Lyndon Croft

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Systems to assess, monitor and mitigate risks to people, including risks associated with the environment and support planning were not always robust and did not always demonstrate a caring approach. Audits and checks completed had not enabled them to identify and address several concerns we found during this assessment. These included shortfalls in the assessment and management of risks to people and safe administration of medicines. Staff had not always been provided with clear guidance on how to safely meet people's individual needs. Staff did not always report incidents or safeguarding concerns in a consistent or timely manner, which meant people were not always cared for in a safe way. Staff and the management team told us, and we saw they cared about improving the service for people and making sure they received safe and dignified support. We saw positive interactions during the assessment.

This service scored 70 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Whilst people and relatives told us they felt staff were caring towards them our findings did not always indicate people were consistently supported safely. Most people told us they felt staff were kind and compassionate and treated them with dignity. Relatives told us they felt staff were caring towards loved ones. However, on relative told us the often had to ask for their loved one’s nails to be cut and cleaned.

Staff told us they had received training in relation to dignity and respect and explained how they put this into practice when supporting people. Staff told us about people’s support needs and how they worked with people to ensure they felt safe and cared for. The registered manager and other staff told us about the culture in the service and how they worked to promote a caring environment. Some staff and relatives told us about how staff changes caused disruption to people having familiar staff who knew people’s complex support needs.

Health professionals we spoke with felt staff were caring and overall, sought advice and guidance in a timely way.

We observed staff speaking to people in a kind and respectful way. However, some terminology used when recording daily notes could be more descriptive and less 'labelling' to give better insight into what had occurred. Words such as ‘aggressive’ were used rather than detailing what had occurred. We observed some staff failing to promote choice and independence during mealtimes. Some staff put protective aprons on people without gaining consent and care plans did not reflect this was their choice. We also observed 1 person who required support with their meal had it put in front of them for a long time before being supported. This meant the food was cold by the time support was provided. During a period of observed practice staff were patient and when people became anxious or upset, we saw staff taking time to listen to them and provide reassurance to help alleviate their anxieties. Most staff were interacting, but others did not engage positively or meaningfully with people. People were all well-presented, clean and tidy in appearance.

Communal areas of the home had been decorated to suit the needs of people using the service. This included signage, individualised doors and decoration. Most people we spoke with told us they were happy with their rooms and had pictures and personal items to make their rooms feel more homely. People and relatives told us they felt their individual needs were respected and met. However, one relative told us, "Sometimes they [relative] refuse personal care but would respond to encouragement. It depends on how staff approach them." The registered manager told us they had booked dementia training for staff to help improve knowledge and skills to prevent such incidents from occurring. Some relatives told us of their concerns in relation to the lack of activities and stimulation for people. This meant at times people were not engaged in meaningful activities for long periods of time and were just sat in their rooms. One relative told us, "Many of the residents just sit in the corridor by the dining room with no interaction." Another relative told us, "There is no atmosphere in the home at weekends. There is nothing going on and residents need stimulation." Some staff also raised concerns in relation to the lack of time to spend promoting hobbies and interests and the impact this had on people’s well-being.

The registered manager and staff told us they promoted a person centred approach and worked to ensure they supported people as individuals. Staff told us how they supported people and understood individual needs and preferences.

Areas of the home where people lived with dementia were being developed to be dementia friendly. People appeared to receive support by an individual approach. The selection of activities provided did not meet all people's needs. The provider was currently advertising for an additional activity co-ordinator to provide weekend cover. We were told and observed activities would benefit from being more individualised. Records corroborated that people’s known interests and hobbies were not being met and meaningful activities were not taking place regularly to include all people. Other relatives were complimentary about the staff and activities and the activity co-ordinator. One told us, "They [staff] put football nights on in a lounge for those who want to watch it."

We saw that DoLS applications were in line with individuals’ capacity assessments. More work was needed to ensure mental capacity assessments or best interest decisions were recorded robustly for each decision-specific area/decision. Following our feedback the registered manager had already implemented this piece of work to ensure all support plans accurately reflected specific decisions applicable to that individual. The management told us they spent time observing practices in the service to improve the outcome for people.

Most people and relatives we spoke with told us they felt they were encouraged to maintain independence and were given choice. We saw and were told people had access to the garden, some of whom needed supervision whilst using the area due to risks associated with leaving or due to mobility restrictions. Most people and their relatives we spoke with told us they felt they were encouraged to maintain independence and were given choice. Some relatives told us they felt their loved ones would benefit from more meaningful activities to keep them occupied. We were told and saw during our visit evidence of activities taking place which included one-to-one activities in people’s own rooms, if they were unable to or chose not to participate in group activities. People we spoke with told us there were no restrictions on what time they went to bed or got up or where they wished to spend their day.

Staff told us they had received training on promoting independence and explained how they supported and encouraged people to maintain this.

We observed on occasions, staff not offering choice at mealtimes and putting on people’s clothing protectors without asking. Care plans did not reflect this was their choice or that it was in their best interest. This did not promote people’s choice and control. However, we did observe staff supporting other people to remain independent and encouraging them with verbal prompts and positive re-enforcement when mobilising and eating their meals.

There were daily walkabouts by the senior team members and staff were observed during these times to monitor the promotion of independence, choice and control.

Most people we spoke with told us if they needed help someone was there to help them. One person said “If I call for help, they [staff] come. Sometimes I do have to wait a long time, but they do come to me." We observed and were told by the management that those who could not use a call bell had pressure alarms or sensors to alert staff should they need help. To ensure people were supported when needed 60 minute observations of people in their rooms were carried out. Those at risk of falling from bed had alarm mats on their beds linked to a call system which staff monitored.

The registered manager told us where call bells were removed, due to risks to people or being unable to use them, checks were in place to ensure people were not left without support when they needed. Some staff told us that at times due to staffing levels they were unable to respond as quickly as they would like.

We observed staff acted promptly, following correct procedures when supporting people with their support needs. This included response to emotional distress and anxiety. People were offered support to use the facilities in the home. Monitoring was in place, but this needed to be improved to ensure it was carried out as scheduled or as per people’s care plans.

The registered manager explained they had introduced a staff recognition programme through which colleagues were able to nominate their team members. This was awarded monthly. They had also introduced a comments and suggestions box for staff, visitors and people using the service to put forward any comments or suggestions. The registered manager told us this information would be used to help implement change based on the feedback received. Staff told us they felt listened to and valued by the management team and they felt they could raise any concerns they had. Some staff told us they felt staffing levels at times were low and this impacted on their wellbeing and ability to support people who they wanted to.

There were regular staff meetings and daily meetings to discuss each department and any issues which may arise. This seemed to be working effectively. The supervision process was not used effectively to cascade and nurture the shared direction of the service, or to demonstrate inclusiveness to drive improvements and personal development. We saw posters informing people of how to complain and for staff on whistleblowing. This demonstrates an open and transparent culture was being promoted.