This inspection took place on 26 and 27 July 2017 and was unannounced.

Lindau Residential Home is registered to provide nursing; personal care and accommodation for up to 37 people. There were 27 people using the service during our inspection; who were living with a range of health and support needs. These included; diabetes, catheter care and people who needed to be nursed in bed.

Lindau Residential Home is a large detached house situated in a residential area just outside New Romney. The service had a large communal lounge available with comfortable seating and a TV for people and separate, quieter areas. There was a secure enclosed garden to the rear of the premises.

The previous inspection on 2 and 3 June 2016 found three breaches of our regulations, an overall rating of requires improvement was given at that inspection. The provider had not ensured actions designed to address risk had been followed through into practice. This specifically related to people that required special air mattresses to help prevent pressure wounds. Medicines had not been administered, recorded, stored or managed in a safe way which posed a risk to the safety of people. People’s health care had not been managed effectively, specifically in relation to catheter care, drinks that required thickener, and wound care records. Not all audits had effectively picked up concerns which we had found during the inspection specifically in relation to the management of medicines. The provider had resolved the issues raised at the previous inspection which were no longer a concern at this inspection.

A registered manager was in post. A registered manager is a person who has registered with the care Quality Commission to manage the service. 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.

Although the provider had displayed their latest ratings at the premises, they had failed to display their latest CQC inspection report ratings on their website which is a legal requirement. We asked the provider to address this and we will follow this up.

There were safe processes for storing, administering and returning medicines. People received their medicines in a person centred and appropriate way.

Accidents and incidents had been properly recorded and audited for trends to try to prevent further accidents. Risks to people were well monitored and action was taken when concerns were identified. People had individual personal emergency evacuation plans (PEEPs) that staff could follow to ensure people were supported to leave the service in the most appropriate way in the event of a fire.

Appropriate checks were made to keep people safe and safety checks were made regularly on equipment and the environment. There were enough staff to meet people's needs. Employment checks had been made to ensure staff were of good character and suitable for their roles.

Robust safeguarding and whistleblowing guidance and contact information was available for staff to refer to should they need to raise concerns about people’s safety. Staff had good understanding about their responsibilities in relation to this.

The registered manager demonstrated a clear understanding of the process that must be followed if people were deemed to lack capacity to make their own decisions and the Mental Capacity Act (MCA) 2005. They ensured people’s rights were protected by meeting the requirements of the Act.

Peoples health needs were well monitored and responded to promptly. External professional healthcare advice was sought and referrals made in a timely way. Staff had the knowledge and skills to complete their roles effectively. Staff had received training in mandatory and other areas.

People were supported to eat and drink and had choice around their meals.

Staff demonstrated caring attitudes towards people and spoke to them in a dignified and respectful way. Staff co

This inspection took place on 2 and 3 June 2016 and was unannounced.

Lindau Residential Home is registered to provide nursing; personal care and accommodation for up to 37 people .There were 32 people using the service during our inspection; who were living with a range of health and support needs. These included; diabetes, catheter care and people who needed to be nursed in bed.

Lindau Residential Home is a large detached house situated in a residential area just outside New Romney. The service had a large communal lounge available with comfortable seating and a TV for people and separate, quieter areas. There was a secure enclosed garden to the rear of the premises.

A registered manager was in post. A registered manager is a person who has registered with the care Quality Commission to manage the service. 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 had not consistently been protected against identified risks to their health, safety or well-being. This included risks associated with medicines. However, environmental hazards such as fire and equipment had been properly addressed. People told us they felt safe living in the service.

There were enough staff on duty to support people promptly and staff had received training and regular supervision to ensure they were competent for their roles. There was a robust recruitment process in place and proper pre-employment checks had taken place.

Staff knew how to protect people from abuse and how to report any suspicions they might have. Accidents and incidents were documented and actions put in place to prevent reoccurrences.

People’s healthcare had not always been evidenced, making it difficult to tell if they had received appropriate care. Adaptations had not been made to the premises to help people living with dementia or memory loss to orientate themselves.

Staff were knowledgeable about the Mental Capacity Act (MCA) 2005 and gave people clear choices. Deprivation of Liberty Safeguards (DoLS) applications had been made by the registered manager and authorisations received in some cases.

People said they enjoyed their meals and dieticians were involved when people lost weight. Drinks were plentiful to ensure people remained hydrated.

Activities were not consistently available or meaningful and were carried out by care staff. People’s care plans, however were individualised and reflected people’s personalities and preferences. People and relatives knew how to complain and complaints had been managed effectively.

Auditing had been carried out to measure the safety and quality of the service, but this had not always been effective in identifying shortfalls. People and their relatives had been given opportunities to give their views about the service and the registered manager had responded by making changes where necessary.

Staff said they felt supported by the registered manager and there was an open culture in the service. People and relatives told us that the registered manager was visible and approachable.

We found a number of breaches 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 this report.

We carried out this inspection over five hours. During this time, we met 19 of the 23 people who lived at the home and spoke with eight people in some detail. We spoke in more fully with two staff members and briefly with most others. The manager was available for part of the inspection, and we were helped by other staff for the remainder of the inspection. During the visit we requested further information from the manager around fire safety procedures. This information was sent to us within the agreed timescale. The summary describes what people who used the service, and the staff told us, what we observed and the records we looked at.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were supported in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available at all times of the waking day. An on call system for managerial support was in place for out of hours emergencies. There were evacuation plans and systems in place in the event of a fire, but documentation for checking the fire safety system was not always completed.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager provided a working description around assessing people’s capacity to consent if there were any concern it was absent. They were able to demonstrate what steps that were taking to ensure they were not unlawfully depriving people of their liberty.

Is the service effective?

People were fully involved in their assessment and care planning. This meant that their true voice was heard and that all care and support was planned with their consent. With consent, family, friends and loved ones contributed to the care plan, which meant the service was able to better understand the person’s needs. Where there was doubt about the legitimacy of a person to act on behalf of another person, steps were taken to obtain the right legal documentation. This meant that the person received the right level of support to remain as safe and as independent as possible.

Some recording around fire safety checks were missing, although several staff independently advised that the checks took place weekly. It is important that these checks are recorded as specified by the organisation’s own policy and procedure. We observed that the staff took immediate action to remedy this oversight.

Is the service caring?

People were relaxed and happy in the company of staff. The manager introduced us to 19 of the 23 people at the home. We observed that everyone looked pleased and relaxed to see the manager, and were confident to speak about the service provided. One person told us about the caring support they had received since taking up residence in the home. They told us, “Staff are excellent. I had given up on life really, but staff have got to know me, they know what I do and don’t like. The manager could see that, and asked me to look after the chickens. It gave me a real purpose again, and I am so much happier”. Another person asked us, “Have you seen our cats? We have two new ones; they are really friendly and sit on our laps, which is lovely”.

Is the service responsive?

Records showed that the manager and team worked together to keep people’s health and support plans up to date. Records confirmed that medical professionals had been consulted without delay and that the action taken and what the outcome was were noted. We saw that the incident reporting system analysed any themes around falls or, for example increased urine infections. We saw that the manager used these data to inform them of what staff training was needed. We also saw that this was an effective way for the manager to implement environmental changes, such as hand-rail placements where they were most needed.

Is the service well led?

The people we spoke to said that the home was run very well. Several people said, “I have no complaints, the food is good, the staff are nice”. One staff team member told us that they had formal supervision with the manager. They said that in addition, the, manager worked alongside the team to support and role model ‘good care’. Feedback from staff surveys showed that the team were happy in their role and where concerns had been raised about inter-personal working relationships, the manager had addressed and resolved these.

Our inspection on 24 September 2013 found that people had not always been protected against the risks of unsafe or unsuitable premises. The provider had been unable to evidence that a fire risk assessment had been completed, to identify that the fire safety arrangements were satisfactory in protecting people, staff and visitors and to minimise the risks of fire within the home. Records had not been available to evidence that hot water temperatures were checked on baths and showers to help minimise the risks of scalding to people who lived in the home. There had been no improvement plan in place to identify how repairs and re-decoration would be undertaken to maintain the premises.

At this inspection, we found that the home had undertaken a fire risk assessment to identify the fire safety arrangements that were required to minimise risks to people, staff and visitors. We found that the home had taken action to implement a range of measures and procedures in accordance with the requirements of the fire risk assessment.

We found that procedures had been implemented to help reduce the risks associated with bath and shower hot water outlets and information made available for staff guidance about recommended safe hot water temperature limits, to help protect people against the risks of scalding.

We found that the home had introduced an improvement plan to identify how repairs and re-decoration would be undertaken.

At the time of our inspection, there were 26 people living at the home.

We spoke with four people who used the service and two visitors. People we spoke with who used the service told us that they were happy with the care and support they received and their comments were positive. One person said “they are wonderful, lovely; I am so happy here”. A visiting relative told us “the staff are wonderful, very good”.

We looked at people's care plans and saw that they were individualised and contained people's choices and preferences. Risk assessments were in place to identify and minimise risks as far as possible for people who used the service.

All the people we spoke with who used the service told us that they felt safe and that they would know what to do if they had any worries or concerns.

We found that people who lived in the home were happy with their accommodation. However, we had some concerns about the fire risk assessment and some of the safety tests the home had undertaken. There were also some areas of the home where maintenance had not been fully completed.

We found that there were enough staff on duty and they told us that they felt supported by the manager; one member of staff told us “the manager is really excellent and will always help us”. We found that staff had undertaken essential training to keep their skills and knowledge up to date. A visitor told us “the staff are well trained, wonderful and patient”.

We found that the home had a complaints policy and a procedure that clearly set out how people were able to make a complaint if they needed to.

Some people living at the service were not able to talk to us directly about their experiences due to their complex needs, so we used a number of different methods to help us understand their experiences. We spoke with staff, spent time with people, read records, looked around the service and made observations of the care and support the people received.

We saw that people were offered choices and their dignity and independence was respected. We saw some positive interactions between staff and the people who lived at the service. Staff assisted people in a professional, yet warm manner and explained what they were doing when they supported them.

People we spoke with told us that they liked living in the service and that staff were friendly and caring. We saw that people looked relaxed. The people we spoke with told us that they were satisfied with the care and support received. One person said “I have been here five years, I have no complaints they really look after your health”. Another said, “Staff are pleasant and they discuss my care with me”.

People living at the home, relatives and visitors all commented on how good the care was. People who use the service told us they were happy with the care and support they received, that they were involved in decisions about their care and support and that their privacy and dignity was respected. One person said “the staff are wonderful, lovely girls all of them. What you ask them to do, they do it gladly.” People had access to health care such as opticians, chiropodists, doctors and district nurses.

We observed good interaction between people who use the service and staff who were on duty on the day of the site visit. Staff were observed supporting people in a calm manner and using preferred names to address them. One person said “we had a Burns’ Night supper on Saturday and had haggis, it was lovely. We had a quiz and music night, we have lots of dos here and friends and family are welcome.”

People told us that the food was good and there was always a choice. One person said “the food is excellent there is always a choice, today we can have roast chicken, pork or salad.” Menus reflected a varied and balanced diet.

Overall the home was clean and tidy. Some areas of the home were newly decorated but a few areas were in need of refurbishment and redecoration. Some parts of the home were not accessible to people. Information received from the provider before our visit stated that the building work would be completed by 12 December 2010. A development plan to improve the environment was in place.

Lindau was registered under the Health & Social Care Act in October 2010 (previously registered under the Care Standards Act) with no conditions of registration.