About the service: Lyndhurst residential is a care home that is registered to provide care to up to 15 people. At the time of the inspection 12 people were living in the home. This included a mixture of people both under and over 65. Some of these people were living with dementia and/or had mental health needs.

People’s experience of using this service:

The service needed to ensure robust systems were in place to maintain compliance with CQC regulations and standards. The service had a poor regulatory history and action was needed to bring the home up to a consistent, high performing standard. Because of this, there were widespread and significant shortfalls in service leadership. Leaders did not assure the delivery of high-quality care.

Improvements were needed to the building environment, and grounds to bring them up to a good standard. This had been an issue at the previous inspection and had the potential to impact upon the care and support outcomes. For example, some carpets were not dementia friendly and the lack of a shower reduced people’s bathing choices.

People and staff praised the registered manager and we saw they had made some improvements to such as to care plans. The staff team said they felt more settled.

People provided positive feedback about the care and support they received at Lyndhurst. People said staff were kind and caring and supported them appropriately.

People said they felt safe from abuse and staff understood the correct processes to follow. Some improvements were needed to the way people’s money was managed to ensure people were fully protected from the risk of financial abuse. Some improvements were needed to medicine management processes to ensure people consistently received their medicines as prescribed.

Care plans were thorough, person centred and detailed. These were subject to regular review and were written in an accessible format.

There were enough staff deployed within the home. Safe recruitment processes were followed. However, action was needed to bring staff training up-to-date.

People had a choice of food and action was taken to address any weight loss. The service worked with healthcare professionals to meet people’s healthcare needs.

A registered manager was in place. 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.

We identified three breaches of regulations relating to Regulation 12 (Safe Care and Treatment), Regulation 17 (Good governance) and Regulation 18 (Staff training) of the Health and Social Care Act (2008) Regulated Activities 2014 Regulations.

Rating at last inspection: The service was rated Requires Improvement at the last inspection. It had been rated Requires Improvement at the two inspections prior to that and Inadequate at the inspection before that.

Why we inspected: The service was a routine inspection which also followed up on concerns found at the previous inspection in November 2017. At this inspection we checked if improvements had been made.

Enforcement: We issued a warning notice for Regulation 17 (Good Governance) and Regulation 18 (Staffing) requesting the service make improvements in these areas.

Follow up: We will meet with the provider and manager to make it clear that improvements are required to the service. We will re-inspect the service in the future to check the required improvements have been made.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection of Lyndhurst Residential Home, known as Lyndhurst, took place on 28 and 29 November 2017 and was unannounced. In July 2016 the home was rated as Inadequate and placed into special measures. We inspected the home in January 2017 and again in July 2017. The most recent inspection of July 2017 found the home required improvement but had made sufficient improvements to be removed from special measures. There were no breaches of regulations at the last inspection.

Prior to this inspection we had received some information of concern regarding staffing levels, food provision and staff training. We did not find evidence to corroborate these allegations. However, during this inspection we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Regulation 17, good governance.

Lyndhurst 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.

Lyndhurst is registered to provide care for up to a maximum of 15 people, some of whom are living with dementia. Accommodation is provided over two floors, which can be accessed using a stair lift. Eleven rooms are single occupancy and two rooms are shared, accommodating two people in each room. There were ten people living at the home on a permanent basis at the time of our inspection and one person staying at the home on a temporary, respite basis.

The home had a manager in post, who had recently been appointed. They had not yet registered with the Care Quality Commission, although they had begun the process of their application. 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.

The registered provider had a safeguarding policy in place and the staff we spoke with understood the signs to look for which may indicate potential abuse. Staff were clear about who they would report safeguarding concerns to.

We observed sufficient numbers of staff to keep people safe and everyone we asked told us there were enough staff to keep people safe. However, we recommended the manager consider using a tool or system to ensure staffing numbers are sufficient. Staff were recruited safely.

Risks had been assessed, such as those relating to medication, skin integrity or falls. Measures had been introduced to reduce risk. However, the risk assessments had not been updated regularly. We saw moving and handling plans were in place which provided staff with information in order to safely assist people to move.

Regular safety checks took place and fire, gas and electrical systems had been tested. Plans and evacuation equipment were in place to safely evacuate people in the case of emergencies. Staff had been trained how to use evacuation equipment effectively.

Medicines were managed, stored and administered effectively and in a safe way. Staff that administered medicines had received specific training to do so safely.

Staff received regular training and observations of their practice. Staff told us they felt supported. However, regular formal supervision for staff was lacking.

The home was in need of cosmetic improvements such as redecorating and carpeting in some areas. There was only one bathroom in use which people used to bathe. There was no facility to shower. This was also found at our last inspection.

Decision specific mental capacity assessments had been completed for people who lacked capacity to make specific decisions, and decisions were made in people’s best interests, as required by the Mental Capacity Act 2005.

People were supported to have maximum choice

The inspection of Lyndhurst Residential Home took place on 18 and 19 July 2017 and was unannounced. The home had previously been inspected during January 2017 and was found to require improvement at that time, with multiple breaches of regulations in relation to safe care and treatment, staffing, good governance and consent. During this inspection, we checked to see whether improvements had been made. Improvements were evident and we found no breaches of regulations during this inspection.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Lyndhurst Residential Home is registered to provide care for up to a maximum of 15 people, some of whom are living with dementia. Accommodation is provided over two floors, which can be accessed using a stair lift. Eleven rooms are single occupancy and two rooms are shared, accommodating two people in each room. There were ten people living at the home on a permanent basis at the time of our inspection and three people staying at the home on a temporary, respite basis.

The home had a manager in post, who had recently been appointed. They had not yet registered with the Care Quality Commission, although they told us this was their intention. 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.

The registered provider had a safeguarding policy in place and the staff we spoke with understood the signs to look for which may indicate potential abuse. Staff were clear about who they would report safeguarding concerns to.

Sufficient numbers of staff were employed to keep people safe and staff were recruited safely.

Risks had been assessed, such as those relating to diabetes or falls. Measures had been introduced to reduce risk and we saw moving and handling plans were in place which provided staff with information in order to safely assist people to move.

Regular safety checks took place and fire, gas and electrical systems had been tested. Plans and evacuation equipment were in place to safely evacuate people in the case of emergencies. Staff had been trained how to use evacuation equipment effectively.

Medicines were managed, stored and administered effectively and in a safe way and the new manager was introducing new, improved systems to reduce the risk of error.

Staff received regular training and supervision, which included observations of their practice. Staff told us they felt supported.

The home was in need of cosmetic improvements such as redecorating and carpeting in some areas.

Team leaders had received training in relation to the Mental Capacity Act 2005 and demonstrated a good understanding of the requirements of the Act. This training had not yet been provided for care and support staff, although they demonstrated they understood the principles of the Act. Decision specific mental capacity assessments had been completed for people who lacked capacity to make specific decisions, as required by the Mental Capacity Act 2005.

People received appropriate support in order to have their nutrition and hydration needs met. Mealtimes were a pleasant experience and people enjoyed the food.

All of our observations indicated staff treated people with kindness and compassion. People told us staff were caring and we observed people’s privacy and dignity being respected. Advocacy was accessed for people when this was appropriat

The inspection of Lyndhurst Residential Home took place on 16 and 19 January 2017 and was unannounced. The location had been previously inspected during July 2016 and was found to be ‘Inadequate’ at that time, with multiple breaches of regulations in relation to staffing, safe care and treatment, good governance, person centred care and dignity and respect, and the service was placed into special measures. During this inspection, we checked to see whether improvements had been made. Whilst we found improvements in many areas, we found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Regulations 12 Safe care and treatment, 18 Staffing and 17 Good governance. We also found a breach of Regulation 11 Consent.

Lyndhurst Residential Home is registered to provide care for up to a maximum of 15 people, some of whom are living with dementia. Accommodation is provided over two floors, which can be accessed using a stair lift. Eleven rooms are single occupancy and two rooms are shared, accommodating two people in each room. There were 12 people living at the home at the time of our inspection.

The previous registered manager had left the organisation and had not been managing the service since December 2013. The current manager had been in post since then but was not registered with the Care Quality Commission. The current manager was on leave and not available during our inspection. The return to work date for the manager was unclear.

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.

The registered provider had a safeguarding policy in place and the staff we spoke with understood the signs to look for which may indicate potential abuse and staff were clear about who they would report concerns to. However, not all staff had received safeguarding training.

Staff were not always recruited safely. A member of staff had commenced work prior to their employments checks being returned.

Although some risks had been assessed and measures had been introduced to reduce risk, some, such as those related to diabetes or moving and handling, had not been adequately assessed.

Improved plans had been implemented since the last inspection in relation to emergencies and evacuating the building. New evacuation equipment had been provided and staff had been trained how to use this effectively. A policy was in place which outlined the procedures to follow in an emergency.

Building and equipment safety and maintenance had improved since the previous inspection. Regular safety checks took place and fire, gas and electrical systems had been tested.

A dependency tool was used to help determine staff numbers and we found the numbers of staff deployed were able to effectively meet people’s needs.

Medicines were managed, stored and administered effectively and in a safe way.

Although staff observations had increased and improved since the last inspection, not all staff had received appropriate training and supervision.

Consent to care was not always sought in line with legislation. No staff had received training in relation to the Mental Capacity Act 2005. This was also highlighted as a concern at the previous inspection.

People received appropriate support in order to have their nutrition and hydration needs met. Mealtimes were a pleasant experience and people enjoyed the food.

All of our observations indicated staff treated people with kindness and compassion. People told us staff were caring and we observed people’s privacy and dignity being respected. There was a pleasant atmosphere in the home.

Care plans had been recently updated and contained person centred information, including people

This inspection took place on 27 and 28 July 2016. Day one of the inspection was unannounced; day two was announced. We last inspected Lyndhurst Residential Home on 25 November 2013 and found it was meeting the legal requirements we inspected against.

Lyndhurst Residential Home is a residential care home in Dewsbury. The home provides accommodation, personal care and support for up to 15 older people, some of whom are living with dementia. Accommodation at the home is provided over two floors, which can be accessed using a stair lift. Eleven rooms are single occupancy and two rooms are shared, accommodating two people in each room.

At the time of the inspection there were 15 people using the service.

A registered manager was registered with the Care Quality Commission at the time of the inspection however they had left the organisation and had not been managing the service since 17 December 2013. The current manager had been in post since then as acting manager and subsequently as the manager but they had not 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 2008 and associated Regulations about how the service is run.

During this inspection we found the registered provider had breached regulations in relation to safe care and treatment, staffing, good governance, person centred care and dignity and respect. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Medicines were not managed safely. There were no risk assessments or care plans in place, nor were there any guidance documents for staff to follow when administering ‘as and when required’ medicines such as diazepam or paracetamol. Staff made decisions as to whether people should be given a medicine used in the management of diabetes based on the amount they had eaten. This had not been agreed with people’s doctors. There was no system for checking the temperature of the medicine fridge or medicine cupboard, and liquid medicines did not have an opened date recorded on them. This meant medicines could be stored at the wrong temperature and be administered after the ‘discard by’ period. The medicine fridge was not locked and was in an area used by people and visitors.

Staff told us there were not enough staff to meet people’s needs. Some people needed two to one care and this meant whilst staff were supporting them, there was no one available to support other people unless the assistant manager or manager were on the floor. Care staff were also responsible for engaging people in activities, doing the laundry and preparing people’s tea as the cook finished work at 2pm. The manager agreed with our observations that there were not enough staff.

There were concerns in relation to fire safety which were passed on to the fire service. This included fire doors not closing properly, no evacuation aids to support people to who lived on the first floor and a fire exit leading to a gate which was locked with a padlock.

There were no premises risk assessments or emergency contingency plan. There was also no evidence of an electrical installation condition report having been completed at the service. Evidence of portable appliance testing (PAT), gas safety check and lifting operations and lifting equipment regulations (LOLER) could not be found at the time of the inspection however they were submitted at a later date.

Staff had not had an annual appraisal nor did they receive regular supervision. Training records showed that staff had not received appropriate training to support them to meet people’s needs.

Some people had authorised Deprivation of Liberty Safeguards (DoLS) in place but one perso

When we visited the service on 3 September 2013 we found the provider did not have systems in place to gain and review consent from people using the service. We asked the provider to make improvements.

We went back on this visit to see whether improvements had been made.

On the day of our visit there were 13 people living at Lyndhurst Residential Home. During our visit we observed people who lived at the home interacting with staff in one of the lounges and the dining area. We spoke with the registered manager and one person living at the home. The other people living at the home were having their tea in the dining room.

We found that, since our previous visit, the registered manager had been on an appropriate training course with the local council. We looked at people’s care records and saw there were now suitable arrangements in place for obtaining, and acting in accordance with, the consent of the people living at the home. This demonstrated that people living at the home had consented to their care and treatment.

On the day of our visit there were 12 people living at Lyndhurst Residential Home. During our visit we observed people who lived at the home interacting with staff in the lounges and dining areas. During our inspection we spoke with three people who used the service, the registered manager, deputy manager and a care assistant. We saw people’s individual needs were assessed and care and support was developed from this information.

The care assistant we spoke with said they felt care at the home was good; they received appropriate training for their role and felt well-supported. They said “I love working here, I really do. We have a good team that works well together to look after people”.

Three people living at the home told us Lyndhurst was a good place to live. They told us they felt safe living at the home, it was clean and tidy and they had never needed to make a complaint.

Comments from the people we spoke with included:-

“I like living here. They feed us too well though; I’ve put weight on”.

“I like reading and I prefer to stay in my room. There are some lovely staff here and the food is good.”

Staff and people living at the home told us there were enough staff working there to support them in the way they needed to be looked after.

Following our visit we spoke with the local authority Infection Prevention and Control team. They confirmed that the home had been issued with an action plan following a visit by them in April 2013 and that the home was working towards complying with the deficiencies identified.

We spoke with three out of the 15 people who live at the service, they told us that they were happy and comfortable living at Lyndhurst Residential Home and that they got the care and support they need.

People we spoke with told us they received care that was appropriate to their needs. One person told us “I have everything I want right here.”

People who use the service told us they were involved in making decisions about their care and treatment. People also said they were kept informed of any changes to their needs. One person told us "I am very very happy, it’s brilliant”.

People told us they were satisfied with the care and support they received. One person told us “I am looked after here very well”.

Staff we spoke with told us they felt supported and had the knowledge and skills to support people who lived at Lyndhurst Residential Home. One staff member said “Everyone is good here”.

A social worker and a relative we spoke with told us that the service user they were visiting “had come on leaps and bounds” since being admitted to Lyndhurst Residential Home. The service user is now able to talk with confidence and use the rest room by themselves. They also told us that the person using the service had put on weight and were doing well as prior to arriving at Lyndhurst Residential Home they did not eat with as much enthusiasm.