Lyndhurst House

Lyndhurst House is registered to provide accommodation and personal care for up to four people who have a learning disability in one adapted building. At the time of the inspection, two people lived at the home all the time and one-person shared time between the service and their family home.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

People’s experience of using this service and what we found

People’s safety could be compromised by staff not fully following approved strategies for managing escalations in behaviour. Staff were not always communicating their concerns about issues affecting people to the registered persons, and the registered manager did not have oversight of some records. The quality monitoring and assurance system was not used robustly to provide an accurate overview of what was happening in the service.

Staffing levels were satisfactory to provide good levels of care. There was a safe system of recruitment in place. Medicines were stored and managed safely.

There were effective systems to assess the needs of people prior to admission. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff understood How the Mental Capacity Act 2005 (MCA) impacted on their support of people and how people could be helped to make decisions.

Staff received an appropriate range of induction and training to undertake their role. Peoples health needs were supported, and staff alerted and involved relevant health professionals when necessary. People were provided with a varied menu that met their dietary needs and preferences.

Staff showed kindness and compassion and promoted and protected people’s privacy and dignity. Staff were supporting people to live full lives, have a community presence and develop independence skills at a pace to suit them.

Care plans were detailed and provided staff with information about people’s individual support needs and guided staff in how they should deliver support.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

Rating at last inspection the last rating for this service was Good. (Published 17/02/2017)

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. The provider acted to mitigate these risks during, and following the inspection. We will check if these actions have been effective when we next inspect. Please see the Safe and Well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Lyndhurst House is registered to provide accommodation and personal care for up to four people who have a learning disability. Lyndhurst House is in the village of Charing, on the outskirts of Ashford. At the time of the inspection, one person lived at the home all of the time and two people lived there at weekends; each had their own, personalised bedrooms. People had access to a communal lounge, dining room, kitchen, laundry room and shared bathrooms. There is a well maintained garden and outside area.

The service has a registered manager, 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 and associated Regulations about how the service is run.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The people at the service had been assessed as lacking mental capacity to make complex decisions about their care and welfare. At the time of the inspection the registered manager had made the appropriate applications for DoLS authorisations for people who were at risk of having their liberty restricted. There were records to show who people’s representatives were, in order to act on their behalf if complex decisions were needed about their care and treatment.

Before people moved into the service their support needs were assessed by the registered manager to make sure the service would be able to offer them the care that they needed. The care and support needs of each person were different, and each person’s care plan was personal to them. People had detailed care plans, risk assessments and guidance in place to help staff to support them in an individual way.

Staff encouraged people to be involved and feel included in their environment. People were offered varied activities and participated in social activities of their choice. Staff spoke about people in a respectful way which demonstrated that they cared about people’s welfare. Staff knew people and their support needs well.

Staff were caring, kind and respected people’s privacy and dignity. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff.

People were encouraged to eat and drink enough and were offered choices around their meals and hydration needs. People were supported to make their own drinks when they wanted to. Staff understood people’s likes, dislikes and dietary requirements and promoted people to eat a healthy diet.

People received their medicines safely and when they needed them. If people were unwell or their health was deteriorating the staff contacted their doctors or specialist services. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable. People were supported to maintain good health and attended appointments and check-ups. Health needs were kept under review and appropriate referrals were made when required.

A system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit to do so. There were sufficient numbers of staff on duty throughout the day and night to make sure people were safe and received the care and support that they needed.

Staff had 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. When staff had completed induction training they had gone on to complete other mandatory training provided by the company. There was also training for staff in areas that were specific to the needs of people, like epilepsy and learning disability awareness. There were staff meetings, so staff could discuss any issues and share new ideas with their colleagues, to improve people’s care and lives.

People were protected from the risk of abuse. Staff had received safeguarding training. They were aware of how to recognise and report safeguarding concerns both within the company and to outside agencies like the local council safeguarding team. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the provider or outside agencies if needed.

Equipment and the premises received regular checks and servicing in order to ensure it was safe. The registered manager monitored incidents and accidents to make sure the care provided was safe. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do.

Quality assurance audits were carried out to identify any shortfalls within the service and how the service could improve. Action was taken to implement improvements. The complaints procedure was on display in a format that was accessible to people.

Staff told us that the service was well led and that they had support from the registered manager to make sure they could care safely and effectively for people. Staff said they could go to the registered manager at any time and they would be listened to. Staff had received regular one to one meetings with the registered manager. They had an annual appraisal, so had the opportunity to discuss their developmental needs for the following year.