The inspection took place on 20 and 28 September 2018. The first day of our inspection visit was unannounced.

Lynhales Hall Nursing Home 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.

Lynhales Hall is registered to provide nursing care and accommodation for a maximum of 73 older people. At the time of our inspection there were 43 people living at the home. The home is divided into two units. The 'main house' provides accommodation for up to 53 people. The 'John Sperry Unit' is a modern ground floor extension to the main building, which provides nursing care for up to 20 people living with dementia.

The registered manager had left the service a few days before our inspection, and the provider was in the process of recruiting their replacement. 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 were not assured staff always adhered to the provider’s safeguarding procedures to ensure abuse concerns were reported and, where necessary, escalated without delay. Work practices in relation to the handling and administration of people’s medicines needed to be improved to ensure they received their medicines safely and as prescribed. Infection prevention and control practices at the home were not as effective or robust as they needed to be. Staff training was not up-to-date and agency nurses had not always been inducted in line with the provider’s expectations. People’s rights under the MCA were not fully promoted by the provider.

The provider monitored and adjusted staffing levels to ensure there were enough staff to safely meet people’s needs in a person-centred manner. The risks associated with people’s individual care and support needs had been assessed, reviewed and plans implemented to manage these. The provider carried out pre-employment checks on prospective staff to ensure they were safe to work with people.

Prior to people moving into the home, an assessment of their individual care and support needs was completed to establish whether the service could meet these. The management team understood the need to avoid any form of discrimination through taking into account people’s protected characteristics. People had support to choose their food and drinks and any physical assistance needed to eat and drink in comfort and safety. Any complex needs or risks associated with people’s nutrition and hydration had been assessed and plans put in place to address these. Staff played a positive role in ensuring people’s health needs were met, and sought prompt professional medical advice and treatment in the event they became unwell. The overall design and adaptation of the premises reflected people’s needs, including those who were living with dementia. Appropriate DoLS applications had been made and any conditions on granted authorisations were reviewed in order to comply with these.

Staff treated people in a kind and compassionate manner and had taken the time get to know people’s individual needs, requirements and personalities well. People had support to express their wishes and participate in decision-making which affected them. People’s rights to privacy and dignity were understood and promoted by staff and management.

The care and support provided reflected people’s individual needs and requirements. People’s care plans were individual to them, promoted a person-centred approach and included information about people’s communication needs. People had support to participate in a range of social and recreational activities. A complaints procedure

This was an unannounced inspection carried out on the 24 August 2017, with a further announced visit on the 29 August 2017.

Lynhales Hall Nursing Home is registered to provide nursing care and accommodation for a maximum of 73 older people. At the time of our inspection there were 48 people living at the home. Lynhales Hall Nursing Home is divided into two units. The 'main house' provides accommodation for up to 53 people. The 'John Sperry Unit' is a modern ground floor extension to the main building, which provides nursing care for up to 20 people living with dementia.

There was no registered manager in post at the time of our inspection. The home had been managed since our last inspection in February 2017 by a temporary manager, who was the provider’s Quality Assurance Auditor. However, a new manager had just been appointed by the provider, who confirmed to us their intention to register with the Care Quality Commission (CQC). 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 last inspected this service on the 14 and 17 February 2017, when the service was rated as ‘requires improvements in each of the domains of safe, effective, caring, responsive and well-led. We also identified four breaches of Regulations under The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. As part of this inspection, we looked to see what improvements had been made and how the provider had addressed the breaches of regulation.

Since our last inspection, the provider had been working closely with Local Authority and the Herefordshire Clinical Commissioning and an embargo had been imposed on new admissions at the home.

During our last inspection in February 2017, we found the provider had failed to effectively monitor the quality of services provided. During this inspection, we found that overall improvements had been made in the governance of the home. However, further improvements were still required. Staff described communication with management as poor. There was no managerial presence to quality check or have an insight into the quality or presentation of the food provided for people.

At out last inspection in February 2017, we found that people's medicines were not always managed safely. We found that overall improvements had been made by the provider. However, further improvements were still required in specific areas. Staff were able to describe how they gave people their medicines, for example by adding them to food. However, this information was not always clearly documented. Some people were prescribed medicines to be given ‘when required’. Additional information was available for staff to help ensure they gave these medicines in a safe and appropriate way. However, some examples lacked sufficient detail.

The provider was unable to satisfy themselves that agency staff had the necessary skills and knowledge to effectively support people. Training and development of staff was inconsistent. Staff did not always receive the support and training they needed to meet people’s individual needs.

The home was working within the within the principles of the Mental Capacity Act.

On the whole, people were supported to have the right amount of food and drink to maintain good health.

People were supported by staff who were kind and caring. People enjoyed positive working relationships with staff. Staff treated people with respect and promoted their independence. Staff actively involved people and their relatives in decisions about their care.

People received support that was individual to their needs and preferences. Staff knew people well and were quick to recognise and respond to any changes in their needs.

People received indiv

This was an unannounced inspection carried out on the 14 February 2017, with a further announced visit on the 17 February 2017.

Lynhales Hall Nursing Home is registered to provide nursing care and accommodation for a maximum of 73 older people. At the time of our inspection there were 57 people living at the home. Lynhales Hall Nursing Home is divided into two units. The 'main house' provides accommodation for up to 53 people. The 'John Sperry Unit' is a modern ground floor extension to the main building, which provides nursing care for up to 20 people living with dementia.

We last inspected this service in July 2016, however due to concerns raised about the quality of nursing care provided at the home this inspection was brought forward. During this inspection we identified four breaches of Regulations under The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider had not protected people against the risks associated with the safe management of medication. Prescribed creams were not always given as prescribed by the GP. One person who had been prescribed a daily emollient for their skin condition, had not been applied for a period of nine mornings. People who were prescribed medicines to be taken ‘when required,’ such as for pain relief, information was not always recorded to help staff decide when the medicines were needed. Medicines were not always administered in accordance with the manufacturers’ directions. One medicine was still applied after it should have been discarded. One person was prescribed a medicine to be administered twice daily. We found it was being given only once daily. Records supporting and evidencing the safe administration of medicines were not always complete and accurate. The provider did not always effectively monitor pain relief for people.

The management of Deprivation of Liberty Safeguards (DoLS) renewal applications did not reflect the requirements of the MCA. People were therefore being unlawfully deprived of their liberty without independent scrutiny. A number of DoLS authorisations had expired and that there had been delays in submitting reassessment applications, some of which were significant delays.

People were not always treated with respect and dignity. One person with a skin condition on their legs received treatment from a nurse in the main communal lounge, in the presence of other people, which placed the person in an undignified situation. They failed to ensure the privacy of the person when delivering care and treatment with little regard to their dignity.

The provider had failed to ensure that records were accurate, complete and contemporaneous in respect of each person.

The home lacked any clear strategy in relation to the effective monitoring of the quality of services provided by staff. Though the provider had management systems in place to record and monitor the standards of care delivered within the home, these were not always completed or were effective. Medication management checks had been undertaken, but these failed to identify the series of concerns we found during our inspection regarding the safe management of medicines.

The provider had failed to display conspicuously and legibly their performance rating from there last inspection visit in July 2016.

There was no effective leadership. Staff told us that the registered manager had failed to provide support and leadership since their appointment. The registered manager told us they had resigned from the service as they had received no support from the provider. No improvement plans had been initiated following internal inspections undertaken by the provider.

Staff told us they were concerned about night time staffing levels at the home. However, during our inspection visit we were told that staffing levels had improved and we saw there was enough staff on duty to meet people's needs.

Supervision and support was inconsistent. We were therefore not confident that all staff

Lynhales Hall Nursing Home is registered to provide nursing care and accommodation to up to 73 older people. At the time of our inspection 67 people were living there.

The inspection took place on 6 and 15 July 2016 and was unannounced.

At the time of our inspection no registered manager was in post. The former registered manager had left in February 2016. Since this time the provider had made arrangements to ensure the home was managed. A new manager who worked for the provider elsewhere was in place at the time of our inspection. This person commenced work at the home on 1 July 2016. They told us they intended to apply for registration as the manager as soon as possible.

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.

Lynhales Hall Nursing Home consists of two units. The ‘main house’ provided accommodation for up to 53 people. The ‘John Sperry unit’ is a ground floor extension to the main house. The unit provided care for up to 20 people who lived with dementia.

Management systems to monitor the quality of care and ensure events and incidents were followed up and acted upon were in place. These however did not reflect fully reflect incidents and actions taken.

Staff members were often seen to be kind and caring while they provided care and support for people. People believed staff to maintain their privacy and dignity.

People and their relatives we spoke with felt people were safe living at the care home. We found staff had knowledge about how to keep people safe and were aware of the action they would need to take if they were aware of abusive practice taking place. Relatives were pleased with the care their family member received and with the welcome and involvement they received.

We found medicine administration and management did not consistently make sure people’s medicines were available and administered as prescribed to meet their health needs.

Staff told us they had received training in order to provide them with the skills and knowledge needed to care and support people. We saw and heard occasions where staff demonstrated behaviour which did not consistently valued people and good practice.

People did not always receive the support needed to ensure their nutritional needs were met. Risks to people were identified and were known to staff. Records were not always maintained to show staff had provided the necessary care to reduce these risks.

There were sufficient staff on duty to care for people who lived at the home. Regular agency staff were used to ensure consistency of care where possible. Systems to ensure safe recruitment of staff were in place.

Staff felt supported by management and received training to ensure they had the skills and knowledge needed to care for people safely. The manager was aware of some training needs required.

People were consulted prior to them receiving care and support. Best interest decisions and referrals to local authorities were undertaken where people were unable to make an informed decision.

The healthcare needs of people were monitored as needed by professionals who were consulted as necessary. Relatives felt involved and were aware of their family member’s health as appropriate. Relatives were confident they could raise any concerns they may have about the care of their family member and believed they would be listened to.