Archived: Lindsay Hall Nursing Home

Updated 14 June 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on the 10 and 11 April 2017. This visit was unannounced, which meant the provider and staff did not know we were coming. It was undertaken by two inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

Before our inspection we reviewed the information we held about the home. We considered information which had been shared with us by the local authority, looked at safeguarding alerts and notifications which had been submitted. A notification is information about important events which the provider is required to tell us about by law. Before the inspection we spoke with the Local Authority to ask them about their experiences of the service provided to people. We observed care in the communal areas and over the three floors of the home. We spoke with people and staff, and observed how people were supported during their meals. We spent time looking at records, five staff recruitment files, training programmes and other records relating to the risk management of the home, such as complaints and accident / incident recording and medicine audits.

We looked at five care plans and risk assessments along with other relevant documentation to support our findings. We also 'pathway tracked' people. This is when we looked at people's care documentation in depth and obtained their views on how they found living at the home. It is an important part of our inspection, as it allowed us to capture information about a sample of people receiving care.

Some people were unable to speak with us. Therefore we used other methods to help us understand 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 spoke with eight people living at the service, three visiting relatives, seven care staff the chef, a housekeeper, maintenance staff, two nurses, the manager and two senior managers from the provider.

Updated 14 June 2017

We inspected Lindsay Hall Nursing Home on 10 and 11 April 2017. This was an unannounced comprehensive inspection. Lindsay Hall Nursing Home provides accommodation and nursing care for up to 38 people living with differing stages of dementia who also have nursing needs, such as diabetes and strokes. There were 25 people living at the home during the inspection. Lindsay Hall Nursing Home is owned by Galleon Care Homes Limited. Accommodation was provided over three floors with a lift that provided level access to all parts of the home.

There was no registered manager in post. An appointed manager was in post and had submitted their application to register with the CQC. We have confirmed that this is in progress. 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.

At a comprehensive inspection in March 2015 the overall rating for this service was Inadequate. At this time we took enforcement action. During a further inspection in August 2015 improvements had been made, breaches in regulation had been met and the overall rating was Requires Improvement.

Due to a high number of concerns raised with us we undertook a comprehensive inspection in July 2016, so we could ensure that people were safe. We found that people's safety was being compromised in a number of areas. The service was placed into special measures and we served warning notices for Regulations 12 and 18 of the Health and Social Care Act 2008 (Regulated Activities).

We undertook a focussed inspection on the 01 and 03 November to look at the safe domain. We found improvements had been made, the breaches of Regulation 12 and 18 were not fully met.

At this inspection we found the breaches of Regulations 11, 12 and 17 were not fully met. There was a clear commitment from the manager and staff to continue with the improvements, developments and learning that had already taken place. The provider’s leadership team acknowledged that this would take some time. They told us they wanted improvements to be fully embedded and would take their time to ensure this was done properly. Staff were now aware of their roles and responsibilities, they had a clear understanding of the vision and direction of the home. This was regularly discussed with them at interview, staff meetings and supervision.

Although there was a quality assurance system and a range of audits and checks took place this had not identified all the shortfalls we found. However, the manager had a good oversight of what was required to ensure the service continued to improve and meet the regulations.

Staff told us they felt supported by the new manager, they could talk to her and raise issues at any time. They felt listened to and knew any concerns would be taken seriously and acted on appropriately. Staff were committed to helping the service improve and develop.

There were a range of risk assessments in place. However, not all risks had been identified in relation to pressure damage. There was lack of information to show that appropriate steps had been taken to ensure people’s risks had been safely managed.

There were systems in place to manage people’s medicines. However, improvements were required to ensure people received their ‘as required’ medicines consistently. Improvements were also required to ensure people received their body creams as prescribed.

Although some activities took place at times, there was a lack of meaningful activities for people to participate in as groups or individually throughout the day. People’s care plans did not include all the information about the care people needed or received. However, people were supported by staff who knew them well and they had a good understanding of people’s individual needs, choices and preferences. Staff were kind and compassionate and worked hard to improve people’s quality of live and provided them with the person-centred care and support they required.

Recruitment had taken place to ensure there were enough suitably qualified and experienced staff to meet people's needs. Recruitment records demonstrated there were systems in place to ensure staff were suitable to work at the home. There was an ongoing training and supervision programme in place. This included observations of staff in practice and assessment of their competencies.

Staff were able to recognise different types of abuse and told us what actions they would take if they believed someone was at risk. Staff were confident they would raise any concerns to the senior person on duty or if appropriate to the local safeguarding team or CQC.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) had been submitted when required. However, there was limited information about how people who lacked capacity were able to make decisions.

The mealtime experience for people had improved and this was ongoing to ensure changes were fully embedded into practice. Nutritional assessments were in place and action was taken when people were identified as being at risk. People were offered choices and supported to eat and drink throughout the day. Staff were also encouraged to eat with people to help people identify it was a mealtime.

People were supported to have access to healthcare services and referrals were made appropriately. This included the GP, mental health team and tissue viability nurses.

The manager had worked hard to develop an open and positive culture. This was focussed on ensuring people received good person-centred care that met their individual needs.

We found a number of breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.