This inspection took place on 22 August 2018. The inspection was unannounced, which meant that the staff and provider did not know we would be visiting.

Linthorpe Nursing Home accommodates up to 28 people in one adapted building set across two floors. At time of our inspection there were 20 people using the service.

Linthorpe Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

When we inspected the service the manager was going through the process of becoming a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered person’s'. 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.

Linthorpe Nursing Home was last inspected in January 2018 and was rated overall as Inadequate. We identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were related to need for consent, safe care and treatment, premises and equipment, good governance, fit and proper persons employed and staffing.

Following the inspection in January 2018 we asked the provider to complete an action plan to show what they would do, and by when, to improve. We received an action plan from the provider which set out a timeframe for making improvements in all of the key questions. At this inspection we found improvements had been made and many of the concerns we had identified at the previous inspection had been addressed. The service has however, continued to remain in breach of two regulations relating to safe care and treatment and good governance. You can see what action we have asked the provider to take at the back of the full version of this report.

During this visit we identified that some important safety checks and assessments had not been carried out. Including those to prevent legionella and risk assessments in relation to people and staff.

We found some risk assessments for people and for tasks carried out by all staff had not been completed.

This is a breach of Regulation 12 of the Health and Social Care 2008 (Regulated Activities) Regulations 2014 related to Safe care and treatment.

The provider’s governance system was not robust. The manager carried out a range of audits however there were no records available of quality assurance audits carried out by the provider or their representative.

This is a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to Good governance.

Whilst medicine systems had improved greatly we found there were still some gaps in systems and recordings.

Equipment and premises checks were undertaken to help ensure the environment was safe. We have made a recommendation about window safety within the building.

Infection prevention and control practices were followed by staff to reduce the risk of infection spreading. Contingency plans were in place to deal with emergency situations.

Policies and procedures were in place to protect people from harm such as safeguarding and whistleblowing polices. Staff knew how to identify and report suspected abuse. People and their relatives told us they felt the service was safe.

There were suitable numbers of staff on duty to ensure people’s needs were met. Safe recruitment practices were in place. Pre-employment checks were made to reduce the likelihood of employing staff who were unsuitable to work with vulnerable people.

The manager had ensured that staff were scheduled to have or had received training to be able to carry out their role.

Staff were supported through regular supervision and an annual appraisal.

Learning

This inspection took place on 8 and 9 January 2018 and was unannounced. This meant the staff and the provider did not know we would be visiting.

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

Linthorpe Nursing Home accommodates up to 28 people in one adapted building across two floors for people with residential and nursing care needs. On the days of our inspection there were 21 people using the service.

The home had a registered manager in place. A registered manager is a person who has registered with 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 not present during our visit however the deputy manager was present and was acting as manager at the time of the inspection.

Linthorpe Nursing Home was last inspected by CQC on 25 May, 6 and 17 June 2016 and was rated Good.

At this inspection, we found the provider did not have the oversight needed to ensure people continued to receive good care. They did not have a robust quality assurance system in place and did not gather information about the quality of their service from a variety of sources. Audits and quality assurance systems did not always identify shortfalls in the requirements of the regulations being met.

Care plans did not reflect a reasonable standard of assessment, planning, implementation and evaluation of care and as a result were not person-centred. People did not have access to meaningful activities in the home or within the local community which reflected their personal preferences and interests. The provider had a complaints policy in place however did not record complaints.

Effective recruitment and selection procedures were not in place and the provider did not carry out relevant checks when they employed staff. Staff used a range of assessment and monitoring tools however these were not always consistently or accurately completed.

Staff mandatory training was not up to date and staff did not receive regular supervisions and an annual appraisal. This meant staff were not support to carry out their roles effectively.

The provider did not have a good understanding of their legal responsibilities with regard to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and staff had not received training in the MCA and DoLS.

There were sufficient numbers of staff on duty in order to meet the needs of people using the service. However we have made a recommendation the provider implements a dependency tool to support staffing levels. Staff demonstrated a good awareness of safeguarding. Medicines were safely administered however the procedures for managing medicines needed to be improved.

People had access to food and drink throughout the day and we saw staff supporting people at meal times when required. People had access to healthcare services and received ongoing healthcare support.

The layout of the building provided adequate space for people with walking aids or wheelchairs to mobilise safely around the home. Facilities included twelve en-suite bedrooms, several lounges, a dining room, communal bathrooms, shower rooms and toilets and a large communal garden. Entry to the premises was via a locked door and all visitors were required to sign in. The service was clean and tidy.

People who used the service and their relatives were complimentary about the standard of care at Linthorpe Nursing Home. We saw staff supporting and helping to maintain people’s independence. People were encouraged to care for themselves where possible. Staff treated people with dignity and r

This inspection was unannounced and the visits took place on 25 May, 6 and 17 June 2016. The staff and registered provider did not know that we would be visiting.

Linthorpe Nursing Home is registered to provide personal and nursing care for up to 28 older people. The home has bedrooms across the two floors. There are two lounges, a dining room, and a small room where people could sit and read. Linthorpe Nursing Home also had the benefit of an enclosed landscaped garden. At the time of our inspection there were 28 people living at the home.

There was a registered manager in post. 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.

People told us they were happy and felt safe. We heard how people felt the home was extremely well-run and that the registered manager was extremely effective.

We found that a range of stimulating and engaging activities were provided at the home. There were enough staff to support people to undertake activities in the community. People were supported to go out independently. The registered provider and registered manager had recently installed a chicken coop in the garden and this was a great focal point for people.

People’s care plans were tailored for them as individuals and created with them and their family involvement. People were cared for by staff that knew them really well and understood how to support them. We observed that staff had developed very positive relationships with the people who used the service. The interactions between people and staff were jovial and supportive. Staff were kind and respectful. We saw that they were aware of how to respect people’s privacy and dignity. Staff also sensitively supported people to deal with their personal care needs.

Staff were supported and had the benefit of a programme of training that enabled them to ensure they could provide the best possible care and support. Staff were all clear that they worked as a team and for the benefit of the people living at Linthorpe Nursing Home. Their comments and feedback fed into the continuous improvement of the service.

The registered manager understood the complaints process and detailed how they would investigate any concerns. They also told us about situations such as people’s treatment in hospital where they had raised complaints on individual’s behalf.

The registered manager and staff had a clear understanding of safeguarding. The registered manager acted as a champion for people and would raise complaints and safeguarding matters when this was needed. One person and their family told us how grateful they were that the registered manager had taken up their corner and ensured action was taken to improve their experience of care. The registered manager also spoke with the safeguarding team at all stages and regularly checked that they were taking appropriate action to deal with any concerns. Also when necessary they took additional action to ensure staff who were not fit to work with people were barred from working in the health and social care field.

People who used the service and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. The registered provider and registered manager had closely considered people’s needs and ensured there were sufficient numbers of staff. For the 28 people using the service there was routinely a nurse, a senior carer and five to six care staff on duty during the day and then a nurse and three care staff overnight.

Where people had difficulty making decisions we saw that staff worked with them to work out what they felt was best. Staff understood the requirements of the Mental Capacity Act 2005 and had appropriately requested Deprivatio

We used the information we gathered under the outcomes we inspected to answer our five 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 people using the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

People were treated with respect and dignity by the staff. People told us they were listened to. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made, and how to submit one. This meant that people would be safeguarded as required.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

The registered manager sets the staff rotas, they took people’s care needs into account when making decisions about the numbers, qualifications, skills and experience of staff members required. This ensured that people’s needs were met.

Recruitment practice was safe and thorough. No staff had been subject to disciplinary action. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

People’s health and care needs were assessed with them and their relatives, and wherever possible they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. The care plans were reviewed monthly as well as when needed to reflect people's current needs.

Visitors confirmed that they were able to see people in private and that visiting times were flexible allowing them to come and go as they please.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, “I could not ask for better”, “It is a wonderful place” and “They could do nothing better”. A relative said, “My mother is spoilt”.

People using the service and their relatives, completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed with an action plan, however the action plan needed to be more robust to show what action is needed, who was responsible for the action and when the action should be completed by.

People who used the service had their problems such as anxiety and mobility recorded in their care plans, with a goal and how they were going to achieve this goal, these were updated on a monthly basis or as needed.

Is the service responsive?

People knew how to make a complaint if they were unhappy although no one asked had made a complaint. We looked at how these complaints had been dealt with, and found that the responses had been open, thorough, and timely. People can therefore be assured that complaints were investigated and action was taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system, records viewed showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

During the inspection we spoke with eight people who used the service and two relatives. We also spoke with the manager, a registered nurse, the administrator, the handyman, kitchen staff and a care assistant. People told us that they were happy with the care and service received. One person said, “It’s just like having my own flat but even better because I get fed and well looked after.” Another person said, “This is a lovely place with friendly and caring staff.”

We were able to observe the experiences of people who used the service. Staff were attentive and interacted well with people. We saw that people had their needs assessed and that care plans were in place.

We asked people about the food that was provided. People confirmed that that they were always offered a choice of food and drink at each meal time. People said that the portion sizes were good. One person said, “The food is good. I’ve put on loads of weight.”

We found medicines were safely handled.

We saw that the service had appropriate medical and non-medical equipment. We saw that regular checks and servicing of equipment had been undertaken to ensure that it was in safe working order.

We found there was an effective complaints system in place at the home.

During the inspection we spoke with four people who used the service and one relative. People who used the service expressed satisfaction with the care and service that they received. Comments made by people who used the service included:

"The staff are always so pleasant. They always seem to have a smile on their face even though they are always busy. Even when they are busy and I ask for a cup of tea they down tools and make me one."

"The food is lovely I had pie, chips and peas today. The meals are different every day."

"To me it's like a second home. The staff are so friendly and they look after me well. I have my own room, feel safe and I sleep better."

"They look after me well."

"I get up at about 8am but like to go back to bed at about 2pm to have a little rest. I then get back up for tea. The staff are very good."

The relative spoken with during the inspection said, "The staff and the care are just so good." and "He/she is just so well looked after. Since moving from a residential care home to a nursing home he/she has needed much less hospital intervention. This home can meet and manage all of his/her needs."

During the inspection we spoke with four people who used the service and one relative. People who used the service expressed satisfaction with the care and service that they received. One person said, "This is my home now and I feel good. I couldn't wish for better, the staff are brilliant, look after me well and they are on the ball with others." Another person said, "I'm happy here and the staff are great." The relative spoken with said, "The staff are very good. He/she is well looked after and it seems to be the same staff on duty. The doesn't seem to be a high turn over in staff which is good. The food is good, plenty of it and a good variety. If we visit on a Sunday we are invited to stay for lunch."

Two people spoken with during the visit informed that there was very little in the way of activities and outings. Others said that they preferred to spend time on their own.