Lynfield

The service was not able to demonstrate how they were meeting some the underpinning principles of right support, right care, right culture.

Right support: The model of care was designed to maximise people's independence. The provider had negotiated additional hours to help people who used the service access and be part of their local community. During lockdown this access had understandably decreased. Daily care records showed in-house activities were not always offered as a substitute. Staff told us they wanted to do more to promote people's independence.

Right care and right culture: Care interactions we observed were kind and focussed on each person's needs. Care aimed to promote people's dignity, privacy and human rights. However, judged that the culture of the service was to occasionally treat the people who used the service as if they were young children rather than adults. This is something we have asked the provider to review and work on before we carry out our next comprehensive inspection. This culture did not appear to impact negatively on the people we saw, and staff were clearly very caring in their interactions. However, treating people in a way which is not appropriate to their age can be demeaning and impact on their dignity.

Oversight and monitoring of the safety and quality of the service needed to improve. Both the registered manager and the provider needed to have more effective systems in place to ensure safe recruitment of staff.

Risks to people's health, safety and welfare had not always been robustly assessed and mitigated. This could have placed them at increased risk of harm. Care plans were detailed and provided staff with clear guidance to help them support people's distressed reactions. We were not fully assured that staff always followed all this guidance.

We have made a recommendation about reviewing incident and accident records to ensure care plans had been followed.

Records were not always accurate and some concerns we identified may have been recording issues rather care issues. Electronic care plans were very detailed and contained a lot of guidance but one record had been replicated from a previous year which could have been very confusing for staff.

Medicines were well managed and medicines to help people with their distress and anxiety were closely monitored and given appropriately.

Staff were clear about how to recognise and report signs of abuse and had received training about this. The provider was clear about their safeguarding responsibilities and worked in co-operation with the local authority safeguarding team to investigate issues.

There were usually enough staff for them to carry out their roles, although sometimes numbers dipped below the provider's assessed levels.

Risks relating to Covid-19 had been assessed and actions to mitigate these risks were recorded. Infection control procedures were mostly good, and staff promoted this well with the people who used the service. Some small improvements were needed to further reduce risks.