About the service: Lindisfarne Newton Aycliffe provides accommodation with personal and nursing care for up to 56 older people. The home is split into three units across three floors. Residential and nursing care is provided to older people and people living with dementia. At the time of this inspection 52 people were living at the service.

People’s experience of using this service: Improvements had been made to the service following our last inspection in March 2018. The provider and registered manager had improved the way people’s topical medicines were managed, the cleanliness of equipment used in the home, the maintenance of the wheelchairs and the audits.

Staffing levels met people’s needs. Staff had received a wide range of training including around working with people who may display behaviours that challenge. Checks were made on the ongoing competency of staff.

The cook and staff had received ‘focus on under-nutrition’ training. Staff were encouraging people who were under-weight to eat fortified foods. A range of menu choices were available.

People participated in a range of activities that met their individual choices and preferences. Staff provided the structured support people required.

Staff reported any safeguarding matters and the registered manager ensured these were investigated appropriately. The registered manager had acted on concerns and complaints and had taken steps to resolve these matters. All incidents were analysed and lessons were learnt and embedded into practice.

People told us that the registered manager and staff listened to their views and that people’s needs were met. Staff were not consistently recording capacity assessments and ‘best interests’ decisions. The registered manager had identified that further improvements could be made to the care records.

For more details, please see the full report which is on CQC website at www.cqc.org.uk

Rating at last inspection: Requires Improvement (report published 15 March 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service had improved and was rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 4 and 5 January 2018 and was unannounced. At our last inspection in October 2015 we rated the service as good and there were no regulatory breaches.

During this inspection we found breaches of Regulations 12, 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had not done all that was reasonably practicable to mitigate risks to people including the safe administration of people’s topical medicines and the cleanliness of equipment used in the home. We found wheelchairs in the home were not being used in a safe manner. The audits carried out failed to identify these issues and records were not always up to date and accurate.

Lindisfarne Newton Aycliffe is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Lindisfarne Newton Aycliffe provides accommodation for up to 56 people across three separate units. One of the units specialised in providing care to people living with dementia. At the time of our inspection there were 51 people residing in the home.

There was a registered manager in post at the time of our inspection. 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 found there were safe arrangements in place for the storage and disposal of people’s medicines. People had been prescribed topical medicines (creams applied to the skin). Guidance had not been given to staff on the frequency topical medicines needed to be applied.

Whilst the home was clean and tidy throughout risks to reduce cross infection had not always been carried out. During our inspection the registered manager made arrangements to make improvements.

We observed wheelchairs were not being used appropriately. Foot plates were missing. The registered manager carried out an audit of the wheelchairs in use during our inspection to reduce the risks to people using the wheelchairs.

People had care plans in place which contained personalised information. These were reviewed on a regular basis.

The service had in place a number of audits for monitoring quality. These audits resulted in actions required to improve or sustain the service. We found some of the audits had not uncovered the deficits in the service.

Risk assessments were in place to manage the environment and people’s personal risks.

During our inspection we reviewed seven staff files. We found the provider carried out robust checks on prospective staff members before they were permitted to start working in the home. Staff had received an induction and were provided with continuous support through training supervision and appraisals.

People were protected from the risk of abuse because the staff in the home understood their roles and responsibilities to keep people safe. Actions had been taken if staff were concerned a person was at risk of harm.

There were regular checks carried out on the building. These included fire checks and the monitoring of hot water temperatures to prevent people from being scalded. Checks were also carried out on beds and bedrails.

Kitchen staff understood people’s dietary requirements and how to provide food to people who were at risk of losing weight. We carried out observations on lunchtime on each of the three floors. People who needed full support to eat were provided with the required support to eat at their own pace. People who needed their food cut up for them did not always eat their meal. Staff later encouraged them to eat food which would have gone cold. We recommended the service

During our visit we found people were asked for their consent before they received any care or treatment and the provider acted in accordance with their wishes. We spoke with several people who used the service. They said staff respected their choices to make informed decisions and have control of their lives. One person told us, “I have my say and I tell them what I think. It’s alright to do that and we can have a joke about.” One relative told us, “Staff talk to me all the time about what’s happening here and anything that’s important to do with my (relative’s) care. If I wasn’t due to visit they would ring me up.”

We found care and treatment was planned and delivered in a way which ensured people’s safety and welfare. One person who lived at the home told us, “The staff and the manager are very good. The nurses are very friendly and I find this is one of the nicest places I’ve lived at.” One visitor told us, “I’ve been visiting my (relative) for two years now and I can honestly say she is well looked after and has all of her needs met by staff who really care for her and everyone else who lives here.”

The provider had made suitable arrangements to protect vulnerable people and respond appropriately to any allegation of abuse.

The provider had taken steps to make sure people at the home were protected from staff who were unsuitable to work with vulnerable people by carrying out thorough background checks.

We found the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and promote their health and wellbeing.

During our visit we found people’s privacy, dignity and independence were respected. We spoke with several people who used the service and their relatives. They said staff respected their privacy and dignity. They told us staff were “very friendly” and “hospitable.” One person told us, “All the staff are professional….they’re also hard working and very kind to new people like me getting used to being here.”

We found care and treatment at the home was planned and delivered in a way which ensured people’s safety and welfare. One person said, “It feels like they know me very well and I would say I’m very well cared for.”

We looked at the way medication was handled at the home. We found people were protected against the risks of unsafe use or management of medicines because the provider had appropriate arrangements in place.

We found staff received appropriate professional development. People told us they were happy with the support they received from staff. One relative said, “The staff have a very good approach to people here.”

People who used the service, their representatives and staff were asked for their views about the care and treatment offered. We saw their responses were acknowledged and acted on. When we spoke with people at the home they said their care was “just what they expected” and they were “happy with the help from staff.”

We spoke with three people who use the service and asked about their medicines. They all told us that they were happy with the care they received and all said their medicines were handled safely.

We visited this location on a weekday and were able to talk to eight users of service. We were told that ‘staff are great and speak to us with respect’, and that ‘this is a lovely home’ and that people can ‘get involved if they want or they’re left alone if they want.’ People who used the service said that they ‘feel safe’ and they confirmed that they knew how to discuss issues and with whom. People who used the service said that staff were well trained and they were confident in how they gave care - they told us that they believe this leads to a ‘relaxed and comfortable atmosphere.’

The inspection took place on 26 and 27 October 2015 and was unannounced. This meant the provider or staff did not know about our inspection visit.

We previously inspected Lindisfarne Newton Aycliffe care home on 5 September 2013, at which time the service was compliant with all regulatory standards.

Lindisfarne Newton Aycliffe is a residential home in Newton Aycliffe providing accommodation for up to 56 older people who require nursing and personal care. There were 55 people using the service at the time of our inspection.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The registered manager was on leave during our inspection but a deputising senior carer was able to assist us as we conducted the inspection, along with the regional manager and proprietor.

We found the service to have comprehensive risk management processes in place, protecting people against a range of risks. The registered manager had undertaken unannounced night-time visits to the service to assure the safety of people who used the service.

Whilst there was a consensus that staff faced a challenging workload when there were unexpected absences, we found there were sufficient numbers of staff on duty in order to meet people’ needs. All people and relatives agreed that staff were attentive and put the needs of people first. We saw call bells were responded to promptly and that staff were calm and patient in their interactions with people.

All staff were trained in core areas such as safeguarding, health and safety, moving and handling, infection control, person-centred care, mental capacity, as well as additional training tailored to the needs of people who used the service, for example dementia. Staff displayed a good knowledge of these subjects when questioned in detail. The service had a training matrix in place to track when staff had attended training courses and when refresher training was due.

We found that the management, administration, storage and disposal of medicines was safely carried out and adhered to National Institute for Health and Care Excellence [NICE] guidelines. Where we identified areas that could be improved the service responded promptly.

The service had a dignity champion in place and we saw regular observations across all floors had been undertaken. The outcomes of this process did not feature in staff meetings or management consideration and this was an area the service could improve on. A significant majority of people, relatives and healthcare professionals agreed that the service was effective in their management of people’s healthcare needs.

All people who used the service we spoke with, relatives and visiting healthcare professionals agreed staff were caring.

There were comprehensive pre-employment checks of staff in place and effective staff supervision and appraisal processes, with staff confirming they felt supported by senior management.

The service was clean. We saw that a recent visit by an infection control team had raised no significant areas for improvement and that regular checks were in place to sustain high levels of cleanliness.

People told us they enjoyed the food and we saw that menus were varied and people had choices at each meal as well as being offered alternatives if they did not want the planned options. Mealtimes we observed were sometimes calm and unhurried although in one dining area the atmosphere was more hurried with loud music playing. We saw that the service had successfully implemented a tool to manage the risk of malnutrition and people requiring specialised diets were supported.

Person-centred care plans had recently been established and documents to ensure people’s life histories, likes and dislikes were incorporated into their care planning. Regular reviews ensured people’s medical, personal and nutritional needs were met. The service did not have a consistent approach with regard to involving relatives in these reviews where that was a person’s preference, and this was an area they agreed to improve.

The service had an activities co-ordinator in place and a range of communal spaces suitable for group activities or for families to have quiet time with their relative. Not all people who used the service had their preferences considered or acted on and we found the service did not proactively plan activities with people’s preferences in mind.

The service had a range of quality assurance, auditing processes and policies and procedures to deal with a range of eventualities. Emergency evacuation plans and maintenance of the premises were up to date.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. DoLS are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. The regional manager and staff we spoke with were knowledgeable on the subject of DoLS and we saw that appropriate documentation had been submitted to the local authority.