We inspected Lyndhurst on 31 May 2017. This was an unannounced inspection. At our previous inspection in September 2015 the home was rated as good.

Lyndhurst provides accommodation and care for to up to 21 people with mental health needs. The home is made up of three, two-storey terraced houses. Two of the properties were adjacent, while the third was very close by and accessible from the others through the back garden which contained a large, open-plan office built between two of the properties.

On the day of our visit there were 13 people living in the home.

The service had a new manager in post who was in the process of being registered with the Care Quality Commission. 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.

People told us they were very happy with the care and support they received. Staff working at the home demonstrated a good knowledge of people’s care needs, significant people and events in their lives, and their daily routines and preferences.

Staff told us they enjoyed working in the home and spoke positively about the culture and management of the service. Staff told us that they were encouraged to openly discuss any issues and had been supported with promotion opportunities within the service. Staff described management as supportive. Staff confirmed they were able to raise issues and make suggestions about the way the service was provided.

The manager and deputy managers provided good leadership and people using the service and staff told us they promoted high standards of care.

The service was safe and there were appropriate safeguards in place to help protect the people who lived there. People were able to make choices about the way in which they were supported and staff listened to them and knew their needs well. Staff had the training and support they needed. There was evidence that staff and managers at the home had been involved in reviewing and monitoring the quality of the service to drive improvement.

There were some issues with recording of risk assessments, but we saw that the manager was taking action to address this. Recruitment practices were safe and relevant checks had been completed before staff worked at the home. People’s medicines were managed appropriately so they received them safely

There were sufficient numbers of suitably qualified, skilled and experienced staff to care for the number of people with complex needs in the home

The service was meeting the requirements of the Deprivation of Liberty Safeguards(DoLS). Appropriate mental capacity assessments and best interest’s decisions had been undertaken by relevant professionals. This ensured that any decisions were made in accordance with the Mental Capacity Act, DoLS and associated Codes of Practice.

Staff were caring and always ensured they treated people with dignity and respect.

Some people participated in a range of different social activities and were supported to attend health appointments. They also participated in shopping for the home and their own needs and were supported to maintain a healthy balanced diet.

The providers head office regularly completed robust quality assurance checks, to make sure the high standards of care were maintained. There was an open culture and staff said they felt well motivated and valued by all of the managers.

We inspected Lyndhurst on 22 September 2015.This was an unannounced inspection. At our previous inspection on 12 June 2014 we found that the provider was meeting the regulations we inspected.

Lyndhurst provides accommodation and care to up to 21 people with mental health needs. The home is made up of three, two-storey terraced houses. Two of the properties were adjacent, while the third was very close by and accessible from the others through the back garden which contained a large, open-plan office built between two of the properties.

The service had a registered manager who had been in post 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 told us they were very happy with the care and support they received.

People were supported and encouraged to be as independent as possible The support staff we spoke with demonstrated a good knowledge of people’s care needs, significant people and events in their lives, and their daily routines and preferences. Staff also understood the provider’s safeguarding procedures and could explain how they would protect people if they had any concerns.

Staff told us they enjoyed working in the home and spoke positively about the culture and management of the service. Staff told us that they were encouraged to openly discuss any issues and described management as supportive. Staff confirmed they were able to raise issues and make suggestions about the way the service was provided.

The registered manager and deputy manager provided good leadership and people using the service and staff told us the manager promoted very high standards of care.

The service was safe and there were appropriate safeguards in place to help protect the people who lived there.

People were able to make choices about the way in which they were cared for and staff listened to them and knew their needs well.

Staff had the training and support they needed. Relatives of people living at the home and health and social care professionals were happy with the service.

There was evidence that staff and managers at the home had been involved in reviewing and monitoring the quality of the service to drive improvement.

There were sufficient numbers of suitably qualified, skilled and experienced staff to care for the number of people with complex needs in the home.

Recruitment practices were safe and relevant checks had been completed before staff worked at the home. People’s medicines were managed appropriately so they received them safely.

The service was meeting the requirements of the Deprivation of Liberty Safeguards(DoLS). Appropriate mental capacity assessments and best interests decisions had been undertaken by relevant professionals. This ensured that any decisions were made in accordance with the Mental Capacity Act 2005, DoLS and associated Codes of Practice.

People participated in a range of different social activities and were supported to attend health appointments. They also participated in shopping for the home and their own needs and were supported to maintain a healthy balanced diet.

An inspector and an Expert by Experience carried out this inspection. The focus of the inspection was to answer five key questions;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

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 and from looking at records.

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If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People are treated with respect and dignity by the staff. People told us they felt safe.Safeguarding procedures were in place and staff understood how to safeguard the people they supported. We saw that care was delivered in safe, accessible surroundings that promoted people’s wellbeing. The home’s three lounges and kitchens were all clean, and extremely well maintained. We saw two bedrooms which were clean, bright, and tidy. Toilets and bathrooms were spotlessly clean and the garden was maintained to a very high standard

Is the service effective?

People's health and care needs were assessed. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People were encouraged and supported to eat healthy, nutritious food. People said that they had been involved in the care planning process and that they were happy with the care that was provided.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. One person told us, "staff are very experienced.'' People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

People’s needs had been assessed before they moved into the home. Records confirmed that people’s preferences, interests and aspirations had been recorded and that care and support had been provided in accordance with their wishes

Is the service well-led?

The Registered Manager had been in post for many years and had a good understanding of the needs of the client group. Staff told us that the manager was "excellent'' and “she is very supportive.” A relative told us “she is amazing and keeps me up to date with what is happening’’

Staff were clear about their roles and responsibilities, and had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We spoke with seven people who used the service. Most people told us they were very happy with the support they received. One person told us "I'm very glad to be here. I get excellent support from my keyworker. Nowhere's perfect, but I think this place is as good as it gets". Another person told us "It's alright here. The staff are cute and try their best". A third person said "I'm supported to do everything I want to do". One person we spoke with told us they were not especially happy at the service. They said "It's not fair to the individual, it's not a normal life. I'm stuck here with my brain being tampered with because of all the medication I am on. The staff try their best though".

We found that the provider took steps to obtain consent prior to support being provided, however this did not always occur. We saw that the support that people received met their needs safely, and the provider facilitated access to other services that people needed.

People were encouraged and supported to eat healthy, nutritious food, and we found that the premises were safe and suitable and offered a range of personal and communal spaces people could enjoy.

We found that staff had the experience they needed for their roles and were checked appropriately before starting work. We saw that people's personal records were fit for purpose and accurate, however some staff records weren't up-to-date at the time of our visit.

There were 14 people in residence and we spoke with four who gave us positive feedback about the services provided. They commented on their privacy and dignity, safety and appropriateness of care, their protection from abuse, and staff’s competency and in all accounts expressed satisfaction.

People felt their privacy, dignity and independence were respected. Their comments included, “staff hardly enter your room, and if they did this is always with prior consent”; “staff never let themselves in my room” and “staff are polite and respectful”.

People were equally content with the treatment and support they experienced, which they attributed to staff’s awareness of their needs and competency. One person told us “I write my care plan, so staff have an idea of where l am and my needs” and on staff’s competency another had commented “staff have been brilliant with me, they do an amazing job”.

The same reaction was expressed when we explored views about their safety and protection from abuse. People felt they could raise any concerns with staff or the manager, with one person stating “staff do not abuse their power”.

We observed a variety of systems that ensured the service was able to respond and deliver quality care, which included surveys, ‘residents’ satisfaction audits and regular annual audits.

We spent the most part of our visit talking with people and observing their interaction with staff and with other people using the service. People told us they could make decisions about their lives. They said they regularly met with their key workers to talk about their care plans. We saw people could choose their meals. A person told us that they were satisfied because their cultural, religious and dietary needs were met. People we talked to told us they were hoping to move on to live independently in the community.

We observed that staff interacted with people in a positive and respectful manner. People who use the service were positive about the staff and their experiences of living at the home. The following were some of the comments people made:

"I see the staff as friends".

"I am happy living here".

"Staff listen to me; they help me".

People told us they were happy with the support they received. They told us they knew about their care plans and they attended their care plan reviews. People told us they were engaged in different activities during the day time. We noted that people were able to participate to travel to and from activities in the community. We observed people had access to communal areas in the home.

People appeared to be relaxed when we visited. They told us they enjoyed working in the garden where they grew plants and vegetables. People told us they liked playing games and doing physical exercises in a room provided by the home.

The people we spoke to told us they felt "very safe" living in the home. A person said they lived in a friendly environment where other people and staff listened to them.

The following were some of people’s comments:

"I have got no complaints; I am happy here".

"My key worker is brilliant, we discuss things".

"People here are friendly".

People told us the staff were supportive and approachable. We observed staff speaking to people in a respectful and sensitive manner. We noted there was positive interaction between staff and people using the service throughout our visit.

Comments from people about the staff included:

"The staff are very good".

"I have a key worker who is brilliant".

"The staff here are good; they make us comfortable; they treat us good".

People told us they felt listened to and were confident staff would respond to any feedback they gave about the service. They told us their key workers always asked them how they were and if they were happy with the service they received. People told us they attended "residents’" meetings, where they discussed the service and any concerns they had. A person told us they received a questionnaire which they completed and returned to the home. The person said this enabled them to make comments about the service.