We inspected Lynfords on the 29 and 30 September 2016 and the inspection was announced. We inspected Lynfords at the same time as we inspected the service's sister home, which was next door. Lynfords provides accommodation and personal care for up to six people with a learning disability and complex needs. The young adults require support with personal care, mobility, health, behavioural and communication needs. There were six people living at the service at the time of our inspection. Accommodation for people is arranged on the ground floor, with a sleep-in room for staff in the staff office. The home was adapted to meet the needs of people living there. Lynfords belongs to the large corporate organisation called ‘The Regard Partnership Limited.’ Regard provides care nationwide and have several homes within the local area.

The service 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.

The registered manager and staff had received training and were knowledgeable about of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). However, mental capacity assessments were not always completed in line with legal requirements and the MCA Code of practice. Mental capacity assessments were needed for people who may not be able to consent to, for example, bed rails. We have identified these issues as an area of practice that needs improvement.

People were safe. The home's equipment was well maintained. Staff understood the importance of people's safety and knew how to report any concerns they may have. Risks to people's health, safety and wellbeing had been assessed and plans were in place which instructed staff how to minimise any identified risks to keep people safe from harm or injury. However, risks assessments did not consistently embed, implement or follow nationally recognised tools and guidance. We have made a recommendation for improvement.

Staff treated people as individuals with dignity and respect. Staff were knowledgeable about people's likes, dislikes, preferences and care needs. They approached people in a calm, friendly manner which people responded to positively.

Peoples' health was monitored and they were referred to health services in an appropriate and timely manner. Any recommendations made by health care professionals were acted upon and incorporated into peoples' care plans.

People had busy lifestyles which reflected their lifestyle choices and likes and dislikes. A visiting relative told us, “(Person) is always clean and well dressed and she is happy. They occupy her well. They understand her love of music.” Communication passports provided an overview of how they expressed themselves. Staff had a good understanding of people's needs and were observed positively interacting with people. Good use was made of easy to read documents using pictures and photographs to help people understand information. People had access to sensory stimulation in the home and in their bedrooms.

There was an open, transparent culture and good communication within the staff team. Staff spoke highly of the registered manager and their leadership style. There were sufficient numbers of staff to meet people's needs and to keep them safe. The provider had effective recruitment and selection procedures in place.

There were suitable arrangements in place for the safe storage, receipt and management of people’s medicines. Medicine profiles were in place which provided an overview of the individual’s prescribed medicine, the reason for administration, dosage and any side effects.

The registered manager took an active role within the home and led by example. There were clear lines of accountability

We used a number of different methods to help us understand the experiences of people who used the service. People had complex needs, which meant that not everyone was able to tell us their experiences.

One person told us, “I’m well and happy.” Another person said, “Yes” when asked if they were happy.

Staff ensured that consent was obtained prior to providing care and support. We observed staff interacting positively with people. We noted that staff gave people choices and if they were unsure what a person had said they checked this out to make sure their wishes were met.

Specialist advice and support was obtained to meet people's individual needs. There were safe systems in place for the management of medication.

The home had a robust recruitment procedure in place to ensure that they employed suitable staff to work in the home. There were detailed systems to ensure that the quality of care provided was monitored and reviewed on a regular basis.

We used a number of different methods to help us understand the experiences of people who used the service. People had complex needs, which meant that not everyone was able to tell us their experiences.

One person said “I like gardening when the weather is good.” They also said “I do flower arranging and I play board games with staff and make cards.”

We observed staff interacting positively with people. We saw that people were given choices and able to make basic decisions in relation to food and choices of activities. Where appropriate, specialist advice and support was obtained to meet people’s needs.

There were sufficient numbers of staff on duty and staff felt well supported. Staff were clear about what they should do if they suspected abuse. They also understood the home’s complaint procedure.

People who use the service told us or expressed that they were happy living at Lynfords. People looked relaxed in the company of staff and with each other. One person was having a manicure and another person was taking part in some arts and crafts activities.

People had support to attend hospital and doctors appointments.

People took part in planning the menu and went out to buy the food, and then they were involved in cooking it. People also ate out at cafes and restaurants.

People who use the service expressed that they felt safe. People expressed that they felt that there were sufficient staff in place. We saw that people had one to one support when they needed it.