Lynde House

People’s experience of using this service

People living in the care home, their relatives and community health and social care professionals were all positive about the standard of care provided at Lynde House. A community health care professional told us, “I would recommend the place to anyone who needed nursing care”, while another added, “I’ve always found the standard of care provided by all the staff who work here to be very high”.

People were kept safe and were confident any concerns they raised would be listened to. Staff understood how to safeguard people. People were cared for and supported by staff who knew how to manage risks they might face. The premises were kept hygienically clean and staff followed current best practice guidelines regarding the prevention and control of infection including, those associated with COVID-19. Medicines systems were well-organised, and people received their prescribed medicines as and when they should. The service was adequately staffed by people whose suitability and fitness to work at the care home had been thoroughly assessed.

Staff had the right levels of training, support and experience to deliver effective care and meet the needs of people living at the care home. People had access to a wide variety of food and drink that met their dietary needs and wishes. People were helped to stay healthy and well. 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. People lived in a suitably adapted and comfortable care home that had been decorated and furnished to a good standard.

People were treated equally and with compassion, and had their human rights and diversity respected. Staff treated people with respect and dignity and upheld their right to privacy. People were encouraged and supported to maintain their independence. People were encouraged to make decisions about the care and support they received and had their choices respected.

People had up to date, detailed, person-centred care plans in place, which enabled staff to understand and meet their needs and expressed wishes and preferences. Staff ensured they communicated and shared information with people in a way they could easily understand. People were supported to participate in meaningful recreational and leisure activities that reflected their social interests. People's concerns and complaints were well-managed, and the provider recognised the importance of learning lessons when things went wrong. People were supported to maintain relationships with people who were important to them. Plans were in place to help people nearing the end of their life receive compassionate palliative care in accordance with their needs and expressed wishes.

People living at the care home, their relatives and staff working there were all complimentary about the way the service was managed, and how approachable the staff in-charge all were. The provider promoted an open and inclusive culture which sought the views of people living at the care home, their relatives, community health and social care professionals and staff working there. The provider worked in close partnership with various community health and social care professionals and agencies to plan and deliver people's packages of care and support.

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

Rating at last inspection and update

The last rating for this service was good (published 20 January 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. If we receive any concerning information, we may inspect sooner.

We found the following examples of good practice.

There were suitably robust measures in place to prevent or minimise the risk of relatives and friends, professionals and others who visited the care home catching or spreading infections. For example, visitor numbers were limited to one visitor per person and there was a booking system in place to stagger visiting times. All visitors were required to have their temperature checked, wash their hands, use hand sanitiser and wear a face covering on arrival at the care home. Easy to understand instructions explaining what visitors must do to minimise the spread of infection were prominently displayed throughout the care home, including on the front door and in the entrance lobby.

Alternative arrangements had been developed to help people maintain social contact with their family members and friends. For example, people could still see their visitors in-person in a designated room that had been partitioned in half using a transparent plastic wall which allowed people living in the care home and their visitors to enter and leave through separate doors. The door for visitors lead straight into the garden, which meant they did not have to walk through the care home to reach the designated visitors room. The service also used video calls and socially distanced garden visits to help people keep in touch with their family and friends.

The service implemented isolation and zoning appropriately after people living in the care home tested positive for Covid-19. Symptomatic residents were isolated in single occupancy rooms together in a designated wing of the care home. People living on this wing in isolation were not permitted to share communal areas, lavatories and bathrooms with others. These isolation measures had been risk assessed, covering the duration and nature of contact these individuals should be exposed too. Managers and staff demonstrated a good understanding of the principles of isolation and zoning.

There were suitable arrangements in place to ensure people admitted to the care home were tested for Covid-19 and had to isolate in their single occupancy bedroom for at least 14 days. People living in the care home continued to be assessed twice daily for symptoms of Covid-19, including having their temperature checked. Furthermore, a local GP regularly visited the care home and was routinely involved checking people who lived there for signs and symptoms of Covid-19.

Staff used personal protective equipment (PPE) in accordance with current infection prevention and control (IPC) guidance. We saw staff wearing PPE correctly in people’s bedrooms and the main communal areas. All staff had received up to date training in the new IPC guidance and use of PPE during this pandemic. Additional external training from Public Health England had also been arranged for all staff to attend by the end of the year. Staff demonstrated a good understanding of safe IPC practices and the correct use of PPE, including donning and doffing procedures (putting on and taking off PPE). Staffs competency to continue following IPC guidance and wearing PPE was assessed quarterly by their line managers. The service had adequate supplies of PPE.

Staff kept the premises clean. Staff had recorded cleaning schedules, which they were required to complete and that included frequency of cleaning of high touch areas, such as light switches, grab rails and door handles, for example. Cleaning staff were required to clean these high touch areas on a continuous rolling loop every couple of hours, which we observed happen during our inspection. We also saw communal areas were kept uncluttered so cleaning could take place effectively. There were laundry processes in place, so clothes were not mixed and washed together, and the laundry room was subject to regular enhanced cleaning.

The provider had thoroughly assessed and mitigated infection risks to staff working at the care home, including staff in high risk groups. The registered manager confirmed the service did not currently use any temporary agency staff. They were also aware of the new Covid-19 regulations in relation to care staff, including part-time, bank and agency staff, only working in one care setting to reduce the risk of spreading infection.

A regular testing scheme for all staff and people living in the care home was in place. Staff were tested at least weekly and people living at the care home monthly. People were also tested without delay if they became symptomatic or if anyone in the household bubble of a member of staff displayed symptoms. The registered manager knew how to apply for coronavirus testing kits for people living in the care home and for staff. They had no issues with the supply of Covid-19 home testing kits. People living in the care home had received the flu vaccination and staff were being encouraged to follow suit. Most staff had taken Covid-19 antibody tests.

There were a range of IPC policies and procedures which had been reviewed and updated since the start of the Covid-19 pandemic. These included contingency plans for managing adverse events, such as Covid-19 outbreaks and related staff shortages. Managers routinely monitored and audited compliance with IPC practices. This included daily tours of the building to check the premises were clean and that staff wore their PPE correctly. Managers also supported people and their relatives to understand the isolation processes and how the service could help to alleviate them feeling lonely.

Further information is in the detailed findings below.

Lynde House is a care home providing personal and nursing care for older people. The service can support up to 76 people. There were 67 people using the service during the inspection. The provider is Barchester Healthcare Homes Limited and is situated in the Twickenham area of London.

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

People said they enjoyed living at the home, it was a nice experience and staff thought it a good place to work. The people, relatives and staff we spoke with felt the home was a safe place to live and work in. Any risks to people were assessed, enabling them to enjoy their lives and take acceptable risks, whilst living safely. The home reported, investigated and recorded accidents and incidents and safeguarding concerns. There were enough appropriately recruited staff to meet people’s needs. Medicine was safely administered.

People’s equality and diversity needs were met, and they said they had not experienced any discrimination against them. Well-trained and supervised staff spoke to them in a clear way that they could understand. People were encouraged to discuss their health needs, by staff and they had access to community-based health care professionals, as well as the staff team. Staff protected people from nutrition and hydration risks and they were encouraged to choose healthy and balanced diets that also met their likes, dislikes and preferences. The premises were adapted to meet people’s needs. Transition between services was based on people’s needs and best interests.

The home’s atmosphere was warm and welcoming with friendly staff providing care and support in a way people enjoyed. The staff we met were caring and compassionate and positive interactions took place between people, staff and each-other throughout our visit. Staff observed people’s privacy, dignity and confidentiality and encouraged and supported them to be independent. People had access to advocates, if required.

People received person-centred care and their needs were assessed and reviewed with them. They did not experience social isolation, had choices, and pursued their interests and hobbies. People were provided with information, to make decisions and end of life wishes were identified. Complaints were investigated and recorded.

The home had an open, positive and honest culture with transparent management and leadership. There was a clear organisational vision and values. Service quality was frequently reviewed and areas of responsibility and accountability established. Records were kept up to date and audits regularly carried out. Good community links and working partnerships were established and registration requirements met.

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.

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

Rating at the last inspection and update

The last rating for this service was good (published 6 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Lynde House is a care home registered to provide accommodation and nursing and personal care for up to 76 people who require personal care and may also have dementia. The service is located in the Twickenham area.

The home 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 and associated Regulations about how the service is run.

In November 2014, our inspection found that the service required improvement regarding staffing levels under the safe question and we made a recommendation accordingly. At this inspection the home met the regulations.

People and their relatives said that this was a nice place to live and staff provided good support and care that was delivered in a respectful way. People were given the opportunity to choose what they wanted to do and joined in the activities provided if they wished.

The home had a welcoming atmosphere and during the inspection visitors told us that they were always made welcome. The home was well maintained, clean and provided a safe environment for people to live and work in.

There were thorough up to date records kept, including care plans that contained clearly recorded, fully completed, and regularly reviewed information. This enabled staff to perform their duties appropriately.

Staff knew people using the service well, including their likes, dislikes, routines and preferences and addressed them in the way they preferred. During our visit everyone received the same attentive service and were treated equally. Staff had appropriate skills, qualifications and were focussed on providing individualised care and support in a professional, friendly and compassionate way. Whilst professional they were also accessible and listened to people using the service and their relatives. Staff said they had access to good training, support and career advancement.

People were protected from nutrition and hydration associated risks with balanced diets that also met their likes, dislikes and preferences. They said the choice of meals and quality of the food provided was very good. People were encouraged to discuss health needs with staff and had access to community based health care professionals, if they required them.

People using the service said the manager and management team were very approachable, responsive to requests made or concerns raised, frequently encouraged feedback and acted upon it. The manager and management team consistently monitored and assessed the quality of the service provided and encouraged all staff to put forward ideas that may improve the quality of life of people using the service. Staff were also enabled to utilise their talents in areas that would not normally come under the remit of their roles, such as the maintenance person running very popular current affairs discussion sessions with people using the service. The home also involved the local community by putting on open days, provided the opportunity for local school students to complete their Duke of Edinburgh Award by visiting the home and gave students from the local six form college an opportunity to do placements to increase their knowledge of adult social care.

We spoke with the relatives of five people who lived at Lynde House and eight staff. We tried to speak with thirteen people who lived at the home. We were unable to speak with some people using the service because some people using the service had a number of complex needs meaning that it was difficult for all the people we spoke with to tell us about their experiences.

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. We saw that staff provided support to people who required assistance to enjoy their meal.

We spent two days inspecting the home. We noticed that while there were high numbers of staff available at main meal times, at other times it was not easy to find staff. We spoke with eight care and nursing staff and asked about the level of staff available to support people. One staff member told us "we are often busy and don't always get time to talk to people; call bells ring all the time". Someone else told us "we definitely need more staff, the ratios are not worked out on need, only on bed numbers".

We spoke with relatives of four people who told us that they would raise issues through relatives meetings or directly with the manager. One relative said "I've not had to complain".

We looked at five care records. Three had incomplete information relating to people's end of life wishes, including missing dates and signatures of people or their relatives. Important decisions about people's human rights, including their right to be resuscitated or not, were not always fully recorded or documented.