Lindisfarne House is registered to provide personal and nursing care to a maximum of 60 people. Care is provided to older people including people who live with dementia and a unit provides support to some younger people who have a physical dependency.

At the last inspection in April 2016 we had rated the service as 'Good'. At this inspection we found the service remained 'Good' and met each of the fundamental standards we inspected.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. 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 told us they were safe. At our last inspection we had found the service in breach of Regulation 18, staffing. At this inspection we found improvements had been sustained and there were sufficient staff to provide individual care and support to people.

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. There were other opportunities for staff to receive training to meet people’s care needs.

People were involved in decisions about their care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff were patient and kind as they supported people.

Records were regularly reviewed to reflect people's care and support requirements. People had access to health care professionals to make sure they received appropriate care and treatment. Staff supported people who required help to eat and drink and special diets were catered for.

Some activities and entertainment were available for people. We have made a recommendation to increase the variety of activities.

Complaints were taken seriously and records maintained of the action taken by the service in response to any form of dissatisfaction or concern.

A range of systems were in place to monitor and review the quality and effectiveness of the service. People had the opportunity to give their views about the service. There was regular consultation with people or family members and their views were used to improve the service.

Further information is in the detailed findings below.

This was an unannounced inspection which we carried out on 19 April 2016. We inspected the service to follow up on the breaches and to carry out a comprehensive inspection.

We last inspected Lindisfarne House in February 2015. At that inspection we found the service was in breach of its legal requirements with regard to Regulation 12 and Regulation 17 of the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014. This was because records were not in place to ensure people were protected from unsafe care as risks to people were not always accurately recorded. Records did not contain all the information to ensure people received appropriate care that met their needs.

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 post. 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.

Due to their health conditions and complex needs not all people were able to share their views about the service they received.

We found improvements had been made with regard to record keeping to ensure people received care and treatment that met their needs.

People told us they were felt safe. However, staffing levels were not sufficient to ensure people's needs were managed safely at all times. Staffing levels were increased as the result of our inspection but they needed to be consistently maintained.

Systems were in place for managing and mitigating risk. A more critical accident and incident analysis was introduced that needed to be maintained and regularly reviewed to identify any trends of accidents and incidents that occurred to help prevent them occurring.

Risk assessments were in place and they accurately identified current risks to the person. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. People received their medicines in a safe and timely way.

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 care they needed.

Records had been updated and they were regularly reviewed to reflect peoples’ care and support requirements. Staff knew the people they were supporting well. Care was provided with kindness and people’s privacy and dignity were respected.

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.

Staff received other opportunities for training to meet peoples’ care needs and in a safe way. A system was in place for staff to receive supervision and appraisal.

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. Activities and entertainment were available for people and people were being consulted to increase the variety of activities and outings.

A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to. People had the opportunity to give their views about the service. There was regular consultation with people or family members and their views were used to improve the service. The provider undertook a range of audits to check on the quality of care provided.

The environment was mostly well-maintained for the benefit of people who used the service.

Staff and people who used the service said the manager was supportive

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.

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 a summary of what we found-

Is the service safe?

Risk assessments were in place. All risks to people living in the home, their relatives and staff were regularly assessed and appropriate steps taken to minimise such risks. People were supported and encouraged to maintain their independence and this was balanced with the risk to the person. Audits were carried out to learn from 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.

Staffing levels were in place to ensure all the needs of the people who lived at the service were met to ensure their safety. A member of the management team was available on call in case of emergencies.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We were told the necessary applications had been submitted and three people were subject to Deprivation of Liberty orders. We saw proper policies and procedures were in place.

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs had been met. Relatives we spoke with told us that the service kept them up to date with what was happening with their relative's care and they felt able to ask any questions. One relative commented; "I am kept informed of any changes in my relative's care."

We observed and people we spoke with said they would like the opportunity for more activities and outings. People did not have access to many activities although they were supported to maintain personal relationships with their friends and relatives. We spoke to an activities person who had just become employed by the service. They had ideas for activities to keep people who lived with dementia engaged and stimulated.

Staff had received regular training to meet the needs of the people who used the service.

Is the service caring?

People were supported by kind staff, who showed patience and gave encouragement when supporting people. People commented how helpful and friendly staff were although they were always busy with paperwork. Some people we spoke with commented how pleased they were with the care provided by staff at the home. One relative commented; "My mother's friend has been here for some time and was well looked after so I was comfortable for my mother to come here." Another commented; "My mother is very happy here." And "I enjoy the food its very good, I have everything here I need." Another person said; "The staff are wonderful and are always available to help me, I am well looked after." And; "I love it here, it's a nice room and the food is good."

Is the service responsive?

People’s needs had been carefully assessed before they moved into the home. People told us they had been asked for their views and these had been recorded. Records confirmed people’s needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service well-led?

The home did not have a registered manager in post as we were told they were working their notice and were leaving the day of inspection. Staff told us they were clear about their roles and responsibilities. They said they felt supported by the manager and advice and support was available from the management team. We did not see a system in place to ensure management were supported in their role. An external quality assurance system was not in place to audit the services provided. We have asked the provider to tell us how they intend to address these issues.

We used a number of different methods which included observation to help us understand the experiences of people using the service, because some of the people using the service had complex needs which meant they were not able to tell us their experiences.

During our observation we saw people were treated with consideration and respect. We saw staff were busy as they provided care and support to people who used the service. We spoke to ten people who lived at the home who told us staff were kind and helpful but they were kept very busy. One person said;" The staff are very kind but they are not always available when you need them." We spoke with three relatives who said; "The staff are brilliant." Another person said;" Lindisfarne House is a fantastic place." Other comments included there was not much to do in the way of activities and outings.

All people we spoke with said they were respected by staff. Comments included: "My privacy is respected at all times" and " I can talk privately to staff."

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There were enough qualified, skilled and experienced staff to meet people's needs.

People who lived at the home were cared for by staff who were appropriately trained and supported to deliver care and treatment safely.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We saw the provider had systems in place to gather feedback from people, who used the service, and to regularly assess and monitor the quality of service people received.

People living at the home and their representatives were involved in and agreed to how their care was provided. A relative told us, “I was fully consulted about the way they would look after him”.

We found that support was planned to meet individual’s assessed needs and was delivered by enough skilled staff to ensure their safety and welfare. People and their relatives told us they received the care and treatment they required. They said, “I’m okay here, the staff help me with what I need”; “They’re very good, they work hard to look after us all”; and, “I feel the care has vastly improved”.

Staff understood their roles in protecting vulnerable people and we saw that any alleged abuse or complaints about their care were responded to appropriately.

People we spoke with made the following comments. “We’ve got freedom here”. “It’s friendly”. “Nothing is a bother to staff”. “They’re very good health wise, if mum needs the doctor, they call them straight away”. “It’s too noisy in the day room, its sensory overload”. “The staff come and do mum’s nails and put rollers in her hair”.

This review was carried out to check improvements made to the home following our visit in November 2011. Some people could not offer direct comments about the care they received. Others expressed satisfaction with the care being provided. Comments included: “The staff know what help I need and come promptly when I ring the bell for them”. “I feel better since I came here to live and I am looked after and don’t have to worry about anything.”