sessions.

We spent two days inspecting the home. We noticed that while there were high numbers of staff available at main meal times, at other times it was not easy to find staff. We spoke with eight care and nursing staff and asked about the level of staff available to support people. One staff member told us "we are often busy and don't always get time to talk to people; call bells ring all the time". Someone else told us "we definitely need more staff, the ratios are not worked out on need, only on bed numbers".

We spoke with relatives of four people who told us that they would raise issues through relatives meetings or directly with the manager. One relative said "I've not had to complain".

We looked at five care records. Three had incomplete information relating to people's end of life wishes, including missing dates and signatures of people or their relatives. Important decisions about people's human rights, including their right to be resuscitated or not, were not always fully recorded or documented.

In May 2012 we inspected the service and found that some people’s care and welfare was not always being addressed.

We made a further unannounced visit the home on the 18th July to review the nutrition and staffing levels following concerns raised, and to check on progress regarding care and welfare of people. We spoke with five visitors, and nine staff who work at the service. We spoke with fourteen people who use the service to understand the experience of living at Lynde House. On the 2nd August we spoke with the Manager about the progress made at the home.

People told us that although they often had to wait for staff to attend to them, they were treated well and their needs were met. They said that staff helped them with activities and provided support when they asked for assistance.

We asked people about the quality and sufficiency of food at meal times and most people told us that they were satisfied with the meals and food.

People explained that they were given options and choices at meals times and one person said that “the food was good value for money” another person said “I can ask for seconds, if I want to”.

People who use the service told us that staff involved them in decisions about their care. They said that they got involved in how the home was managed by contributing to meetings and making suggestions relating to a range of topics at the home. People felt that they could raise issues and talk to staff about their care and treatment and were treated with respect and dignity. While some people received appropriate care and support, there was, however, a lack of consistency and they could not always be confident that they would receive good quality care. People were sometimes at risk because of the failure to provide the full attention, care and support they needed.

We inspected the home in March 2014 to follow up on compliance actions made at the previous inspection in June 2013. While some improvements had been made, we found new concerns relating to respecting and involving people. Some people were not being consulted about their care and treatment and in some cases there was a lack of involvement of people. Important records about people's care were not being appropriately maintained.

We spoke with the relatives of five people who lived at Lynde House and eight staff. We tried to speak with thirteen people who lived at the home. We were unable to speak with some people using the service because some people using the service had a number of complex needs meaning that it was difficult for all the people we spoke with to tell us about their experiences.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We saw that staff provided support to people who required assistance to enjoy their meal.