The inspection took place on 15 March 2018 and was unannounced. This meant staff did not know we were visiting.

We last inspected the service on 18 February 2016 and rated the service as Good. At this inspection we found the service had improved to Outstanding.

St John of God Care Services Lindisfarne [usually called Lindisfarne Court] care home provides accommodation with personal care for up to 13 people. The service provides care to people with learning disabilities, acquired brain injury and physical disabilities. At the time of this inspection there were 12 people living at the home, with one person in hospital.

The service had 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.

Staff were exceptional in their caring approach to people using the service and in their support to people’s families. People and relatives we spoke with told us the staff team were dedicated and wanted the best for people they were caring for. Healthcare professionals told us of the "tireless work" the service undertook to ensure peoples' rights were upheld.

We were told of how the service had supported people, their families and other people living at the home in an extremely caring way when someone had passed away this year. The registered manager continued to involve and offer support to this person’s family by inviting them to events at the home and maintaining meaningful contact with them.

Staff went out of their way to promote dignity and respect for people. Staff took exceptional pride in ensuring people’s personal care was carried out to the highest standards. Even when people had no verbal communication and limited understanding, we witnessed staff asking permission and talking with people all the time about what they were assisting them with.

The service had used an innovative recruitment drive since our last inspection and we saw that the registered manager had built a strong and consistent staff team. The recruitment had fully involved people using the service through the whole process from being involved in flyers to advertise vacancies to informing candidates when they had been successful in post. Morale amongst the staff we spoke with was very high and people, families and the staff team spoke of the outstanding leadership by the registered manager.

The registered manager was a passionate advocate for people in terms of promoting their health and well-being with other statutory services. Many people at the service had very complex healthcare needs. We saw how they and the staff team provided person centred care for people not just whilst people were at home but also if due to health needs they required hospital services. Everyone at the service was committed to supporting people to uphold their wishes and to ensure they received the best possible care wherever they were.

The service had worked to develop excellent community links and increased community presence for people. Feedback we received from professionals was highly praising of the registered manager and staff team and demonstrated supportive joint working arrangements.

Staff and the management team understood their responsibilities with regard to safeguarding and had been trained in safeguarding vulnerable adults. People we spoke with and their families told us they felt safe at the home.

Where potential risks had been identified an assessment had been completed to keep people as safe as possible. Accidents and incidents were logged and investigated with appropriate action taken to help keep people safe. Health and safety checks were completed and procedures were in place to deal with emergency situations.

Medicines were managed safely and administere

We carried out an unannounced inspection at Lindisfarne Court on 18 and 19 February 2016.

Lindisfarne Court provides care and accommodation for 13 people who require personal care in a residential area of Darlington. The people living at the service which comprises of three purpose built adjoining bungalows, have physical and some also have learning disabilities.

We last inspected the service on 7 November 2013, the service was not in breach of any regulations at that time.

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. The registered manager at Lindisfarne Court had worked at the service for over five years.

We observed the care and support people received as due to the nature of people’s disability, some people could not communicate directly with us and we spoke with two people who could communicate directly with us. We discussed safeguarding with staff and all were knowledgeable about the procedures to follow if they suspected abuse. Staff were clear that their role was to protect people and knew how to report abuse including the actions to take to raise this with external agencies.

There were policies and procedures in place in relation to the Mental Capacity Act and Deprivations of Liberty Safeguards (DoLS). The registered manager and staff had the appropriate knowledge to know how to apply the MCA and when an application should be made and how to submit one. This meant people were safeguarded.

The staff we spoke with told us that there were enough staff on duty to meet people’s needs. We saw that six staff plus the registered manager or senior support worker routinely provided support to people during the day with three staff being available throughout the night. The service told us they had staffing issues during 2015 and tackled recruiting difficulties with an innovative advertising campaign that had led to 11 new staff being employed.

We saw that staff were recruited safely and were given appropriate training before they commenced employment. Staff had also received more specific training in managing the needs of people who used the service such as medicines training and enteral feeding. Enteral feeding refers to the delivery of a nutritionally complete feed directly into the stomach.

Medicines were stored and administered in a safe manner.

There was a regular programme of staff supervision in place and records of these were detailed and showed the home worked with staff to identify their personal and professional development.

We saw people’s care plans had been well assessed. The home had developed care plans to help people be involved in how they wanted their care and support to be delivered. We saw people were being given choices and encouraged to take part in all aspects of day to day life at the home, from menu planning to planning holidays and activities.

Staff had a good awareness of people’s dietary needs and staff also knew people’s food preferences well. We saw everyone’s nutritional needs were monitored and mealtimes were well supported. We saw from records and talking with staff that specialist advice was sought quickly where necessary not only for nutritional support but any healthcare related concerns.

We observed that all staff were very caring in their interactions with people at the service. People clearly felt very comfortable with all staff members. There was a warm and caring atmosphere in the service and people were very relaxed. We saw people were treated with dignity and respect. People told us that staff were kind and professional.

We also saw a regular programme of staff meetings where issues where shared and raised. The service had a complaints procedure and staff told us how they could

We were not able to speak to all of the people using the service because of complex mental and physical needs, which meant most were not able to tell us their experiences. However, we gathered some evidence of people’s experiences of the service by reviewing the care records and observing care practice and we spoke with four people using the service.

Care plans were written from the point of view of the person using the service and two people we spoke with told us they had been involved in writing their care plans and reviewed them.

People were supported to have their nutritional needs met. One person told us; “I like the choice you have here”.

The service had policies and procedures to ensure the safe recruitment of staff and people using the service and their families were also involved in the selection of new staff.

The service had a regular audit programme in place to make sure the service was safe and provided good quality care and support. People using the service and their families were regularly asked their views and how the service could improve.

There was a complaints process in place and people told us they could talk to the staff. One person told us they would speak up if “something was going on”.

We were not able to speak to all of the people using the service because of complex mental and physical needs, which meant most were not able to tell us their experiences. However, we gathered some evidence of people’s experiences of the service by reviewing the care records and observing care practice and we spoke with three people using the service.

Staff members on duty were observed speaking to people in a kind and respectful way.

Of the three people we spoke with, they told us;

“It’s a home from home”,

“They are a great staff team who help me with all the needs that I have”,

“I can talk to all the staff” and

“I can get up and go to bed whenever I want”.