Lincoln House is registered to provide accommodation and nursing care for up to 60 people some who may be living with dementia. The service is split into two areas, a nursing wing and a residential wing.

This unannounced inspection took place on 27 September 2016.

At the last comprehensive inspection on 11 and 12 November 2015 the overall rating for the home was requires improvement. Improvements were needed to make the home safer, effective, responsive, caring and well led. We asked the provider to take action to make improvements to the assessment and monitoring of the service. During this inspection we found improvements had been made.

There was a registered manager in post at the time of this 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.

People told us that they felt safe living in the home and they were cared for by staff in a respectful and dignified manner. Their rights to privacy and expressing their views and opinions were respected and supported. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe.

Staff had received training, which was regularly updated in order to enable staff to provide care in a way which ensured that people's individual and changing needs were met. Staff knew how to manage any identified risks and provided the care needed as described in each person's care record.

People’s health, care and nutritional needs were effectively met. People were provided with a varied, balanced diet and staff were aware of people’s dietary needs. Staff referred people appropriately to healthcare professionals. People received their prescribed medicines and medicines were stored in a safe way.

There was a warm and welcoming atmosphere in the home and staff worked closely with people and their families to ensure each person was supported to maintain their individual interests and to have a meaningful and enjoyable life. In addition staff provided a varied programme of activities for people who wished to participate in them.

The registered manager ran the home in an open and inclusive way and encouraged people, their relatives and staff to speak out if they had any concerns. The registered manager and deputy manager listened and took action to resolve any issues or concerns identified. More formal systems were also in place for handling and resolving formal complaints.

The provider and registered manager worked together as a team in order to regularly assess and monitor the quality of all the services provided. This approach ensured that any shortfalls in quality would be quickly identified and actions take to improve and develop the services people received.

This inspection was unannounced and took place on 11 and 12 November 2015.

Lincoln House Care Home is a service that provides accommodation and care for up to 60 older people, some of whom may be living with dementia. The service is split into three areas, a nursing wing, a residential wing and it also has three intermediate NHS beds. On the day of the inspection there were a total of 51 people living at the home.

There was a registered manager employed at the home. 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 and associated Regulations about how the service is run.

People who lived at Lincoln House Care Home felt safe and were happy living there. Relatives were also happy with the standard of care that was being provided and most people we spoke with recommended it as a place to live.

People were cared for by kind, caring and compassionate staff who listened to people and made them feel valued. However, there were not always enough staff to support people which resulted in some having to wait for long periods for assistance. This on occasion, compromised their dignity. Not all people’s medicines were being managed safely.

Most people’s preferences on how they wanted to be cared for were being met and people had a choice about the care they received and how it was delivered. People were asked for their consent by the staff before they started a task. However, the staff had a limited knowledge about how to provide care to people who lacked capacity to make their own decisions in line with the principles of the Mental Capacity Act.

The equipment that people used had been well maintained and risks to the safety of the premises were managed well. People had access to a choice of food and drink however, some people’s risk of not eating or drinking were not being managed effectively to make sure that they received sufficient food and drink to meet their needs.

People were provided with a number of different activities to complement their hobbies and interests and any complaints made were investigated. The staff felt supported in their roles and were able to raise any concerns to the management team without fear of recriminations.

A number of improvements had been made recently to the home. The registered manager had plans in place to continue to make improvements to the quality of care that people received. However, some systems that were currently in place to monitor the quality of service given were ineffective which meant that people had or were at risk of experiencing poor care.

There are some breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and you can see what action we have told the provider to take at the back of our report.

We have made recommendations regarding following the principles of the Mental Capacity Act 2005 when making ‘best interest’ decisions on behalf of people.

We spoke with four people using this service about the food on offer. One person told us "I could not fault the food here at all" and a second person told us "The food is mostly to my liking". Other comments received included "I always enjoy my meal, there is a good variety offered" and "....it's lovely...there is always enough for me".

Medicines were prescribed and given to people appropriately. We reviewed the medication administration records for 10 people using this service. We saw that medication was appropriately documented and each dose signed for by a member of staff who had received training on administering medication.

There were effective recruitment and selection process in place. During our review of staff files we saw that an application form was completed by prospective employees followed by a face to face interview prior to their selection for employment. We also found that references were sought from previous employers and prospective staff members were asked to provide details of their relevant qualifications, skills and experience.

During our inspection in December 2012 we found that the people living in the residential unit of this home were at risk of receiving care which did not meet their needs as accurate records about them were not being maintained. We checked to see that improvements had been made. We found that they had.

People we spoke with told us that “staff were respectful” and that their privacy and dignity had been maintained. One person told us, “They [the staff] always make me feel comfortable” and another person told us, “I am aware of the information that is held about me, but the nurses keep hold of that.” A third person spoken with told us that the staff were very respectful during the morning. They commented that, “They come in and ask me if I am ready to get up and they always warn me that the lights are going on.”

Whilst we were speaking with two of the people they required assistance. They used the call bell system to request help for a member of staff. We waited in each case and observed that people were not left waiting, the staff responded promptly.

Our observations of the home demonstrated to us that it was clean, mostly free from any unpleasant odours and that infection control practices were in place. For example, we observed staff wearing disposable gloves and aprons.

We reviewed details of a recent complaint made by a relative of one of the people living in the home. We saw that the relative had been responded to in a timely manner and that they had confirmed to the home, by e-mail, that they were fully satisfied with the actions taken.

However, we are not confident that people living on the residential unit were protected from risks to their health and wellbeing because accurate records about their care needs were not in place

During our visit to Lincoln House on 01 November 2011 we spoke with seven people in private and a further five within various lounges, including their visitors.

The majority of people expressed positive comments regarding the care and support they receive at Lincoln House such as, "We get a good varied menu, and they ask me every day what I would like, I now have to watch my weight".

"It’s like living in a hotel, the girls are very helpful, even when they are busy, they come and tell me that they won't be long and they never are."

"Lovely place, staff are wonderful."

However, not everyone was happy all of the time with comments such as, "The porridge is sometimes cold" and "I would like some smoked fish occasionally".

One visitor told us, "the biscuits are the cheap variety and sometimes it would be nice to have the luxury ones".

One person told us, "I see the nurse each day and we speak about my care I've seen my care plan and read what is written, they are very supportive towards me".

Another person commented about the activities that are now offered to people, "I have a copy of the month's arranged activities in my room and can choose which ones to go to. I enjoy the gardening, and reading times, because that’s what I enjoyed at home."

Overall, there was a high proportion of positive comments and these, plus the negative comments, were fed back to the owner to act upon.

After speaking with people and staff, we spoke with the owner and lead nurse and checked five outcomes that support the care and welfare of people, their safety and looked round the premises, and checked how the service monitors the views of people living in the home.