Lindum House

Lindum House is a care home which provides both nursing and personal care for those who may have dementia or a physical disability. It is registered to support 64 people within 2 units, 1 nursing and 1 residential. At the time of our inspection 36 people were using the service.

People’s experience of using this service and what we found

People received their medicines as prescribed. We have made a recommendation to ensure the provide continues to embed and implement good practice relating to topical medicines.

People were safe. Risks to people's health, safety and wellbeing were managed by staff with the relevant skills and knowledge to meet their needs. Any accidents or incidents were appropriately responded to and were monitored and learned from to reduce the risk of them happening again.

The service was clean, well maintained and adapted to people’s needs.

Suitable staff were employed, and staffing levels met people's needs. People's medicines were administered as prescribed. People were supported by kind and caring staff who were attentive to people and their needs.

People had choice and control regarding their care and were enabled to follow their own routines. People's privacy and dignity was maintained, and people's independence was promoted. Staff were knowledgeable about people's needs and supported people to access healthcare services when required.

People had a varied diet and meals were served in line with people's personal preferences and dietary requirements. The management team promoted a positive culture through appropriate support for their staff.

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.

There were effective governance systems in place to drive improvements. The provider had good oversight of the service and was committed to embedding and sustaining the improvements made since the last inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 12 October 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 12 October 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 10 June 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve their management of risk, person centred care and governance of the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Caring and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lindum House 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.

Lindum House is a care home which provides both nursing and personal care for those who may have dementia or a physical disability. It is registered to support 64 people within two units, one nursing and one residential. At the time of our inspection 51 people were using the service.

People’s experience of using this service and what we found

People were not safe and did not always experience high quality care. The quality and safety of the service had deteriorated since our last inspection. The lack of provider and management oversight had not been consistently maintained. Systems and processes designed to identify shortfalls, and to drive improvement were not effective and had not identified the concerns we found during this inspection.

Risks to the health and safety of people were not consistently monitored and mitigated. This included risk associated with catheter care, skin integrity, choking and allergies. Staff had not always had sight of people’s risk assessments and care plans. Medicines had not always been managed safely.

We found incidents and complaints were not used as opportunities to learn lessons. Feedback was not consistently sought from people or their relatives to help shape the service. The provider had not always fulfilled its duty of candour. We have made a recommendation regarding this.

There was not always sufficient staff to meet people’s needs. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the systems in the service did not support this practice. Staff told us morale was low.

Staff were recruited safely and had received training suitable to their role. However, the quality of training was inconsistent and best practice was not always followed by staff. Staff failed to recognise and report when people were at risk of harm. We have made a recommendation to improve staff knowledge about safeguarding and how to report poor practice.

People had enough to eat and drink but there were mixed reviews about the quality of food and the dining experience.

The provider was responsive to our findings and started to make improvements during the inspection.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 20/10/2018).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of care and support in relation to catheter care and staffing levels. This inspection examined those risks.

The information CQC received about the incident indicated concerns about catheter care and staffing levels. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, effective, caring and well-led only.

We have found evidence that the provider needs to make improvements. Please see the safe and well led section of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ‘Lindum House’ on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, staffing, person-centred care and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

People were supported to have visitors and safe visiting processes were followed in line with national guidance. Alternative arrangements were available to support people to maintain contact with their family and friends in the event of an outbreak.

The building was clean, tidy and well maintained. Social distancing was promoted through the layout of furniture and consideration of how activities could be provided safely.

Risks to people and staff in relation to COVID-19 had been assessed and action taken to manage the risks.

Staff took part in regular testing for COVID-19 and were vaccinated. They appropriately wore personal protective equipment (PPE) to minimise the risk of infections spreading.

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.

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 their food and a choice was offered at mealtimes. We saw the mealtime experience was positive. People had their weight monitored to ensure they were receiving enough nutrition and where there were concerns, appropriate referrals had been made to professionals.

People’s independence was encouraged and we saw there was a variety of activities organised for people.

People and relatives were asked for their views through surveys and day to day conversations. They said they would talk to the manager or staff if they were unhappy or had any concerns. They told us they felt confident to do this.

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 home. However, the dining experience of people living on the first floor of the service was task orientated and lacked interaction and communication. We have made a recommendation in the report about this.

The assessment and monitoring of diabetes and people with this condition was not robust. We found no evidence of risk assessments and care plans relating to diabetes in the care files we looked at. Some input from diabetic specialists was seen, but there was little evidence that staff were proactive with regard to recognising the special needs of people with diabetes. We have made a recommendation in the report about this.

Staff had access to adequate induction and training opportunities, but the percentage of staff receiving supervision, to assess and monitor their practice, needed to improve. We saw some very good interactions during our inspection, between staff and people, but we also saw areas of practice that could improve. This may have been recognised by the management team if staff were supervised on a more frequent basis. We have made a recommendation in the report around this.

The environment within the service was comfortable, clean and homely, but it was not particularly designed to be dementia friendly. Only a fifth of people using the service lived with dementia. However, improvements could be considered regarding the dementia design aspect whenever the service was refurbished or redecorated. We have made a recommendation around this in the report.

We found that some people who used the service had limited input to the development of their care plans and they told us that the care being provided was decided by the staff on duty rather than in accordance with their wishes. We have made a recommendation around this in the report.

People told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm and there were enough staff to meet people’s needs. Staff had been employed following appropriate recruitment and selection processes.

People were confident about raising any concerns with the registered manager. We saw the registered manager investigated these and gave people a written response to their complaint.

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.

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.

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'.