This inspection took place on 6 and 7 September 2018 and was unannounced.

Lyndhurst rest home 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 can accommodate 44 people. At the time of our inspection there were 29 people living at the service.

Accommodation is spread over 3 floors in a large and extended detached property, overlooking the seafront at Tankerton, with many rooms benefiting from this position. There were 2 dining rooms and 2 communal lounge areas where people could choose to spend their time.

There was no registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run. A new manager had been appointed in June 2018, they had applied to CQC to become registered as the manager at the time of this inspection, but no decision had yet been made about their application. In the week following this inspection a decision was made to agree their application.

Lyndhurst was last inspected March 2018. At that inspection it was rated as 'Inadequate' overall. A number of breaches of Regulation were found during that inspection and the service remained in special measures.

Following the last inspection, we met with the provider to confirm what they would do and by when to improve all of the key questions at least good. Subsequently the provider has sent us a fortnightly action plan, detailing the improvements they were making.

At this inspection we found many improvements had been made, however we found one new breach of the regulations and three areas for improvement. The service is no longer in special measures.

At this inspection we found that recruitment systems had not remained robust. We reviewed recruitment records for staff, and found that safe processes had not always been followed.

Quality assurance audits had been recently introduced and were carried out to identify any shortfalls within the service and how the service could improve. Action was taken to implement improvements. Their effectiveness to ensure they are embedded into the service is an area for ongoing improvement.

Staff completed induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to care for, support and meet people's needs. Staff continued to receive training to ensure their skills and knowledge were current. The manager was in the process of reviewing the training offered, and making arrangements for staff to attend further training, working with new training providers. These actions require time to ensure they are fully embedded and sustained into the service and therefore this is an area for ongoing improvement.

People were encouraged to eat and drink enough and were offered choices around their meals and hydration needs. Staff understood people's likes and dislikes and dietary requirements and promoted people to eat a healthy diet. Some people required their food intake to be monitored; staff were completing this but not consistently. This is an area for ongoing improvement.

At our previous inspection medicines were not consistently managed safely. At this inspection we found that improvements had been made and medicines were now managed safely. At our last inspection there was not sufficient staff on duty to meet people's needs. At this inspection we found that staffing levels were safe and met people’s needs. People told us they felt there were enough staff and they didn’t have to wait long when they ne

This inspection was carried out on 21 and 22 March 2018 and was unannounced.

Lyndhurst rest home 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 can accommodate 44 people.

Accommodation is spread over 3 floors in a large and extended detached property, overlooking the seafront at Tankerton, with many rooms benefiting from this position. There were 2 dining rooms and 2 communal lounge areas where people could choose to spend their time.

The service did not have a registered manager in post. The last registered manager left the service in December 2017. A new manager was appointed shortly after; however, they have since left. 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.

Lyndhurst was last inspected September 2017. At that inspection it was rated as 'Inadequate' overall. A number of breaches of Regulation were found during that inspection and the service was placed into special measures.

At this inspection, although people and relatives gave some positive feedback about the service, and we found improvement in some areas; we continued to have significant concerns about the safety and well-being of people. Risks continued to be identified and a number of continued breaches of Regulation were found. The service remains in special measures.

Risks including those associated with medicines, risks to people’s health and wellbeing including falls, eating and drinking, skin care, moving people and accidents and incidents had not been properly assessed or minimised in order to keep people safe. There had been improvements to the environment and recruitment procedures.

There were not enough staff to safely meet people’s needs, the provider did not use a recognised tool to assess and determine safe staffing levels. Staff training had not been effective in some areas. Training with a new provider had been booked, however we were not able to make a judgement at this inspection on its effectiveness. There continued to be minimal evidence that lessons had been learned and improvements made when things went wrong. The new deputy manager and the provider’s area manager had begun to carry out staff supervisions and implement competency checks.

People’s healthcare was not always consistently and effectively monitored. Risk assessments and new care plans were not always current; posing a risk that people could receive inappropriate care or treatment. Care plans had been written by a consultant and lacked person centred detail. End of life care plans required attention to ensure they were person-centred. The provider’s management team were aware of this and told us about the plans they had to improve this.

The principles of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards had not been properly understood or applied in the service. The commission had not been notified of the outcome of all DoLS applications, as is legally required. The service had begun to notify the Commission of other incidents and events that they were legally required to and had displayed their CQC rating.

Complaints were not responded to and investigated effectively. There were times when people were not treated with dignity and their privacy was not respected. People’s involvement in care decisions and planning was not clearly evidenced. There was little adaptation to the premises to make them suitable for those living with dementia, although we were told of plans to implement changes.

The service was not well-led. Issues raised at our las

This inspection took place on 22 and 27 September 2017 and was unannounced. The inspection took place in response to information of concern from a number of sources. Lyndhurst Rest Home provides accommodation and personal care for up to 44 people. There were 42 people using the service during our inspection, many of whom were living with different stages of dementia.

Lyndhurst Rest Home is a very large and extended detached property spread over three floors. It is situated on the seafront at Tankerton and has direct sea views from many of the windows. There were two lounges for people to use and two separate dining rooms where some people took their meals.

There was a registered manager in post who was present throughout the inspection. 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.

Lyndhurst Rest Home was last inspected in November 2016 when it was rated as good in every area. At this inspection we identified serious concerns which placed people’s health and well-being at risk.

There had been a lack of adequate oversight by the provider and registered manager and the shortfalls in safety and quality had not been picked up until we highlighted them during our inspection. The registered manager took immediate action in response to some of our concerns but the scope of our concerns led to a large number of breaches of Regulation. We raised five safeguarding alerts with the local authority immediately following our inspection.

Risks to people’s safety had not been adequately assessed, monitored and minimised. This included risks associated with medicines, hygiene, falls and eating and drinking. Staff had received safeguarding training but did not challenge poor practice that was happening in the service.

There were not consistently enough staff to meet people’s needs and their deployment was not effective at times. Training in a range of subjects had been delivered to staff but understanding was lacking in some crucial areas. Recruitment processes were generally robust but required further improvement to ensure all necessary checks were made on applicants’ documentation.

Risks to people’s health were not always properly monitored or addressed. Mental capacity assessments sometimes conflicted with what happened in practice.

People did not all appear well-kempt and their personal care needs had not been appropriately supported. Staff did not always act to preserve people’s dignity and their independence. Plans about people’s end of life decisions needed to be improved to ensure people’s choices and rights were observed.

Care plans were written in a person-centred way but did not always reflect practice in the service. The registered manager told us that no complaints had been received since the last inspection however some relatives said they had repeatedly raised concerns with staff.

Feedback had been sought from relatives via a questionnaire but action had not been effective in

remedying concerns about people’s personal presentation.

The premises were reasonably well maintained throughout and maintenance tasks had been completed promptly. Safety checks on equipment and utilities had been routinely carried out. Fire alarms were tested weekly and emergency lighting and extinguishers were checked regularly.

The district nurse, GP and other professionals visited the service to provide health checks and treatment to people.

Deprivation of Liberty Safeguards (DoLS) had been applied for and authorised when necessary.

Staff spoke directly with people with kindness and compassion. There was a range of activities available to people, delivered by designated staff. People and relatives said the registered manager was approachable an

This inspection took place on 7 and 9 November 2016 and was unannounced. At last inspection in March 2015, we found there were no breaches in regulation.

Lyndhurst Rest Home provides accommodation and personal care for up to 44 older people, living with dementia. Accommodation is provided in 36 single and 3 double rooms, of which 29 are ensuite. There are two upstairs floors which can be accessed by a passenger lift. People living at the service share two communal lounges and two dining rooms. There is a garden to the rear of the property with a grass area and a patio with seating. Rooms to the front of the service have a sea view.

The service has a registered manager who was available and supported us during the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Staff knew how to follow the service’s safeguarding policy in order to help people keep safe. Checks were carried out on all staff to ensure that they were fit and suitable for their role. Staffing levels ensured that staff were available to meet people’s needs.

Assessments of individual risks to people’s safety and welfare had been carried out and action taken to minimise their occurrence, to help keep people safe. Accidents and incidents were recorded and the appropriate action taken to reduce the likelihood of them happening again.

Regular checks were made of the environment to ensure it was safe; and to services and equipment to make sure they were in good working order.

Medicines were managed and stored appropriately. Staff received training in how to give medicines safely and their competency in administering medicines was checked to ensure that people received their medicines as intended by their doctor.

The service was clean and staff knew what action to take to minimise the spread of any infection.

People had their health needs assessed and monitored and effective relationships had been developed with health professionals. People were offered a choice at mealtimes and support was provided in an individual manner when people needed it.

New staff received an induction which included shadowing existing staff. They were provided with a regular programme of training in areas essential to their role. Staff had received training in the Mental Capacity Act 2005 and understood its main principles. CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager had submitted DoLS applications for everyone to ensure that people were not deprived of their liberty unlawfully.

Staff were proud to work in a strong staff team where there was effective communication and they felt well supported. Staff were able to make their views known through supervision and staff meetings.

Everyone gave positive feedback about the caring nature of the staff team. Staff communicated with people in a kind manner and treated them with compassion, dignity and respect. Staff had developed positive and valued relationships with people and their family members.

A plan of care was developed for each person to guide staff on how to support people’s individual needs. Information had been gained about people’s likes, and past history; and staff demonstrated they understood and acted on people’s choices and preferences.

People were offered a range of group and individual activities. An activities co-ordinator manager had been employed to increase the range and suitability of what was on offer to ensure people received personalised activities. Special events were celebrated which involved people, their family members, friends and staff.

The views of people, their relatives and staff about the quality of care provided at the s

We found the provider had made the required improvements to compliance actions identified at our inspection on 18th June 2014. The provider had acted to improve care records of people using the service. This action meant that people were now protected against the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were now being maintained. Records relating to people's care needs were fit for purpose and kept securely.

At our inspection we looked at our five 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, their relatives and visitors, and the staff supporting them. We also looked at records.

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.

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

Is the service safe?

People were treated with dignity and respect by the staff. Visitors told us that people were always smartly dressed. One relative told us, “I feel that they (person who lives in the home) are in safe hands when I leave so I do not worry”.

A range of equipment was available in the home to aid people with their mobility. This equipment had been serviced and maintained regularly. Staff had been trained in how to assist people with their mobility needs and we saw that this was safely carried out at our visit.

Recruitment practices were safe and thorough. Appropriate checks were undertaken before staff began to work at the home.

The home had obtained guidance in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards, but had not developed its own policies or procedures. No applications had been submitted, but the registered manager was seeking advice on whether an application now needed to be submitted.

Is the service effective?

We saw that people were asked for their consent before undertaking an activity or being supported with their care or treatment. Staff had received training in the Mental Capacity Act 2005 and most knew how to support people to make decisions in their best interests on a day to day basis. However, some staff were more confident than others in this area.

People and visitors told us that they were happy with the care provided in the home. Comments from people included, “Staff are lovely” and, ”I am very happy living here. There is a choice of food and I can sit in which room I like”; and “Staff are helpful”.

People’s health and care needs were assessed with them and/or their family members. These records were reviewed regularly and generally kept up to date.

Staff had a good understanding of people’s care and support needs and knew them well. However, they did not know some people’s personal histories as this information was not always available.

Staff had received training in how to support people with dementia and challenging behaviour and said that this had helped them to gain the skills and experience they needed to support the people living in the home.

Is the service caring?

People were supported by kind and attentive staff. We that staff showed patience and gave encouragement when supporting people. For example, during an activity people were encouraged to play musical instruments and to dance. We saw that people enjoyed this activity.

We observed that care and support was provided in accordance with people’s wishes, although these individual preferences were not always recorded in people’s plans of care.

People using the service completed an annual satisfaction survey. An action plan was in place to address any shortfalls or concerns identified.

Is the service responsive?

People’s needs had been assessed before they moved into the home. However, the home did not proactively seek information about people’s life history or always record their method of communication which is important for people with dementia.

The home employed an activities coordinator five mornings a week. She offered people a range of activities in the home. People had been on an outing the day before our visit. This meant that people had access to activities in and outside the home.

During the day we saw many relatives and visitors in the home which showed that people were supported to maintain relationships with their friends and relatives.

People and visitors said that they felt confident to make a complaint if they were unhappy.

Is the service well led?

The home manager had worked at the home for a number of years, was registered with the Care Quality Commission (CQC) and had achieved a national qualification to manage a social care service.

The service had a quality assurance system in place which consisted of internal and external audits from the provider.

Records about people's care and welfare were not always comprehensive, person centred or accurate. We have asked the provider to tell us how they are going to make improvements and meet the requirements of the law in relation to providing accurate, personalised care and treatment records.

People completed an annual customer satisfaction survey. The home manager told us that this would be extended to include staff and social and health care professionals when it was next sent out.

Staff told us they were clear about their roles and responsibilities.

There were 43 people living in the home when we visited. We saw around 25 - 30 of these people in communal areas and three others that were in their rooms. We introduced ourselves to five people that lived in the home and spent time talking and listening to four of them. This helped us to find out their views about living there. We also met with five relatives who were visiting. Two of the relatives we met spent time telling us their views about the standard of care, treatment and support provided.

We were told that the home was a good place to live, that the staff were, "Lovely. Never ending patience", and that, "Nothing is too much trouble". We were told that the manager was, "Very good. The place is very well run".

The staff and the manager were proactive in the provision of care, treatment and support. The welfare and safety of people living in the home was considered paramount and closely monitored. Changing needs were quickly noticed, care plans adjusted and action

taken. There was an effective working relationship with visiting health care professionals who contributed much to the delivery of health care and who provided consultation and guidance in relation to specific health issues.

The inspection visit was carried out by one Inspector, and lasted for over four hours. During this time, we (i.e. CQC) talked with many of the people living in the home, but due to their dementia, some of the conversations lacked clarity.

We saw that people were relaxed, and many said that they were “happy living in the home” or made comments such as “everything is lovely.”

We talked with two relatives, who were very positive about the service. Their comments included:

“The standard of care here is marvellous. There is not one member of staff who is not good. I know that if I share any concerns at all that they will be dealt with. I am always made welcome when I visit.”

“I am very, very happy with my relative’s care. The care is 101%. The staff are always welcoming and smiling. There are always lots of things for people to do if they want to join in. The staff are brilliant.”

The people who use this service were seen to be calm and appeared to be settled and content. We met several people in the lounge and dining areas and one person in their bedroom. The people who live in the home had varying degrees of dementia. We made observations during the visit to support our judgements and what people told us. One person said that the care was "beautiful", and that he is "very well looked after". Other people were smiling and singing in the lounge, showing their enjoyment of their life in the home.