Lindisfarne Seaham is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home provides personal and nursing care for up to 62 people some of whom are living with dementia. The home is on three floors serviced by a lift and it separated into four separate areas. When we inspected there were 46 people living at the home.

This inspection took place on 19 and 21 September 2018 and the first day was unannounced.

At our last inspection on 21 and 24 March 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. The home was meeting the requirements of the fundamental standards.

People, relatives and staff felt the service was still a safe place. People were protected from the risk of abuse because staff understood how to identify and report it.

We received mixed comments about staffing levels. Management were monitoring and increasing staffing levels to meet the needs of people in the home.

People received their medicine safely and were supported to access the support of health care professionals when needed.

Where risks were identified to people who used the service or to the environment these were assessed and plans put in place to reduce them. Accidents and incidents were analysed to identify trends and reduce risks.

People’s needs had been assessed both before and after their admission to identify their care needs.

Staff were well supported and received the training they needed. Training levels were closely monitored and there were high levels of completion. Training was also being developed to give staff more opportunities to reflect on their practice.

People received a varied and nutritional diet that met their preferences and dietary needs. The service provided a range of nutritional food and drink which were adapted for different diets.

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 told us they thought the service was very caring and we observed compassionate and caring interactions between people and staff. People told us, and we observed, that care was delivered with dignity and respect and people were supported to be as independent as possible.

Care plans were very detailed and reflected people’s needs and preferences. Care plans were evaluated regularly and included meaningful information about people’s needs.

People were actively engaged in a range of activities and had regular opportunities to access the wider community.

Feedback on the service was encouraged in a range of ways and was positive. People told us they did not have any concerns about the service but knew how to raise a complaint if needed.

The management team were approachable and they and the staff team worked in collaboration with external agencies to provide good outcomes for people. Processes were in place to assess and monitor the quality of the service provided and drive improvement. We saw on-going improvement plans being put into action.

Further information is in the detailed findings below.

This inspection took place on 21 and 24 March 2016 and was unannounced. This meant the staff and provider did not know we would be visiting.

Lindisfarne Seaham provides care and accommodation for up to 62 people who require nursing or personal care, some of whom have a dementia type illness. On the day of our inspection there were 48 people using the service.

The home had a registered manager in place. 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.

Lindisfarne Seaham was last inspected by CQC on 7 August 2015 and was compliant with the regulations in force at that time.

Accidents and incidents were appropriately recorded and investigated. Checks were carried out to ensure that people who used the service were in a safe environment and the home was clean, spacious and suitable for the people who used the service.

The provider understood the safeguarding procedures and had followed them, and staff had been trained in safeguarding vulnerable adults.

Medicines were stored safely and securely, and procedures were in place to ensure people received medicines as prescribed.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. Staff were suitably trained and training sessions were planned for any due or overdue refresher training. Staff received regular supervisions and appraisals.

The provider was working within the principles of the Mental Capacity Act and was following the requirements in the Deprivation of Liberty Safeguards.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external health care specialists.

People who used the service, and family members, were complimentary about the standard of care at Lindisfarne Seaham. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they moved into Lindisfarne Seaham and care plans were written in a person centred way.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs.

People who used the service, and family members, were aware of how to make a complaint and the provider had an appropriate complaints process in place.

Staff felt supported by the management team and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service.

We carried out this focused inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lindisfarne Seaham on our website at www.cqc.org.uk

We carried out an unannounced focused inspection of this service on 7 August 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

Three breaches of legal requirements were found following the previous comprehensive inspection on 17 December 2014. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now meet legal requirements. This report only covers our findings in relation to this requirement. At the last inspection on 17 December 2014 we asked the provider to take action to make improvements. We asked the provider to:

• Complete the review and update of all of the records at the home;
• Complete staff training in how to support people at the home who had behaviour which they found challenging and ensure there was a policy and procedure in place to guide staff practice in these circumstances;
• Continue to carry out quality checks and audits to ensure they were robust and sustained improvements at the home.

The inspection was led by an adult social care inspector.

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.

We found that records such as care files had all been regularly reviewed and these provided accurate information and were very informative.

We found that staff had received appropriate training to help support people who had behaviour which challenged them, there was a policy available and procedures were in place to support staffs practice. The number of incidents had significantly reduced since the last inspection.

We saw that quality checks and audits were consistently carried out and used to improve services at the home and the provider and senior managers visited the home to ensure the quality of services was maintained.

We inspected Lindisfarne Seaham on 17 December 2014. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting. We started the visit during the early hours of the morning and worked through the day.

Lindisfarne Seaham is a purpose-built nursing home, which can accommodate up to 62 people. The nursing home provides services for people living with a dementia who may also display behaviour that challenges.

The home had a registered manager in place who was appointed to this post in February 2012. 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.

In August 2014 we completed an inspection and issued a formal warning telling the provider that by 10 November 2014 they must improve the following areas.

• Regulation 9, (Outcome 4): Care and welfare of people who use services, as the service was failing to ensure people were protected against the risks of receiving inappropriate or unsafe care or treatment.

• Regulation 12, (Outcome 8): Cleanliness and infection control, as the service was failing to ensure people were protected from the identifiable risks of acquiring a health care associated infection.

• Regulation 15, (Outcome 10): Safety and suitability of premises, as the service was failing to ensure people at its property were protected against the risks associated with unsafe or unsuitable premises.

Whilst completing the visit 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 also checked what action had been taken to rectify the breach of regulation 22 (Staffing) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We found that the provider had ensured improvements were made in these areas and these had led to the home meeting the above regulations.

During the inspection we found that the provider had commenced completing a range of processes designed to monitor and assess the on-going performance of home such as audits. However these had recently been introduced and many had yet to be completed. Those we saw such as the medication audit were comprehensive and critically evaluated the service. We found that this review had led to action plans being developed. However we had insufficient evidence to determine whether all of the processes that had been introduced would be effective in sustaining on-going compliance with the regulations.

We found that at times staff needed to physically intervene but had not received appropriate training to deal with any behaviour that challenged. The provider did not have a policy in place to support staff identify the actions that needed to be taken when any intervention occurred. Staff at times worked with people who may pose risks to others on their own but means for calling for assistance were not at hand. During the course of the inspection the regional manager ensured alarms were purchased to replenish the stocks at the home.

Staff had been reviewing and updating all of the records maintained at the home such as care records, audits, policies and training information but this work was not complete. We found that where records such as care files had been reviewed these provided accurate information and were very informative. Those records which had not yet be completed, such as over a third of the care files, provided insufficient and inconsistent information needed to met people’s needs.

People who lived at the home required staff to provide support to manage their day-to-day care needs and their behaviour. We found that the registered manager had taken appropriate steps to ensure staff reviewed their behaviour; analysed what worked or not; and took action to ensure the home could continue to meet the individual’s needs.

Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards training and the registered manager understood the requirements of the Act. This meant they were working within the law to support people who may lack capacity to make their own decisions.

People told us that they made their own choices and decisions, which were respected by staff but they found staff provided really helpful advice. We observed that staff had developed very positive relationships with the people who used the service. Where people had difficulty making decisions we saw that staff gently worked with them to work out what they felt was best option. We saw that when people lacked the capacity to make decisions staff routinely used the ‘Best Interests’ framework to ensure the support they provided was appropriate.

The interactions between people and staff that were jovial and supportive. Staff were kind and respectful, we saw that they were aware of how to respect people’s privacy and dignity.

People told us they were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight and nutritional needs.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments.

People told us they liked living at the home and that the staff were kind and helped them a lot.

Staff had received a range of training, which covered mandatory courses such as fire safety as well as condition specific training such as diabetes and other physical health needs. We found that the staff had the skills and knowledge to provide support to the people who lived at the home. People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. We saw that eleven staff routinely provided support to people who used the service during the day and eight staff provided cover overnight.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

We saw that people living at Lindisfarne Seaham were supported to maintain good health and had access a range healthcare professionals and services. We saw that people had plenty to eat. We saw that each individual’s preference was catered for and staff ensured that each individual’s nutritional needs were met. Staff monitored each person’s weight and took appropriate action if concerns arose.

We saw that the provider had a system in place for dealing with people’s concerns and complaints. People we spoke with told us that they knew how to complain and but did not have any concerns about the service.

We found the provider was breaching three of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These related to use of physical interventions, assessing and monitoring the performance of the home; and record keeping. You can see what action we took at the back of the full version of this report.

People told us their consent was gained prior to care being delivered and we found that staff acted in accordance with their wishes. Where appropriate we found the provider acted in accordance with legal requirements where people did not have the capacity to give consent themselves. People told us, "Staff never presume, they always ask before helping me in any way" and "I decide and the staff always ask me before doing anything."

We found people's care and support needs were appropriately assessed and their care was planned. They received care safely and to an appropriate standard. People told us, "Staff support me to get to out and about, which I enjoy" and "If I am off colour, the staff are quick to get me the doctor."

People were cared for in a clean and hygienic environment and we found the service had appropriate measures in place to monitor and manage infection control. One person said, "They clean, all day, every day." A relative told us, "Spotless and always smells nice."

There were enough qualified, skilled and experienced staff to meet people's needs. People told us, "They are helpful, know what they are doing and always at hand."

We saw the provider had a complaints policy and procedure in place and people told us they would confidently raise any concerns they had with the manager. People told us, "Everyone listens and they will sort out anything that is troubling me."

We visited the home in response to information forwarded to CQC concerning how the home supported people to maintain a healthy and nutritious diet.

When we visited the home we checked to see how peoples assessed needs were met. We found care and treatment at the home was planned and delivered in a way which ensured people’s safety and welfare. One relative told us, “The care here is excellent, very good quality. I have not found better anywhere else.”

We looked at how the home supported people with their diet and found people were protected from the risks of inadequate nutrition and dehydration.

A community psychiatric nurse who was visiting people told us she felt confident the home was able to effectively support peoples dietary needs.

When we visited we looked at how the home made sure people were safeguarded against abuse. We found people were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. One relative said, “I’m here every day; I know my (relative) is safe and properly cared for.”

We found the provider 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 found people’s privacy, dignity and independence were respected. We spoke with several people who used the service and their relatives. They said staff respected their privacy and dignity. They told us staff spoke politely with them, were friendly and pleasant. One person told us, “Overall the home is very good, the carers... will do what I ask of them and fairly quickly.”

We found care and treatment at the home was planned and delivered in a way which ensured people’s safety and welfare. A community psychiatric nurse who was visiting people told us he felt confident the home was able to effectively support peoples’ mental health needs.

We looked at the way medication was handled at the home. We found people were protected against the risks of unsafe use or management of medicines because the provider had appropriate arrangements in place.

We found staff received appropriate professional development. People told us they were happy with the support they received from staff. One person said, “I can confirm that the staff are all doing their jobs properly. There are variations because that is human nature. Some are excellent.”

People who used the service, their representatives and staff were asked for their views about the care and treatment offered. We saw their responses were acknowledged and acted on. When we spoke to people at the home they said, “you can get a cup of tea when you want” and “the staff are good to you.”

We did not speak with people about their medicines.

“I was given enough information about the home before I came here, and I am always kept up to date about things that involve me”.

“This place is excellent, the tops, I have a great relationship with the staff, they talk to me about my care and they respect my views”.

“My special nurse talks to me and listens to what I say, she makes me feel safe and content”.

“I know that there is a file kept all about me, but I don’t really want to know what is in there, they do ask me, but I am not bothered because I trust them”.

“It is nice here, they look after me and I am safe”.

“I don’t have any complaints at all, the staff are lovely”.

“Smashing place”

“Always kept lovely and clean”.

“It’s very comfortable”.

“Great staff, they certainly know what they are doing”

“I think the staff are lovely and well trained”.

Comments from relatives surveys said :

“Excellent, my Mother is very well looked after”.

“This is the best care home my Dad has been placed in. The level of care is excellent”.

“The family are happy with the care of my father”.

“Very friendly staff”.

“Friendly atmosphere”.

“Sometimes not enough staff around”.

“As always, my Mother is well looked after”.

“My relative is very happy living here and that is important to me”.

“A good home with excellent standards”.

During our inspection we asked the provider and staff specific 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, talking with people who use services, speaking with 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 caring?

We spent time observing care practices at the home.

Although staff appeared caring and respectful when interacting with people who used the service we saw no therapeutic activities taking place which would provide people with interest or stimulation and help improve peoples’ wellbeing. Staff did not demonstrate an understanding of the diverse needs of people they were supporting. For example, on one occasion we saw a person who was upset receiving the same response from staff even though that response clearly made them more agitated. On another occasion we watched staff administer a sedative medication to a service user within a short period of them becoming upset, without trying any other distraction techniques or other appropriate ways of supporting them first.

Is the service responsive?

There was no evidence of activities taking place designed to meet the likes and Interests of individuals with complex needs in relation to their dementia. For example, we saw no therapeutic activities take place which would provide meaningful interest or stimulation and improve peoples’ wellbeing.

Is the service safe?

We saw that the home was neither clean nor well maintained. For example, we found many of the chairs used by people were soiled and or torn, some bedding and mattresses were soiled and / or damaged which prevented adequate cleaning placing people at risk of infection. Kitchen areas had not been effectively cleaned and there was a build-up of dead insect carcasses in many light fittings. We saw ‘clean’ equipment and laundry was being stored in a toilet. There was poor odour control in some areas, some of the carpets and flooring was damaged, stained or sticky and clinical waste materials were not properly stored. We found risk assessments in relation to the prevention of infection had not been completed. And checks to make sure the building was clean and in a good state of repair had not been regularly completed.

We saw the building was not well maintained with faults including windows which would not close into the rebate, taps which were loose or would not turn off or on and damaged electrical equipment. Ways of activating the nurse alarm system were missing in many areas. This meant people would find it difficult to summon help if they needed to. Some fire protection bedroom doors were not working or allowing doors to close properly. The home’s fire detection system had been turned off during the night on one occasion which meant some people had not been protected against a fire risk.

Is the service effective?

Care plans did not always reflect people's current needs with respect to managing their behaviour as a result of their dementia. People's health and care needs were assessed with them by their social worker. However, where people had very complex needs, we found there was very little information to guide staff about how to meet these needs safely. For example, there was not enough information to guide staff about what they should do to support people who, as a result of their dementia, became agitated or displayed other behaviours which placed either them or others at the risk of harm. There was no evidence of specialist therapeutic activities for people with complex needs in respect of their dementia. There was also no evidence that The National Institute for Care Excellence (NICE) ‘Dementia Supporting people with dementia and their carer’s in health and social care 2006’ had been put into practice. (NICE is a non-departmental public body with the responsibility to develop guidance and set quality standards for social care, as outlined in the Health and Social Care Act 2012).

The environment had not been adapted to meet the needs of people with dementia. For example, there was little evidence of contrasting colours being used to aid independence, for instance on light switches, grab rails and toilet seats. There were ‘dead ends’ to corridors where exit doors were locked.

Is the service well-led?

When we visited the home we found the leadership of the home had failed to make sure that people with complex needs were catered for or that their care plans were adequate, accurate and complete.

There was little evidence of infection control audits taking place or regular checks of the building to prevent the spread of infection or to make sure it was clean and well maintained.

There were insufficient staff numbers to make sure peoples’ needs were met in a well maintained and safe environment. For example, there were insufficient staff to carry out routine ‘deep cleaning,’ service users were not assisted to the toilet promptly and the registered manager has had to spend time working as a nurse at the home because of staff shortages.