We carried out a review of the data available to us about Lindisfarne CLS Nursing on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Lindisfarne CLS Nursing, you can give feedback on this service.
Lindisfarne CLS Nursing is a nursing home providing accommodation for up to 56 older people and people living with a dementia. There were 48 people using the service when we visited.
People’s experience of using this service and what we found
People told us staff were caring and they felt safe. We observed staff deliver care and support in a kind and compassionate manner. It was clear staff understood people's needs and how to manage any presenting risks. Risk assessments were clear and readily identified how to mitigate them. Staff were familiar with these documents and the actions they needed to take.
There were enough staff on duty and staff were recruited safely. People were protected from abuse by staff who understood how to identify and report any concerns. Incident monitoring records were appropriately used to understand themes and reasons for the events. Medicine management was effective. Staff adhered to COVID regulations and procedures.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
The systems the registered manager had in place allowed them to critically review the service and proactively looked at how improvements could be made. Staff told us that the registered manager was approachable and listened to their views. All felt the registered manager was running a good service.
Staff were passionate about providing good care outcomes and took ownership for their practice. They had established good working relationships with all visiting professionals, and this had supported them to deliver effective care and support.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 19 August 2017).
We completed a targeted inspection in January 2021 to look specifically at infection control and were assured.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
This report only covers our findings in relation to the Key Questions safe and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lindisfarne CLS Nursing on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
We found the following examples of good practice:
¿ Systems were in place to prevent people, staff and visitors from catching and spreading infections.
¿ Staff had undertaken training in putting on and taking off personal protective equipment (PPE) and other relevant training.
¿ Staff were observed wearing appropriate PPE and suitable supplies of PPE were readily available.
¿ Staff supported people's social and emotional wellbeing. People and their relatives were supported to keep in contact using a range of technology.
¿ The home was clean and additional cleaning of all areas and frequent touch surfaces was being carried out.
¿ Due to an outbreak of COVID-19 at the time of our inspection, only essential health and compliance visits were taking place. When visits recommenced, plans were in place to safely manage visits in accordance with national guidance. Visits would be staggered to allow for additional cleaning and were by appointment only.
¿ The home was following national guidance for anyone moving in. Staff worked with people and their relatives to ensure they were aware of self-isolation procedures.
¿ People were supported to understand the pandemic and the need for infection prevention and control (IPC) measures, such as staff wearing face masks.
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.
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:
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.
This inspection took place on 14, 15 and 21 October 2014. 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. During our inspection on 14, 15 and 21 October 2014 there were 29 service users at the home, 14 of whom were accommodated on the first floor.
The provider is required to have a registered manager at this home as condition of their registration. 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. Although we found that the provider had appointed an acting manager, when we visited on 14, 15 and 21 October 2014 there was not a registered manager in place nor had CQC received an application for a manager to be registered at this home since November 2013.
At our previous inspection carried out on 9, 10, 22, 24, 29, 30 July and 7 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.
At this inspection we found that improvements had not been made to meet these requirements and Lindisfarne CLS Nursing was inadequate in all areas we inspected.
We looked at guidance for providers in dementia care including the following:-
The provider had failed to take account of this guidance.
We found peoples care and welfare needs were not properly met at this home. People who had dementia care needs did not have them properly met at the home. For example people who displayed behaviours which challenged staff or other service users because of their dementia type illness were not supported by staff in a consistent or well-planned way. Detailed intervention plans for when people became agitated were not in place and best practice guidelines to help avoid these circumstances were not considered. Medicines that have a sedative effect on people were found to be used in some circumstances without guidance or sufficient agreed practice to safeguard and protect service users’ rights.
Responses, strategies and preventative measures for people who had become sexually disinhibited because of their dementia type illness were not in place at the home. There were no detailed or organised plans in place for people who were likely to display these behaviours placing them and others at risk.
People were at risk of poor nursing care at the home. Nurses did not demonstrate that they had an understanding of peoples nursing care needs or were taking actions to meet them. For example some people had pressure ulcers but nurses on duty did not know this and their care plan records gave inconsistent and contradictory information. Some people at the home had life limiting or multiple illnesses but nursing staff did not know about them; did not know what impact this had on their daily needs; nor did they have packages of care in place to support these needs.
Some people required support with their diet so that they could remain as healthy as possible. Care planning for people who needed support with their diets was not sufficiently detailed or was contradictory. The weight and condition of people with dietary needs was not routinely measured to make sure support was working or not and kitchen staff were not involved in supporting people with these needs. Nursing staff also omitted to make sure peoples’ nutritional support medicine was available and in stock at the home.
We found that peoples’ mental health care needs were not understood or supported at the home. For example if people had been subject to treatment and support under the Mental Health Act 1983 the provider did not carry out an assessment of their mental health needs or demonstrate their best interests, rights or care and welfare were protected at the home. Staff were not aware of which people in the home were subject to detention under this Act.
Staff recruitment procedures at the home were not safe. Recruitment records at the home did not demonstrate that service users were protected from those who were unsuitable to work with vulnerable people. For example thorough background checks, including those to make sure applicants had not been legally barred from working with vulnerable adults or children had not been carried out; nurses legal status (registration with professional bodies); and if people from abroad were eligible to work were not checked.
Staff deployment was inconsistent or inaccurate, for example some staff were recorded on the homes rota as working there but in practice were regularly working at another home. We found that the and the provider also failed to regularly assess the needs of service users in relation to overall staffing levels and monitor the services provided. For example we found one nurse and two care staff were allocated to look after 29 service users who had both nursing needs and displayed challenging behaviour. Key staff were also inappropriately organised at the home. For example the home required deployment of nurses who had both mental health and general nursing qualifications all times but the staff rota did not ensure staff with these skills were on duty.
Staff training records had not been compiled and ordered. The provider could not demonstrate the level of training staff had received or how this met the needs of the home or service users. Training in key areas such as how to support people with behaviours that challenge staff or other service users, could not be demonstrated.
The provider did not take measures to safeguard service users who were likely to harm themselves or place themselves in situations which may cause them serious injury or risk of death. For example we found two serious incidents had taken place where the provider had failed to put in measures to reduce the likelihood of harm. We made a safeguarding alert to Durham County Council during the inspection as we were concerned about the provider failing to protect one person’s health.
We found that people were not protected from the risk of infection. Furniture, equipment and surroundings of bedrooms and communal areas were not properly cleaned and there was poor odour control. We found that in a significant number of areas of the home appropriate standards of cleanliness and hygiene were not maintained. This demonstrated that cleaning had not been carried out effectively other procedures used at the home placed service users at risk of infection.
There was a lack of adequate maintenance to the home which meant that service users were not protected against the risk of unsuitable or unsafe premises. For example mobility aids were insecure, furniture was in danger of falling on people, windows did not work properly and refurbishment work had not been completed. One person’s bedroom fire door did not close properly putting them at risk if there was a fire. Combustible materials were being stored in the stair well emergency exit which could have become blocked in the event of a fire. Fire evacuation plans were unsafe and neither the nurse in charge nor care staff knew what to do in an emergency.
The provider did not effectively assess and monitor the quality of the home to make sure it was safe, effective and meeting the homes ‘Statement of Purpose’. The home had a ‘Quality Assurance Policy’ but both the acting manager and area manager could find ‘nothing in place.’ Other areas of monitoring such as the frequency of accidents and incidents and the measures to reduce risks to people living at the home could also not be found. An annual plan to ensure a quality service and residents and relatives surveys were not carried out.
Complaints at the home had not been handled properly. For example responses to complaints by a relative had not been made and this was not recorded in the homes complaints file.
Other monitoring of the home had not taken place. For example, at the July 2014 inspection we made the provider aware that the ambient room temperature of the home were excessive. At this inspection we found the home to be again excessively warm however no monitoring had taken place and no remedial action had been taken to ensure the ambient temperature of the home remained in line within Health and Safety guidelines.
We found that the provider failed to make improvements to the quality and safety of services for people at the home. The provider did not take action following a CQC inspection on 9, 10, 22, 24, 29, 30 July and 7 August 2014 where the home was found to be in breach of five regulations and people using the service were found to be at risk despite Warning Notices being issued. The provider did not act in a timely fashion to achieve compliance, meet service users’ needs and adequately protect them from receiving poor care. Although the provider had taken steps to appoint an acting manager and area manager, approximately five weeks before this inspection, their impact on the service was limited and we found the provider remained in breach of regulations which warranted further enforcement action to be considered.
The provider did not have key policies in place which would support staff to take effective measures to care for people being accommodated at the home at the home. For example the homes response to incidents where staff were required to restrain service users for their own safety were not supported by clear policy and procedural guidance.
We found there were multiple of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We are taking action in line with our enforcement policy outside of this inspection process.
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 on the first floor of 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 interest or stimulation and help promote positive behaviour and improve peoples' wellbeing. We observed staff to respond to service users' requests if they were awake, however, there was no proactive interventions from staff. Staff did not demonstrate an understanding of the diverse needs of people they were supporting. For example, on one occasion staff walked past a person who was clearly agitated. On another occasion we watched a service user appear to become quite faint so we obtained a chair for them to sit on as staff were busy elsewhere. When staff became available they walked this person to their room at a pace that was not comfortable for them. We also saw they were not offered a wheelchair to use, despite having been unsteady on their feet. On another occasion a service user was left with a cut on his arm, that was bleeding, the nurse in charge saying they would attend to it when they had finished the medication round.
Is the service responsive?
There was no evidence of activities taking place designed to meet the likes and tastes of individuals with complex needs in relation to their dementia. For example, we saw no therapeutic activities take place which would provide interest or stimulation and help promote positive behaviour and improve peoples' wellbeing. There was no evidence the service had responded to one person's changing mental health needs.
Is the service safe?
The staff that we spoke to did not follow the procedures to ensure that people were safe. This was because despite us advising them of the excessive heat on the first floor of the home on three separate occasions, they failed to notify the local safeguarding authority or take action to protect people from abuse.
We saw that the first floor of the home was neither clean nor well maintained. For example there were strong unpleasant odours in some areas, for instance the shower room, communal areas and some people's bedrooms. When we showed the acting manager the shower room she said 'I'm not going in there its minging'. We looked at every mattress on the first floor of the home and found many of them were stained or damaged demonstrating they had either not been cleaned effectively or could not be cleaned effectively. Many pull cords were missing from the nurse alarm system both in people's bedrooms and also in communal bathrooms. This meant people could not summons help if they needed to. Neither the acting manager or quality assurance manager could provide us with an explanation as to why these pull cords were missing.
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. We saw where people's needs had changed placing them at risk of harm, the staff had not instigated a referral onto the relevant mental health care professional. 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.
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. In contradiction 'fire safety' signs directed the reader to exit doors which were locked.
Is the service well-led?
The service did not work well with other agencies and services to make sure people received their care in a joined up way. For example, when one person's mental health needs had changed there was no evidence the relevant health care professionals had been contacted by the care home.
There was little evidence of infection control audits taking place or regular checks of the building to make sure it was clean and well maintained.
People's personal care records were not accurate and complete.
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.
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 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.'