The inspection took place on 31 May and 1 June 2018 and was unannounced. At the last inspection we found the provider did not operate systems that ensured the quality and safety of the service. At this inspection we found improvements had been made to the quality monitoring systems, however, not all shortfalls had been identified.

Lyndhurst Park 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.

Lyndhurst Park accommodates 27 people in one adapted building. At the time of our inspection there were 24 people living there with two people admitted during our inspection.

There was a registered manager at the service. 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 who lived at the service and their relatives were complimentary about the care and the staff. They felt staff knew them well and delivered effective and kind care. They told us they were happy living at the home and enjoyed the food. Relatives told us they were confident their loved ones were safe and well cared for. Relatives told us that they felt the service was particularly good at making it feel like home.

We found shortfalls in the management of medicines during our inspection and we identified this was a breach of regulations. The registered manager took steps to address these quickly, however this was a breach of regulations at the time of our visit.

We found some areas within the home needed maintenance. The provider told us they would address these immediately.

The provider’s systems had not identified the shortfalls in ordering and storage of medicines.

The home was clean and smelt fresh throughout, however the provider had not identified some infection control risks. We have made a recommendation about this.

The provider had failed to display their most recent rating on their website.

The provider had a consistent staff team with very low turnover. Many of the staff had worked at Lyndhurst Park for many years. This had a mostly positive impact in that it created a stable caring environment. People’s choices and preferences were respected, although these had not been entered on the new electronic records system yet.People received care from staff who knew them well. Staff morale was good, and staff felt supported and worked well as a team. However, the longevity of the provider and staff team meant that shortfalls were not always noticed as everyone was used to the environment and to working in a particular way.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This inspection was unannounced and took place on 23 and 24 November 2016.

Lyndhurst Park Nursing Home is registered to provide accommodation and nursing care for up to 27 people including people who require respite care. The home specialises in the care of older people. Some people at the home have complex needs or dementia and as a result have limited communication skills. At the time of our inspection there were 27 people living at the home. The home is a large building over two floors. There are communal lounges, a dining room and an indoor pond.

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 2008 and associated Regulations about how the service is run. They worked alongside the provider to manage the home on a daily basis.

People and relatives told us they felt safe. We found improvements could be made with some of the medication procedures in the home. Nurses knew people’s administration preferences. However, staff did not have guidance for people who needed medicines ‘as required’, medicines were not always stored securely and some medicine administration seen was not safe.

Staff had a working knowledge of infection control.

The provider and staff understood about Deprivation of Liberty Safeguards (DoLS) and the process to follow to make sure people’s human rights were respected. People who lacked capacity had decisions made following the code of practice.

Quality assurance systems did not identify all concerns found on the inspection. There were limited records to demonstrate learning from issues found by the management. When shortfalls had been identified they had not always resolved them.

A safe recruitment procedure was not always being followed because staff had not always received complete checks before starting to work with people.

Staff knew how to recognise and report abuse. They had received training in safeguarding adults from abuse and knew the procedures to follow if they had concerns. However, one concern found had been raised with the local authority.

Staff were supervised informally and had annual appraisals. They told us they received enough training to meet most people’s needs.

People were supported by sufficient staff to enable them to take part in a range of activities according to their interests and preferences. There was a low staff turnover which meant people received consistent care and support. The registered manager and provider were currently recruiting more staff because they had identified people’s needs were changing.

People's health care needs were monitored and met. Staff and the registered manager made sure people saw the health and social care professionals they required and implemented any recommendations made which people agreed to.

Staff supported and respected the choices made by people. People’s cultural and religious diversity was respected. People had a choice of meals, snacks and drinks and most people told us they enjoyed the food. People who required special diets received them and staff understood about special diets to meet people’s care and health needs.

There were systems in place to manage complaints and the registered manager and provider demonstrated a good understanding of how to reduce the likelihood of them.

People and their relatives thought the staff were kind and caring and we observed positive interactions. People’s privacy and dignity was respected by staff.

Staff had good knowledge about people’s needs. Their care plans contained information about end of life care choices which helped to ensure best practice for people when nearing the end of their life. The needs of the people were reflected in their care plans.

We found one breach in the Health and Social Care Act 2008 (Regu

We spent time in communal areas of the home observing and speaking with people. We met with people living at the home and visiting the home, spoke with staff on duty and observed the practice of staff members. We also looked at support plans for people living at the home.

People were able to comment directly on their care so we spent time speaking with them and their relatives.

We saw that staff treated people with consideration and respect. Staff were able to recognise when people wanted assistance and responded promptly.

People's care needs were delivered in line with their individual care plan. We saw that people looked at ease with staff. Staff were clear about their role to protect people and involve them in day to day decisions. Staffing levels met people's needs.

People we spoke with said “the staff are very kind” and “I like it here the staff are lovely”.

We also spoken with relatives who said “the staff are very kind”.

We spoke with staff who said they felt supported and enabled to do their jobs well.

At the time of the inspection there were 24 people living at the home. During the day we spoke with 12 people who lived at the home and four members of staff. We also spent time observing care practices.

Everyone said that they were able to make decisions about their day to day lives. People told us that there were not set times to get up or go to bed and they were free to decide how they spent their day. One person said “You can do what you like” another person commented “You can more or less do whatever you want to.” We saw that people were able to spend time in the privacy of their rooms or in the communal areas.

People spoken with felt that their privacy and dignity was respected. During the inspection we observed that staff spoke to people in a kind and friendly manner. We saw that where people required assistance this was provided in a discreet and sensitive way to protect people’s dignity.

Everyone asked said that they were happy with the care that they received. Comments included “They look after you very well,” “I couldn’t wish for better care” and “Everything is done to make sure that you are comfortable.”

People told us that staff were ‘kind and gentle’ when they assisted with personal care. We observed that people appeared clean and well presented which demonstrated that staff took time to assist people with washing and dressing.

There were some organised activities in the home to provide mental and social stimulation. People said that they sometimes had singers who came to entertain them and another person commented that they very much enjoyed massages with a visiting aroma therapist. Two people said that they would like to have more activities while others commented that they preferred to entertain themselves.

People told us that they felt safe at the home. People said that if they had any worries or concerns they would be comfortable to raise them with the providers or a member of staff. One person said “If there was anything to complain about I would speak to someone. I know they would sort it out.” Another person told us “They do everything to make sure you are content.”

People said that they could have personal or professional visitors at anytime. Everyone said that they were able to see visitors in their private rooms or the communal areas.

Most people we spoke with during the inspection felt that there was always enough staff on duty. Two people said that they thought the home was short staffed but agreed that they got the care they needed at a time which suited them.

People were very complimentary about the staff who supported them. Comments included; “Staff are very good,” “Staff are kind” and “Staff are polite and respectful.”