Lindisfarne Ouston is registered to provide accommodation for people who need nursing and personal care. No one in the home at the time of our inspection required nursing care. Nursing tasks were completed by the local district nursing service. The registered provider had decided the time was right to provide accommodation for people with nursing care needs. Preparations were underway to meet these needs. The home can accommodate up to 56 people. At the time of our inspection there were 31 people using the service.

At the last inspection on 15 and 16 December 2015 we rated the service as requires improvement. During this inspection we found improvements had been made.

This inspection took place on 2 and 3 February 2016 and was unannounced

The home 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.

Staff and relatives told us they had confidence in the registered manager to run the service. Staff felt supported by the registered manager.

We found the registered manager had in place effective systems to monitor the quality of the service and ensure risks to people were reduced. They had put actions in place to improve the service and people’s well-being. A regional manager monitored the service and carried out a visit each month to follow up on actions taken and note where further improvements were required.

A staff survey had recently been carried and a relative’s survey was underway. These had been carried out to seek view’s about the service. We looked at the feedback received by service immediately prior to our inspection and found this was largely positive. These findings were a reflection of the many positive comments we received from people during the inspection.

Staff were trained and supported by the service through training and supervision. All of the staff who responded in their survey reported feeling trained to carry out their role. We found staff had been trained in “Focus on Under-nutrition”. This initiative trains staff to prevent people in care homes from losing weight and enduring associated health problems. We found the home had implemented the training and saw there was no one in the home who had experienced weight loss where actions had not been taken to address this.

People and their relatives described staff to us as, “Lovely” and went on to describe a kind and patient approach to people. We carried out observations of staff and found they understood people’s backgrounds about which they had meaningful conversations. We also found staff protected people’s privacy, dignity and confidentiality.

There was clear working in the home with other health care professionals to promote people’s well- being. Advice from healthcare professionals had been incorporated into people’s health care planning documents.

People’s medicines were administered to them in a safe manner. We found they were stored securely and there were systems in place which protected people from unsafe medicines practice.

We found people’s care plans had improved since the last inspection. They included a person centre approach where the plans were centred on each individual. Specific and detailed guidance had been given to staff to about how to care for people. We found these were reviewed regularly and where necessary referrals were made to other agencies when people’s needs changed.

Accidents and incidents were reviewed by the registered manager who had made the statutory notifications to CQC. We found the registered manager had thoroughly investigated the accidents and incidents and taken action to avoid any possible reoccurrence.

Safety checks were carried out in the home to make sure people were protected from

This inspection was carried out by one inspector. We spoke with ten people who used the service and observed their experiences of care to support our inspection. Not everyone we met could express themselves verbally due to their health condition. We spoke with the registered manager, eight staff, one healthcare professional and five relatives.

We considered our inspection findings to answer questions we always ask:-

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

Below is a summary of what we found.

Is the service safe?

There were concerns with the management of medication, including administration and recording.

We saw that people had received an assessment of their needs before moving into the home to ensure that staff were able to safely meet the person’s care and support requirements.

We found call bells were being answered promptly by staff.

There was no person in the home subject to an authorisation made under the Deprivation of Liberty Safeguards (DoLS) at the time of inspection. Staff had received training, so they knew how to safeguard people at risk of abuse and we saw best interest decisions had been made to protect people from harm.

The provider had emergency procedures in place to keep people safe from harm, including fire evacuation procedures.

Is the service effective?

Staff had received adequate training to meet the needs of the people who lived at the home.

We had a mixed response from relatives that we spoke with. Some told us they were happy with the care being delivered and their relative’s needs were met, while others were less positive. One relative also told us, “I can go on holiday with no worries and know they are being looked after properly.” Another relative told us they wanted to see more activities, particularly exercise to help their relative.

We saw people had a choice of where they ate meals and what they had. Meals were found to be nutritious and in adequate quantities. Refreshments were available throughout the day. One person said, “Staff are very accommodating when it comes to serving meals.”

Reviews to make sure people’s needs had not changed were not always carried out. In these cases this did not ensure staff supplied the correct amount of care and support.

There was evidence learning from incidents or accidents took place and appropriate changes were implemented.

Is the service caring?

Observations during the visit showed staff being attentive to the people they were supporting. We found positive interactions taking place and people were comfortable and relaxed with the staff that supported them. We saw staff responding in a kind manner to the people who lived at the home.

The home held regular meetings for the people who lived at the home to share their views and for the home to respond to any issues raised. We were told yearly surveys were also completed to further collect the views of the people living at the home and

People who lived at the home were escorted to hospital by staff if the need arose, which meant that people were supported by a familiar face.

Is the service responsive?

We could see from care records, that when a person’s needs changed appropriate actions were taken to ensure that needs were met, including for example; arranging for people to see a GP.

We saw staff quickly responding to requests from people who wanted help.

We saw only limited activities taking place for the majority of people who lived at the home on the day of the inspection, although we saw a wider range of activities were available on other days.

One relative told us that staff contact them to update them on any changes to the health of their relative or any other information that they may need to know about.

We found that complaints were listened to and actions taken to respond. We saw evidence of this during the inspection.

Is the service well-led?

There was a registered manager in post at the home. The home also had a deputy manager to support the registered manager.

All of the people, who lived at the home, and their relatives that we spoke with, knew who to contact if they had a problem. One person who lived at the home said, “I have never had cause to complain.”

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 make informed decisions and have control of their lives. One person told us, “They never tell us to do anything. They always ask – and politely.”

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, “It suits me, I can cope with it.”

The provider had made suitable arrangements to protect vulnerable people and respond appropriately to any allegation of abuse. We spoke with a visiting social worker who told us she did not have any concerns and felt the people at the home were protected from 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.

When we visited the home we checked on improvements which were required following our previous inspection. We found the provider now had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and promote their health and wellbeing.

During our visit we spoke with several 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 with them.

One person said, “Being at this home is one of the best things I’ve had in my life – I’m very satisfied with my care.”

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

One person told us, “No grumbles – I’m well looked after.”

People told us they were happy with the support they received from staff.

One person told us, “I am confident that they know what they’re doing.”

People said their care was monitored by the provider and the manager to make sure that it was meeting their needs. One person said, “She (the manager) is firm but fair with the staff – I like that.”

During our visit we spoke with people who use 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, “They’re good staff even if it’s always busy.”

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

One person told us, “I’m well looked after – no complaints.”

People said that staff helped them to take medicines safely.

One person said, “They’re good, they always remember when its time for my tablets.”

People at the home were happy with the support they received from staff. One person said, “Absolutely wonderful – couldn’t be better.”

People said that their care was monitored by the provider and the manager to make sure that it was good enough.

One person said, “The manager runs the home very well – I wouldn’t have a problem talking to her.”

This inspection took place on 15 and 16 December 2015 and was unannounced. This meant no one from the service knew we were carrying out the inspection.

At our last inspection in August 2015 we rated the home as inadequate. The home was placed in special measures. There were a number of breaches of regulations. We found the registered provider had breached Regulation 9 and had failed to do everything reasonably practicable to ensure people received person centred care which reflected their need and personal preferences. The registered provider had also breached regulations 12 and 17. In relation to regulation 12 we found the care and treatment of people was not provided in a safe way; risk assessments did not give staff clear guidance on how to ensure risks were mitigated and people’s topical medicines were not being managed in a safe way. With regard to regulation 17 we found systems and processes required by the registered provider had not been implemented by the registered manager. The registered manager had also failed to assess, monitor and mitigate risks to people and records were not accurate, complete and were not kept contemporaneously. During this inspection we found the registered provider had made improvements.

Lindisfarne Ouston is registered to provide accommodation for people who need nursing and personal care. No one in the home at the time of our inspection required nursing care. Nursing tasks were completed by the local district nursing service. The home can accommodate up to 56 people. At the time of our inspection there were 31 people in the home. Following the last inspection the registered provider had entered into a voluntary agreement with CQC not to admit any more people to the home until improvements had been made.

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 the time of our inspection the home had a new manager who expressed their intention to register with the CQC.

People who used the service and their relatives were complimentary about the care provided at Lindisfarne Ouston. They told us the staff were helpful.

There were insufficient numbers of staff on duty at night in order to meet the needs of people using the service. Following the inspection the registered provider told us they would put another member of staff on duty at night.

Since our last inspection the registered provider had not recruited anymore staff. Existing staff had received supervision and appraisals and had also received updated training on care planning, infection control, moving and handling and the Mental Capacity Act 2005.

The service was working within the principles of the Mental Capacity Act 2005 and had applied to the appropriate supervisory body to deprive people of their liberty. We saw mental capacity assessments had been completed for people and best interest decisions had been made.

We found the registered provider supported people’s human rights and in particular supported Article 8, the right to respect for private and family life, home and correspondence. Relatives told us they could visit the home at any time.

The registered provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. Training records were up to date and staff received supervisions and appraisals were planned.

We found the building required further work to support people with dementia type conditions to remain independent. The layout of the building provided adequate space for people with walking aids or wheelchairs to mobilise safely around the home and was suitably designed for people with dementia type conditions.

We found the staff approach was consistently caring irrespective of what the member of staff was employed to do.

During our inspection the activities coordinator was away from the service. The home did not have in place a programme of activities.

All of the care plans had been reviewed and brought up to date. Each care plan was reviewed on a monthly basis and the reviews addressed what was in each plan. We found that whilst people’s care plans were up to date further work was required to ensure all documents were contemporaneous.

The registered provider had a complaints policy in place. The manager had investigated complaints and had given an outcome to each complainant.

PRN is a type of medicine which is given as and when required. We found the plans in place for PRN for people with dementia type conditions explained why the medicines should be given but did not give guidance to staff about the behaviours people might display should they be in pain. We fed this back to the management team at the end of the inspection. The management team acknowledged our comments.

The registered provider had a quality audits system in place to measure the quality of the service. However not all of the audits had been carried out. The manager explained that following the previous inspection the revision of people’s care planning documents had to be a priority. We saw these and people’s medicines had been audited. Actions had been outlined and followed up from the audits.