This inspection took place on 24 May and 8 June 2017 and was unannounced. This meant staff and the provider did not know that we would be visiting.

Lindisfarne Birtley is registered to provide care to 66 people, some of whom may have dementia. This includes a separate unit that provides care to younger people with mental health needs. The home is situated in a residential area in the centre of Birtley. All bedrooms are for single occupancy and the home is equipped for people with disabilities. At the time of the inspection there were 56 people using the service.

At the last inspection in June 2015 we found some improvements were need. Staff were aware of people’s care and support needs and most care plans reflected people’s needs. However, the monthly review of care plans did not capture or accurately reflect people’s needs if they had changed. We rated the service as ‘Requires improvement’ in one domain, namely 'responsive' and as being ‘Good’ overall.

At this inspection we found that the team had worked collaboratively to improve the care records.

The registered manager had been in post since April 2014. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like 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.

Care plans were personalised and had been regularly reviewed, to ensure they reflected people’s current needs and preferences. However we noted a variation in the quality of these care records across the three floors. Some care records were very difficult to navigate and others we found quite hard to understand because of poor archiving practices so we struggled to know which piece of information was the most current. The registered manager and area manager had identified this gap in staff practice and by 8 June 2017 had ensured that staff had reviewed the care records.

People were supported to maintain a healthy diet and to access external professionals to monitor and promote their health. However we noted variations in staff practices during meal times. On some units the meals served during lunchtime were very well organised and an enjoyable experience. On other units people were either not encouraged to sit at tables so struggled to understand that they were having lunch, or they sat for a long time before the meal was served so lost interest and left the dining room. We checked whether staff had made sure one person had received their meal, which they did. We also noted that, at times, staff merely gave the meals out and did not speak to people as they did this or when assisting people to eat. We discussed this with the registered manager on 24 May 2017 and they took action to improve staff practices.

People and their relatives told us staff at the service provided personalised care. People were supported to access a wide range of activities that they enjoyed. The activities coordinator had formed close links with an organisation called Equal Arts. This organisation provided a wide range of equipment that could be used to set up stimulating activities and which the activities coordinator routinely used. We saw that regular crafts, singing and memory sessions were run with and without Equal Arts. On 24 May 2017 we observed an extremely well run and simulating session where people formed a choir and all appeared to thoroughly enjoy the session. We also heard that people from across the service were regularly engaged in activities outside of the service.

People and their relatives spoke positively about the staff, describing them as kind and caring. Staff treated people with dignity and respect. Staff knew the people they were supporting well, and we saw the vast majority of staff having friendly and meaningful conversations with people. People were supported to be as independent as possible a

This was an unannounced inspection which we carried out on 24 June 2015.

We last inspected Lindisfarne Birtley in October 2014. At that inspection we found the service was not meeting all its legal requirements with regard to staffing levels, respect and involvement, staff training, record keeping and monitoring the quality of service. At this inspection we found that action had been taken to meet the relevant requirements.

Lindisfarne Birtley provides accommodation over three floors for up to 66 people who need support with their personal and health care. The home mainly provides support for older people many who are living with dementia. The home also provides support to some younger people with an acquired brain injury and/or mental health needs.

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.

Several changes had taken place since the last inspection to improve the outcomes for people who lived at the home especially for people who live with dementia.

Staffing levels had been increased to the top floor of the home and two units had been created on this floor from the one larger communal area to provide care and support to smaller groups of people. This also improved the dining experience for people who lived with dementia on this floor. This model of care was planned to be provided to the middle floor of the home to promote individual care.

People received their medicines in a safe and timely way. However we have made a recommendation about the management of some medicines.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. Staff had other opportunities for training to give them some insight into the specialist needs of some people.

Lindisfarne Birtley 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 and Best Interest Decision Making, when people were unable to make decisions themselves.

The necessary checks were carried out to ensure the building was safe and fit for purpose.

The environment was better designed to encourage and maintain peoples’ independence and orientation.

Menus were varied and a choice was offered at each mealtime. Staff supported people who required help to eat and drink and special diets were catered for.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the treatment they needed.

Staff were caring and patient and had time to spend talking with people. People who lived with dementia were more involved in daily decision making.

Record keeping had improved to reflect the care and support provided by staff and to ensure people’s needs were safely met.

Activities and entertainment were available for people.

People had the opportunity to give their views about the service. There was regular consultation with people and/or family members and their views were used to improve 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.

People said the registered manager was supportive and approachable.

The quality assurance system had improved and the provider undertook a range of audits to check on the quality of care provided.

We considered our inspection findings to answer questions we always ask:

. Is the service safe?

. Is the service effective?

. Is the service caring?

. Is the service responsive?

. Is the service well-led?

This is the summary of what we found.

Is the service safe?

An assessment of people's care and support needs was carried out before people started to use the service. This was to ensure staff had the skills and had received the training in order to safely meet the person's support requirements.

Risk assessments were in place. Audits were carried out to look at accidents and incidents and the necessary action was taken to keep people safe.

Information was available to show that the service worked with other agencies to help ensure people's health needs were met and to prevent admissions to hospital wherever possible.

We saw there were enough staff on duty at the time of inspection to ensure the welfare and safety of people who used the service.

Is the service effective?

Care was provided for both younger people with physical dependency and/or mental health needs, as well as care to older people, some with dementia and cognitive impairment. We found the service was not well equipped to meet these specialist needs of people who lived with dementia. The environment was not suitably designed to help orientate people and there was little evidence of the involvement of people who lived with dementia in daily decision making about their care needs.

Most people commented how helpful and friendly the workers were. Relatives told us the service kept them up-to-date with what was happening with their relative's care and they felt able to ask any questions. Most people we spoke with commented how pleased they were with the care provided by staff at the home.

Is the service caring?

People’s dignity and independence were not respected. We observed some staff had very little interaction with people and some had not developed a good understanding of people’s communication needs and how best to communicate with them. Staff working with older people were not observed interacting and engaging with people in a respectful way.

Is the service responsive?

Information was collected by the service with regard to the person's ability and level of independence before they moved into the service. Various assessments were completed by the manager of the service with the person and/or their family to help make sure staff could meet their needs. Regular reviews were carried out with the person who used the service and their representative to make sure plan's of care were kept up to date. This helped ensure staff provided the correct amount of care and support.

Referrals for specialist advice were made when staff needed guidance to ensure the health needs of people were met.

People's individual needs were taken into account and they, or their representative if they were not able, were involved in decision making with regard to their care. They were kept informed and given some information to help them understand the care and choices available to them, however this was not developed sufficiently to involve people with dementia.

Information collected by the service gave staff some insight into the interests and areas of importance to the person. Activity provision was not sufficiently developed to help ensure activities reflected people's interests and provided stimulation to people with dementia if they wished to become involved. Activity provision and opportunities for socialisation were not offered by support workers when activities personnel were not on duty. Staff we spoke with and people who used the service said there was little time for any socialisation and engagement as staff were kept busy with other tasks.

Regular meetings took place with staff and people who used the service and their relatives to discuss the running of the home and to try to ensure the service was responsive in meeting the changing needs of people.

Is the service well-led?

There was a focus from management on the provision of individual care and support to people who used the service. However there was less emphasis about individualised care and support for people with dementia and cognitive impairment. Staff had some knowledge about the support needs of people.

Most staff commented they felt supported by the manager and advice and support was available from the management team.

We saw people had the opportunity to comment on the quality of the service and that they felt able to speak to the manager and staff about any issues.

The reason for this visit was to check if improvements had been made in areas of care and welfare and the premises following a previous inspection. We spoke with some people who received care but, due to their needs, some were unable to communicate with us.

Records showed care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

The premises were maintained so people who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We used a number of different methods to help us understand the experiences of people living at the home, this included observation because most of the people living there had complex needs which meant they were not able to tell us their experiences.

Other people we spoke with said they were happy staying at the home and the staff were kind.

Comments included:

"There's plenty to eat."

"The staff are helpful."

"It's fine."

We found overall there were enough qualified, skilled and experienced staff to meet the needs of people living on the dementia care unit.

We used a number of different methods to help us understand the experiences of people using the service, because most of the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke to the relatives of three people who told us:

"The staff are good."

".... didn't settle at the last place but is quite settled here."

"The staff are very helpful and polite."

Other comments included:

"The food is good."

"I like the food."

"The staff are kind."

Lindisfarne Birtley provides accommodation for up to 66 people who need support with their personal and health care. The home mainly provides support for older people many who are living with dementia. The home also provides support to some younger people with an acquired brain injury and/or mental health needs. The home is a large, purpose built property. Accommodation is arranged over three floors and there is a passenger lift to assist people to get to the upper and lower floor. The home has 66 single bedrooms all with an en suite facility. There were 62 people living at the home at the time of our inspection.

This was an unannounced inspection, carried out over two days on 30 October and 5 November 2014. There was a registered manager 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.”

We last inspected Lindisfarne Birtley in June 2014. At that inspection we found the service was in breach of its legal requirement with regard to regulation 17 with regard to respecting and involving people. This was because people who lived with dementia were not provided with care that met their individual needs.

At this inspection we saw some improvements had been made, however we found further work was needed to improve the care and experiences of people who lived with dementia. We saw people who lived with dementia enjoyed a better dining experience although this could still be improved. We found people who lived with dementia were not encouraged to remain involved with their surroundings and to make choices.

We found there were not always enough staff on duty to provide individual care and support to people and to keep them safe as staffing levels were not maintained.

We saw 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. We found, however there were limited opportunities for staff to receive training to meet all of their care needs. For example, only the manager had an understanding and knowledge of The Deprivation of Liberty safeguards and best interest decision making when people lacked mental capacity.

We saw detailed care plans were not in place to help staff manage and provide consistent care to people who may display distressed behaviour. We saw some people records showed, there was a use of “ when required” medicines, to manage their behaviours.

We saw staff did not interact and talk with people when they had the opportunity. There was an emphasis on supervision and task centred care.

Staff did not always provide care that was responsive to people’s needs. Care records we looked at were not all up to date with evidence of regular evaluation and review to keep people safe and to ensure staff were aware of their current individual care and support needs.

We saw records were not in place for all people to make staff aware of the person’s individual preferences, likes and dislikes. This meant staff were not reminded the person was a unique individual with a history. Information was also not available for all people with regard to their end of life care wishes.

We spoke to the activities organiser, who had lots of ideas to help keep people stimulated. We saw they engaged well with people, however when they were not available, other staff did not provide activities for people to remain stimulated. Relatives we spoke with did say more activities and outings needed to be provided for people. They spoke of two outings that had taken place in the summer but said more stimulation was needed in the service. One person said; “The days can be very long.”

We found there was not an ethos from management to encourage staff to ensure people maintained some control in their lives. There was little evidence that people were helped to make choices and to be involved in every day decision making.

The audits used to assess the quality of the service provided were not effective as they had not identified the issues that we found during the inspection.

The necessary checks were carried out to ensure the building was safe and fit for purpose.

We found five breaches of the Health and Social Care Act 2008(Regulated Activities) Regulations 2010 in relation to staffing levels, respect and involvement, staff training, record keeping and monitoring the quality of service.

You can see what action we told the provider to take at the back of the full version of the report.