Lindisfarne Chester-Le-Street Nursing provides accommodation for up to 53 people who require nursing and person care. At the time of inspection there were 39 people using the service, 38 of whom required nursing care. The home has two floors; both floors have bedrooms, lounges and dining rooms.

At the last inspection, the service was rated as ‘Good’ overall. We found a breach of Regulation 12 (Safe care and treatment); of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and asked the provider to make improvements in relation to maintenance. During our inspection we found the improvements had been made.

The service had a registered manager in post. 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 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.

People received their medicines in a safe manner. We found there were appropriate arrangements in place for the receipt, storage and disposal of people’s medicines.

We observed staff respond promptly to meet people’s needs. Staff told us there were enough of them on duty to give people the support they needed.

Staff had assessed the risks to individual people living in the home. Risks assessments documented the nature of each risk and the actions staff were expected to mitigate the risks.

People were given a choice of menu each day. Staff supported people to eat where necessary and provided prompts to others to encourage them to eat. People’s personal weights in the home remained stable. We saw if a person had lost weight action was taken so they could be reviewed by a dietitian.

Partnership arrangements were in place with local GPs and a Community Psychiatric Nurse who both visited the home on a regular basis to review people’s health care needs. The services of chiropodists, opticians and the Speech and Language Therapy (SALT) Team were sought by staff to ensure people’s needs were met.

We found staff were caring and respectful towards people who lived in the home. Personal care was carried out behind closed doors to protect people’s dignity and privacy.

Care plans were detailed and person centred. Staff demonstrated they knew people well and gave us information about people living in the home. We saw care plans were reviewed each month to ensure they were accurate and up to date.

Complaints made about the home had been investigated by the manager and appropriate responses were given to the complainants.

The registered manager and the two regional managers who supported the service regularly audited the service and addressed any deficits they found. The audits included visits by the registered manager during the night to monitor the service provided. A remedial action plan was kept by the registered manager. When an improvement was identified this was added to the plan; target dates for actions were set and the improvements were made.

Further information is in the detailed findings below.

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 relative told us, “I wanted my (relative) to move somewhere near to where I lived. I looked around here, talked to the manager and social worker to make sure they were suitable...and I think the staff here have made an excellent job of looking after him.”

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, “I think this is a good place to live, very nice. These (staff) keep everything ship-shape.” One visitor told us, “I’m very happy with the care and support my (relative) gets from staff at this home. They all know my (relative) very well and can tell straight away if he’s out of sorts, and they get onto it straight away.”

The provider had not followed their procedures to protect vulnerable people and did not respond appropriately to an 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.

People’s personal records had not been reviewed by the provider to make sure they were accurate and fit for purpose.

During our visit we spoke with people who used the service and with their relatives. They said staff respected their privacy and dignity. They told us staff knocked on their bedroom doors before entering and were polite in the way that they were talked to.

One person said, “I’m happy here, my family helped me to choose this one.”

People at the home said that they felt involved in decisions about their care.

One person told us, “I make sure I get what I want.”

People said that the home was kept clean and hygienic.

One person told us, ”Cleaners are always pottering about doing something”

People at the home were happy with the support they received from staff. One person said, “Staff make sure that everyone is looked after.”

When we visited the home we found that some people were unable to tell us directly about their experiences and views of their care. However, we did talk to relatives that were visiting and saw staff practices as they worked with people to meet their needs.

When we spoke with some of the relatives of the people living at the home they told us that they felt their relatives were treated well. One relative told us, “The staff are very caring and obliging.” Another relative said, “They’re so nice here and do what they can for you.”

We also asked relatives about what they thought about the care provided at the home. They told us they were generally happy with the standard of care, and one relative told us “It’s pretty good here.”

Relatives told us that they thought that the home was usually clean. One relative said, “It’s very rare that there is a bad smell when you come in here.”

When asked if there were any improvements they would like to make to the home three relatives mentioned the laundry and problems related to their relative’s clothes going missing. One relative told us, “Lots of things get lost.” Another relative said, “I don’t know how they manage to lose so many things, everyone has their name on everything that is washed, they are washing a lot though.”

Relatives told us that the service sometimes felt short staffed. One relative told us, “80% of the time its fine, however sometimes they’re short of staff.” Another relative said, “It’s pretty good here, a few changes could be made here and there. When people are off there is a shortage, they need more staff.” A third relative said, “The staff that are here are excellent, but sometimes there just don’t seem to be enough, and people are sometimes left for a while if they need the toilet.”

We inspected Lindisfarne CLS Nursing on 23 and 24 April 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

Lindisfarne CLS Nursing provides nursing and personal care for up to 56 service users. The home is arranged over two floors, both of which cater for people with dementia type illness with the first floor providing services for males only. At the time of the inspection 19 people lived at the home.

At the inspection in October 2014 a new manager had been in post for several weeks. At this inspection we found they had now successfully become the 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 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.

At our inspection carried out in July and August 2014 we found the home was in breach of the following:

• Regulation 9, Care and welfare of service users,
• Regulation 11, Safeguarding service users from abuse,
• Regulation 12, Cleanliness and infection control,
• Regulation 15, Safety and suitability of premises,
• Regulation 20, Records.

The provider was issued with a Warning Notice in respect of each of these areas. We followed these up at an inspection in October 2014 and found that the provider continued to fail to meet these regulations. We also found that the home was failing to meet regulations 10 (Assessing and monitoring the quality of service provision); 17 (Respecting and involving people who use services); 18 (Consent to care); 19 (Complaints); 21 (Requirements relating to workers); 22 (Staffing); and 23 (Supporting staff) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The provider has also failed to ensure a registered manager was in post since 30 September 2013.

At this inspection we reviewed the action the provider had taken to address the above breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found that the provider and registered manager had made significant improvements to the way the care and treatment was delivered and the overall operation of the home and these had led to the home meeting the above regulations.

During the inspection we found that the provider had commenced a range of processes designed to monitor and assess the on-going performance of the home, such as audits. We found that this review had led to action plans being developed. We saw that the processes that had been introduced had the potential to be effective in sustaining on-going compliance with the regulations but had not been in operation long enough to confirm this would be the case.

We found that the building was very clean and was being maintained. A designated infection control champion was in post and we found that all relevant infection control procedures were followed by the staff at the home. We saw that audits of infection control practices were completed. Action was needed to make sure staff were adept at identifying issues such as when mattresses needed replacing and when repairs needed to be completed as a matter of priority.

Staff had a greater understanding of the requirements of the Mental Capacity Act 2005 but had not fully introduced either the principles or the appropriate documentation into the home. They had requested Deprivation of Liberty Safeguard (DoLS) authorisations when appropriate. However the nursing staff needed to ensure capacity assessments were completed in line with the Mental Capacity Act 2005 code of practice.

We found that the registered manager had worked closely with staff to ensure they provided care and treatment that was effective. We saw that all interactions between staff and the people who used the service were extremely person-centred and supportive. We found that this had led to significant improvements in individual’s experience and their presentation so much so that, for the first time since July 2014, we were able to hold long conversations with people who used the service. This change meant we could talk with people about their care. People and relatives told us that they were now extremely happy with the service.

People were consistently engaged in a range of meaningful activity and occupation throughout the day and we heard from visitors that this was now usual for the home. Relatives told us that they were now extremely impressed with the care being provided and thought the home was providing an excellent service.

We found that care records now reflected the treatment people received and staff routinely ensured, when necessary individuals were referred to external health care professionals.

Staff took action to monitor people’s weight and ensured they were provided with sufficient food and fluid. The cook designed menus that were nutritious and offered a range of alternatives including fortified meals for people who were at risk of losing weight.

People told us they were now very confident that should they have a complaint this would be fully investigated and resolved to their satisfaction.

The registered manager and provider had reviewed and updated all of the records maintained at the home such as care records, audits, policies and training information. We found that records such as staff files and training records had been reviewed these provided accurate information and were very informative. We found that staff were appropriately recruited and had received a wide range of training including condition specific training such as a number of courses related to supporting people with dementia.

Medication practices had improved and were in line with expectations.

People and the staff we spoke with told us that there was enough staff on duty to meet people’s needs. They found the staff worked very hard and were always busy supporting people. They now worked in partnership with the people who used the service. We found information about people’s needs had been used to determine that this number of staff could meet people’s needs. We noted that the provider’s calculation would allow for additional staff to be on duty at peak times and the manager undertook to provide additional staff during peak times.

When we concluded our inspection the provider had resolved the breaches of regulations identified at the last inspection. We found that action was needed to address aspects of one regulated activities regulations 2014, of the Health and Social Care Act 2008. You can see what action we told the provider to take at the back of the full version of the report.