This was an unannounced inspection which we carried out on 10 February 2015.
We last inspected Lindisfarne House in September 2014. At that inspection we found the service was in breach of its legal requirements with regard to regulation 17 and regulation 10 of the Health and Social Care Act 2008. (Regulated Activities) Regulations 2010. This was because people who lived with dementia were not provided with care that met their individual needs and an effective quality assurance system was not in place to check the quality of service provided.
Lindisfarne House is a purpose built care home that provides personal and nursing care to a maximum of 60 older people, including people who live with dementia. This also includes 15 younger people who have physical disabilities.
A registered manager was in place. 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 2008 and associated Regulations about how the service is run.
People said they felt safe and they could speak to staff if they had any concerns. Comments included, “I quite like it here, I definitely feel safe here.” A relative said, “(Name) is safe from harm here.” Another relative said, “(Name) is safe in here, they are comfortable and well looked after, she would tell me if she wasn’t happy.” We found there were enough staff on duty to provide care and support to people and to keep them safe.
People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. One staff member commented, “The company is pro-active in making sure everyone has read and understands the whistle blowing policy. I have no doubt anyone here would act straight away if they saw or found something that made them uncomfortable.”
When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.
People received their medicines in a safe and timely way.
The necessary checks were carried out to ensure the building was safe and fit for purpose.
Records showed that risk assessments such as for pressure area care, nutrition, falls and oral health were in place to reduce the risk to people’s safety. However, they were not always regularly reviewed and evaluated. Referrals were made to health professionals where problems had been identified.
Staff were appropriately trained and told us they had completed training in safe working practices and were trained to meet people’s specific needs.
Staff knew people’s care and support needs, but detailed care plans were not always in place to help staff provide care to people in the way they wanted. Information was available for people with regard to their individual preferences, likes and dislikes.
People said staff were kind and caring. Comments included, “The staff are very kind to us.” And, “I have nothing but praise for the staff, no complaints.” Another person said, “I think the staff enjoy their work, they don’t have much time to talk but they chat to me when they are helping me.” And, “It’s like a first class hotel.” A relative said, “It’s a very sociable home….the staff always make me feel at home. Their attention to detail is amazing and their level of care is fantastic.”
Menus were varied and a choice was offered at each mealtime. One person commented, “The food is good, I get everything I need.” And, “The food is mostly good, I would say 85% of the time, we get fair helpings and are sometimes offered seconds.” Another person said, “If I fancy a treat I’m served breakfast in bed.” Staff were sensitive when assisting people with their meals and the catering staff provided special diets which some people required.
The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Staff had received training and had a good understanding of the Mental Capacity Act 2005 (MCA) and best interest decision making, when people were unable to make decisions themselves.
People had access to health care professionals to make sure they received care and treatment. Staff did not always follow advice given by professionals to make sure people received the treatment they needed.
Activities and entertainment were available for people and staff supported people to access these if they wished.
People had the opportunity to give their views about the service. A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to.
The provider undertook a range of audits to check on the quality of care provided. The registered manager was introducing changes to improve the quality of care and to ensure the service was well-led for the benefit of people who used the service.
We found that the provider had not protected people against the risk of unsafe care and treatment and did not always deliver appropriate care that met their needs. This was in breach of regulation 9 of the Health and Social Care Act 2008(Regulated Activities) Regulations 2010, which corresponds to regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We found that the provider had not protected people against the risk of unsafe care and treatment because of inaccurate record keeping. This was in breach of regulation 20 of the Health and Social Care Act 2008(Regulated Activities) Regulations 2010, which corresponds to regulation 17 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 the report.