This comprehensive inspection was unannounced and was conducted on 22 and 23 May 2017.

Lindsay House is located on Parbold Hill within the county of Lancashire, and is run by Akari Care. It is a two storey building, which was previously used as a vicarage. All rooms are of single occupancy. However, shared accommodation can be arranged, if required. Some bedrooms have en-suite facilities, although communal toilets and bathrooms are available. There is dedicated access for wheelchair users and a passenger lift is installed. Support is provided for up to 31 people, who require help with personal care needs. At the time of our inspection 26 people were living at Lindsay House.

The registered manager was on duty when we visited Lindsay House. 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 of the Health and Social Care Act and associated regulations about how the service is run.

During our previous inspection, 13 July 2015, we found that the service was in breach of regulation, and that improvements were needed in relation to risk assessments, care planning, infection control and quality assurance. The service was required to make improvements in relation to the effective use of infection control measures, better risk assessment and quality assurance processes, and more effective staff deployment so that people’s needs were always met. During this inspection, we found that improvements had taken place.

People and their relatives were happy with their care. They spoke highly of the staff, who treated them with kindness and respect. The planning of people’s care was based on an assessment of their needs, with information being gathered from a variety of sources. We found that assessments had been conducted and people’s needs had now been included in the risk assessment process and clear information was provided for the staff team. People had the care they needed. Care plans had improved, and were devised to address people's individual needs and were regularly reviewed.

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 understood how people's care was to be provided. Care was provided with people's consent, either verbally or more formally when needed in line with best interests decisions that met the requirements of the Mental Capacity Act 2005. Where necessary, applications had been made under the Deprivation of Liberty Safeguards. Where deprivations of liberty had been authorised with conditions, these were met.

People's nutrition and hydration needs were met. Food was attractively presented and special dietary requirements were catered for. Where there were concerns about unplanned weight loss or swallowing difficulties, the appropriate action was taken to address these, including pursuing referrals to the relevant health professionals.

People were supported with their health needs and had access to the relevant health professionals, such as GPs and district nurses. Medicines were managed safely and people had their medicines as prescribed. People were protected against avoidable harm and the risk of abuse. The premises and equipment were clean and well maintained. Risks associated with the building were now robustly assessed and the necessary action taken to manage these. The systems relating to the use of the laundry were now safe and clean and soiled were kept separate, and the laundry was clean and tidy. Litter bins were now provided and used appropriately.

People's individual risks, such as risks of malnutrition, pressure sores and falling, were assessed and managed through their care plans. Accidents and incidents were monitored for any further action that was necessary

During the course of this inspection we gathered evidence against the outcomes we inspected, to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with those using the service, their relatives and support staff and from looking at records. Many of those using the service were unable to communicate with us verbally. However, we were able to speak with five of them, who gave us positive responses to the questions we asked. If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People we spoke with told us they felt safe living at Lindsay House and their dignity was always respected. Systems were in place to help managers and the staff team to learn from untoward incidents, such as accidents and safeguarding concerns. This helped the service to continually improve. Care and support was provided in a safe manner. People living at the home (or their relatives) were involved in making decisions about the care and support provided.

At the time of our visit to this location, we toured the premises and found the environment to be fit for purpose. It was safe, clean and hygienic. Equipment was well maintained and serviced regularly. Therefore, people were not put at unnecessary risk. Recruitment practices were robust, which helped to ensure new staff were suitable to work with this vulnerable client group.

Is the service effective?

People were consulted before any intervention was provided and their consent was obtained for specific areas of care and support. There was an advocacy service available. This meant that when required, people could access additional support, if they needed it. The health and personal care needs of those using the service had been thoroughly assessed, with a range of people involved in their care and support. Specialist dietary needs had been identified, where required. Systems were in place to ensure the service was effectively assessed, so the quality of service provided could be consistently monitored. The premises had been sensitively adapted to meet the needs of those with mental health disabilities. Visitors confirmed they were able to see people in private and visiting times were flexible.

Is the service caring?

We asked those living at the home about the staff team. Feedback from them was very positive. They said staff were kind and caring towards them and helped them to meet their needs. When speaking with staff it was clear they genuinely cared for those they supported and were observed speaking with people in a respectful and friendly manner.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. One person commented, "The staff are extremely approachable. Nothing is too much trouble. They help me to have a bath, but I can more or less dress myself." Another told us, "It is marvellous here. They (the staff) are just wonderful."

Is the service responsive?

Staff were observed responding to people well by anticipating their needs appropriately.The service worked well with other agencies and services to make sure people received care and support in a consistent way.

Evidence was available to show the home responded well to any suggestions for improvement and appropriate action was taken to rectify any shortfalls identified.

A system for recording and monitoring complaints was in place. Those we spoke with told us they would know how to make a complaint, if they needed to do so. One person living at the home told us, "I did have an issue once that upset me, but Lyndsay (the manager) sorted it out for me. She has told me that if I ever have a problem or if I am upset about something, I must go straight to her and she will deal with it."

Is the service well-led?

People's assessed needs were fully met by a well managed staff team. Staff spoken with had a good understanding of their roles. They were confident in reporting any concerns, in accordance with the complaints policies of the home. They felt well supported by the managers of the service.

The service had a robust quality assurance system in place and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result, the quality of service provided was continuously monitored. People living at Lindsay House and their relatives completed annual satisfaction surveys. Where shortfalls or concerns were raised these were taken on board and dealt with appropriately.

People we spoke with all said they could get up and go to bed when they wanted. One person also said, “I can get what I want to eat, even if it’s not on the menu for the day.”

We asked people living in the home and some of their relatives if people felt safe and whether their needs were met. One person said, “The staff are very good and know what I like and don’t like.”

We ate lunch with people living in the home and found the food to be of a high standard. Food was freshly cooked and was tasty and nutritious.

We spoke to people living in the home about their medication. One person told us, “I get my pills when I need them; there are a lot to keep on top of.”

People we spoke with who lived in the home and their relatives said that staff were able to provide the support required to meet people’s individual needs.

We spoke with people and their relatives about opportunities they had to feed back to the home. We were told that the home always had someone available to answer any questions.

Not all people living at the home thought the staff were always nice. One said, “Most of the staff are ok but some can be quite snappy”.

Some relatives we spoke to had concerns about their family members support needs increasing.

People we spoke to living in the home thought they were kept safe. One person said, “They are very good with me”. A relative of someone living in the home said, “I am very confident in the staff and the manager”.

People we spoke with liked the building and thought it was designed well as a care home. One person living in the home said “I like it here, it’s comfortable and I can get around”.

The majority of people we spoke to said all the staff were really nice.

Relatives we spoke with had taken part in surveys and said that any issues they had raised were resolved.

This comprehensive inspection was unannounced and was conducted on 13 July 2014.

Lindsay House is located on Parbold Hill within the county of Lancashire. It is a two storey building, which was previously used as a vicarage. All rooms are of single occupancy. However, shared accommodation can be arranged, if required. Some bedrooms have en-suite facilities, although communal toilets and bathrooms are available. There is dedicated access for wheelchair users and a passenger lift is installed. Support is provided for up to 31 people, who require help with personal care needs. At the time of our inspection 21 people were living at Lindsay House.

We last inspected this location on 23 April 2014, when we found the service to be compliant with all regulations we assessed at that time.

The registered manager was on duty when we visited Lindsay House. She had worked at the home for 15 years, but had managed the day-to-day operation of the service for nine years. 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 of the Health and Social Care Act and associated regulations about how the service is run.

During this inspection we found that the premises were not safe throughout. During a tour of the home we identified a number of hazards including a number that could have been avoided. In addition, improvements to some areas of the home were needed.

The planning of people’s care was based on an assessment of their needs, with information being gathered from a variety of sources. Although a range of assessments had been conducted people’s needs had not always been included in the risk assessment process and some contradictory information was provided for the staff team.

We found that the registered person had not protected people against the risk of unsafe care or treatment, because records provided some conflicting information and areas of potential health risks were not always well recorded.

We found that arrangements to control the spread of infection were not always effective and that good infection control practice was not consistently followed.

We found that the quality monitoring systems were not always thorough enough to identify and address potential risks to the health, safety and welfare of those who lived at Lindsay House.

Because of additional responsibilities, such as laundry and domestic duties, which care staff were expected to complete each day, the safety and well being of people who lived at the home was being potentially compromised.

Staff members were well trained and those we spoke with told us they received a broad range of training programmes and provided us with some good examples of modules they had completed. They confirmed that regular supervision sessions were conducted, as well as annual appraisals.

They were confident in reporting any concerns about a person’s safety and were competent to deliver the care and support needed by those who lived at the home. The recruitment practices adopted by the home were robust. This helped to ensure only suitable people were appointed to work with this vulnerable client group.

Equipment and systems had been serviced in accordance with the manufacturers’ recommendations, to ensure they were safe for use. This helped to promote people’s safety.

People were helped to maintain their independence. Staff were kind and caring towards those they supported. Assistance was provided for those who needed it in a dignified manner and people were enabled to complete activities of daily living in their own time, without being rushed.

The management of medications, in general promoted people’s safety. Medication records were well maintained and detailed policies and procedures were in place.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for person-centred care, safe care and treatment, staffing and good governance.

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