This inspection took place on 21 and 28 August 2018 and was unannounced.

Lindum House provides both nursing and personal care for those who may have dementia or a physical disability. It is registered for 64 people. People in care homes receive accommodation and nursing or personal care as a 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. At the time of our inspection 55 people were receiving a service.

At our last inspection in July 2017, we rated the service requires improvement. At that inspection, we found that the building was not dementia friendly. We recommended the service seek advice and guidance from a reputable source about use of the Mental Capacity Act 2005. During this inspection we have found that the provider has met these requirements.

The service had a manager in place who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

Medicines were managed safely and staff had a good knowledge of the medicine systems and procedures in place to support this. We found staff had been recruited safely and training was provided to meet the needs of people. Staff received regular supervision and appraisal and told us they felt supported in their roles. There was sufficient staff in place to meet people's needs.

Staff received training on safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm. Accidents and incidents were responded to appropriately and monitored by the management team. The service was clean and infection control measures were in place. People and relatives spoke positively about the clean and well-appointed environment.

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. Care plans reflected people's current needs and were person-centred.

People’s nutrition and hydration needs were catered for. A choice of meals was offered and drinks and snacks were made readily available throughout the day.

There was a positive caring culture within the service and we observed people were treated with dignity and respect. People’s wider support needs were catered for through the provision of activities provided by an activity coordinator, volunteers and visiting entertainers.

There was a complaints policy and procedure which was available to people who received a service and their relatives. All complaints were acknowledged and responded to quickly and efficiently. The service sought feedback from people who received a service; feedback was positive.

There was a range of quality audits in place completed by the management team. These were up-to-date and completed on a regular basis. All the people we spoke with told us they felt the service was well-led; they felt listened to and could approach management with concerns. Staff told us they enjoyed working at the service and enjoyed their jobs. People spoke highly of the provider and they felt proud to work at the service. The service had built positive relationships with visiting professionals.

We inspected this service on the 5 July 2017. The inspection was unannounced. At the last inspection in May 2016, we asked the provider to take action to make improvements to the safety of medicines management, the support of staff to enable them to carry out their duties, meeting people's needs and quality assurance systems. At this inspection we found that these actions had been completed.

Lindum House is registered to provide nursing care for up to 64 older people, some of whom were living with dementia. At the time of our visit 46 people were living at the service.

A registered manager was employed at the service. 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.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. We saw all incidents of suspected abuse had been reported to the local authority and CQC had received notifications of these events.

There were systems in place to monitor and improve the quality of the service provided. We saw there were a range of audits carried out both by the manager and provider. We saw where issues had been identified action plans with agreed timescales were in place to help drive improvements. However the provider audits had not highlighted that the environment was not adapted for people living with dementia.

This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and you can see what we asked the provider to do at the back of the full report.

Improvements had been made to medicines management and people received their medicines safely.

Risk assessments were in people's care plans for areas such as moving and handling, falls and pressure care so staff knew how to support people to remain safe. However, these did not reflect the capacity of the person or the care given in every case.

We saw people’s care plans contained person centred detail. Staff knew people very well. As part of the 'resident of the day initiative' the manager told us they reviewed people's care plans and risk assessments. Where people did not have capacity staff had carried out an assessment and made decisions in the person's best interest. However, we saw this had not happened for one person.

We made a recommendation that the provider should use good practice guidance around MCA and best interest decision making to ensure staff can support people to make decisions in accordance with MCA guidance.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

Following the last inspection the manager had implemented robust systems to ensure staff felt supported through supervision, appraisal, training and staff meetings. Staff told us they felt positive about the changes and felt very well supported by the manager.

The manager had analysed staffing levels that were needed. The rotas reflected these numbers but at times staff were very busy. The service would benefit from staff being deployed more efficiently. We concluded that people had enough staff to meet their needs.

We found safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

There were positive interactions between people and staff. We saw staff treated people with dignity and respect. Staff were attentive and patient with people. Observation of the staff showed they knew the people very well and could anticipate their needs. People and their relatives told us they were happy and felt very well cared for.

People told us they enjoyed thei

This inspection took place on the 25 and 26 May 2016 and was unannounced. At our last inspection of the service on 12 September 2014 the registered provider was compliant with all the regulations in force at that time.

Lindum House provides both nursing and residential care for people over the age of 18, older people and people living with dementia or a physical disability. The service can accommodate a maximum of 64 people. The service is situated in the market town of Beverley. The accommodation is provided over two floors and most of the bedrooms have en-suite facilities. There is a range of communal rooms on each floor. There is on-site parking for staff, visitors and relatives and the home is accessible to people in wheelchairs.

The registered provider is required to have a registered manager in post and there was a registered manager at this service who had been in post since 2015. 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.

During this inspection we found that the home was not always safe. Risks to the health and safety of people using the service were not always thoroughly assessed and effectively managed and this placed people at risk of otherwise avoidable harm. This was a breach of Regulation 12 (2) (a) (b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The recording and administration of medicines was not managed appropriately in the service. This was a breach of Regulation 12 (1) (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There was insufficient support and supervision of the staff to ensure that issues raised during this inspection around staff competence, care practices and staff attitudes were identified and addressed by the management team. This had an impact on the quality of life for people using the service. This was a breach of Regulation 18 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found the majority of the time care and support was offered appropriately and in a friendly and helpful manner. However, we also saw some staff interactions that were carried out without thought or consideration of the people using the service. This was a breach of Regulation 9 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People confined to bed for most of the day and others unable to move down to the ground floor for activities were receiving little or no stimulation and social interaction on a daily basis. This meant people were bored or spent their day sleeping. This was a breach of Regulation 9 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Record keeping within the service needed to improve. We saw evidence that medicine records, care plans, risk assessments, turn charts and wound care records were not always accurate or up to date. This meant that staff did not have access to complete and contemporaneous records in respect of each person using the service, which potentially put people at risk of harm. This is a breach of Regulation 17 (1) (2) (a-c) of the Health and Social Care Act (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of this report.

Improvements were needed to the number of staff on duty to meet the needs of people who used the service. People and staff commented that the levels of staff on duty fluctuated on a daily basis and this was also evidenced in the staff rotas. We have made a recommendation in the report about this.

People’s nutritional needs had been assessed and they told us they were satisfied with the meals provided by the

One inspector carried out this inspection to answer our five 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, speaking with people who used the service, the staff who supported them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us that they were consulted about their care and were able to make their own decisions about life in the home. People felt staff respected their privacy and dignity. We found people were being looked after by friendly, supportive staff within a warm and homely environment. Care was personalised and reflected people’s choices and decisions. Care records were up to date.

The home had policies and procedures in relation to Deprivation of Liberty Safeguards (DOLS) and twelve applications had been submitted in the last six months. The registered manager had a good understanding of when an application should be made and how to submit one. This meant that people were safeguarded as required.

Is the service effective?

People’s health and care needs had been assessed and care plans were in place. There was some evidence of people being involved in assessments of their needs and planning of their care. People said they could discuss their care with the staff or manager and on the whole felt well supported and cared for.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. One relative told us that they visited the service regularly and they were delighted with their parent’s care. The relative said "My parent is really well looked after and I am always made welcome when I visit."

People who spoke with us said “We are very satisfied with our care, the food is good and there are plenty of choices available” and “We get help from the staff when we need it, you only have to ask and they cannot do enough for you.”

Is the service responsive?

There was a weekly activity programme that people could participate in as wished. We observed people participating in simple entertainments such as watching television, reading daily magazines and newspapers and chatting to visitors, staff and other people who used the service. We saw people playing dominoes in one of the lounges and there was a film show in the afternoon. Two people who spoke with us said they took part in the gardening club and morning club run by the activity co-ordinator.

People were supported by the staff to fulfil their spiritual needs. People accessed the in house church services and were given support from staff to attend if needed. Visits from clergy could be arranged on request.

We saw that there was a complaints policy and procedure on display that was accessible to people who used the service. We spoke with five people and they said they could talk to the staff or care managers if they had any problems. They told us they felt happy and safe within the service and that any issues they had were dealt with quickly.

We looked at the complaints records and saw that one complaint had been received in the last year. We looked at the investigation which had been completed in line with the complaints policy. This meant people could be assured that complaints were investigated and action taken as necessary.

Is the service well led?

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. Feedback from these individuals was obtained through the use of satisfaction questionnaires and meetings. The questionnaire information was analysed by an external company and where necessary action was taken by the provider to make changes or improvements to the service.

The service had an open door policy so staff were able to discuss any concerns with the manager and there were regular staff meetings so that people could talk about any work issues. This meant that staff were able to provide feedback to their managers and their knowledge and experience was recognised and taken into account.

During the day we observed daily activities including lunchtime and observed interactions with staff and people who used the service. We spoke with six people who used the service, relatives, a visiting professional and staff including the manager. We reviewed documentation including four care plans.

We saw that care needs were discussed with people and/or their relatives and before people received care their consent was asked for. One person said “I’m always asked before they help me or if they have to examine me”.

From what people told us, what we observed, and noted as part of the review staff cared for the people who used the service appropriately. The visiting professional said “All the information was to hand, it was a good care plan”.

Food and drinks were specially prepared to ensure that people had a nutritious and balanced diet. People who used the service told us the food was “very good”, there was enough of it and they had a variety of dishes.

There were enough qualified, skilled and experienced staff to meet people's needs. The relatives we spoke with said that the staff were good and they were involved in the reviews of care.

There were appropriate systems in place to monitor and improve the quality of the service.

We used a number of different methods to help us understand the experiences of people using the service. During the day we sat with the service users and observed their daily activities including lunchtime and observed their interactions with staff. We spoke in detail with three people who used the service, one relative, a visiting health professional and staff including the manager and two care workers. We reviewed documentation including four care plans.

From what people told us, what we observed and noted as part of the review staff cared for the people who use the service appropriately.

Staff were suitably recruited to ensure they could offer the appropriate care to people. People were protected from harm and the risk of harm through staff training and risk assessments. Staff could tell us what they would do if they saw abuse happening or someone reported abuse to them.

Staff told us they tried to ensure that people's dignity and human rights were respected and we saw evidence of this during our inspection. There were appropriate systems in place to monitor and improve the quality of the service.

The people we spoke to said that “Its OK here", the staff were “Pretty good”, and “You can have a laugh”. The visiting health professional said “The staff are generally helpful and respectful”.

People spoken with told us they felt safe at the home, “I do feel safe here – I couldn’t rely on carers coming to me at home”. One person said that they had noticed an improvement in the attitude of care workers, “There is less talking down to us – it was sometimes disrespectful but now it is better and a happier atmosphere, I am hopeful now”.

One person told us the care was exceptionally good. Other people told us that staff supported them to be independent and were on hand when needed, “The staff are great, I get on well with them and they gave me emotional support when I needed it”.

We spoke with seven people who live at the home. They told us the staff were very kind and helpful and were sensitive when helping them. They told us the staff were quick to respond when they used the call bell system and were always on hand if they needed anything.

People told us they felt safe and trusted the staff, and that they felt confident that any concerns they had would be taken seriously and dealt with properly.

People told us staff listened to them and they were able to attend meetings about the way the home was run.