Lindisfarne Newton Aycliffe

Lindisfarne Newton Aycliffe provides accommodation with personal and nursing care for up to 56 people. The home is split into 3 units across 3 floors. Residential and nursing care is provided to older people and people living with a dementia. At the time of this inspection 44 people were living at the service.

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

The provider did not have effective systems in place to monitor people’s safety when eating and drinking. Fire drills had not been carried out in line with the provider’s policy. Governance processes had not identified or remedied this issue. The provider was required to have a registered manager at the service,. There was a manager in post but they had not applied for registration when we inspected.

People received kind and caring support from staff who knew them well. We saw people were treated with dignity and respect when being supported. Staff helped people to express themselves and make decisions.

Medicines were managed safely. Staffing levels were monitored and staff safely recruited. People were safeguarded from abuse. The provider had effective infection prevention and control systems in place.

Staff received regular training, supervision and appraisal. The premises were adapted for the comfort and convenience of people living there. 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.

Care plans were in place, and staff said these helped them to provide responsive care. Staff could communicate with people effectively. People had access to a range of different activities at the service. The provider had a clear complaints process, which people and relatives were aware of.

Staff spoke positively about the leadership of the manager and the support they received. Feedback was sought from people, relatives and staff. The service worked successfully in partnership with other agencies and external professionals.

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 16 March 2019).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident was subject to further assessment 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 eating and drinking. This inspection examined those risks.

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

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 a breach in relation to eating and drinking support, record keeping and quality assurance audits at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Lindisfarne Newton Aycliffe provides accommodation with personal and nursing care for up to 56 older people. The home is split into three units across three floors. Residential and nursing care is provided to older people and people living with a dementia. At the time of this inspection 48 people were living at the service.

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

People spoke positively about the care they received and said they were happy at the service.

People were safeguarded from abuse. Staffing levels were monitored, and the provider was recruiting more staff. Effective infection prevention and control measures were in place.

People received effective support with eating and drinking and spoke positively about meals at the service.

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 16 March 2019).

Why we inspected

We undertook this targeted inspection to check on specific concerns we had received about how people were being cared for and how staff were providing support. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

• Measures were in place to reduce the risk of visitors catching and spreading infections.

• Admissions to the service were carried out safely.

• Personal protective equipment (PPE) was in place and staff were supported to use this correctly.

• The premises were clean and tidy, with regular cleaning taking place.

• People and staff were regularly tested for coronavirus.

People’s experience of using this service: Improvements had been made to the service following our last inspection in March 2018. The provider and registered manager had improved the way people’s topical medicines were managed, the cleanliness of equipment used in the home, the maintenance of the wheelchairs and the audits.

Staffing levels met people’s needs. Staff had received a wide range of training including around working with people who may display behaviours that challenge. Checks were made on the ongoing competency of staff.

The cook and staff had received ‘focus on under-nutrition’ training. Staff were encouraging people who were under-weight to eat fortified foods. A range of menu choices were available.

People participated in a range of activities that met their individual choices and preferences. Staff provided the structured support people required.

Staff reported any safeguarding matters and the registered manager ensured these were investigated appropriately. The registered manager had acted on concerns and complaints and had taken steps to resolve these matters. All incidents were analysed and lessons were learnt and embedded into practice.

People told us that the registered manager and staff listened to their views and that people’s needs were met. Staff were not consistently recording capacity assessments and ‘best interests’ decisions. The registered manager had identified that further improvements could be made to the care records.

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

Rating at last inspection: Requires Improvement (report published 15 March 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service had improved and was rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

During this inspection we found breaches of Regulations 12, 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had not done all that was reasonably practicable to mitigate risks to people including the safe administration of people’s topical medicines and the cleanliness of equipment used in the home. We found wheelchairs in the home were not being used in a safe manner. The audits carried out failed to identify these issues and records were not always up to date and accurate.

Lindisfarne Newton Aycliffe is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Lindisfarne Newton Aycliffe provides accommodation for up to 56 people across three separate units. One of the units specialised in providing care to people living with dementia. At the time of our inspection there were 51 people residing in the home.

There was a registered manager in post at the time of our inspection. 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 there were safe arrangements in place for the storage and disposal of people’s medicines. People had been prescribed topical medicines (creams applied to the skin). Guidance had not been given to staff on the frequency topical medicines needed to be applied.

Whilst the home was clean and tidy throughout risks to reduce cross infection had not always been carried out. During our inspection the registered manager made arrangements to make improvements.

We observed wheelchairs were not being used appropriately. Foot plates were missing. The registered manager carried out an audit of the wheelchairs in use during our inspection to reduce the risks to people using the wheelchairs.

People had care plans in place which contained personalised information. These were reviewed on a regular basis.

The service had in place a number of audits for monitoring quality. These audits resulted in actions required to improve or sustain the service. We found some of the audits had not uncovered the deficits in the service.

Risk assessments were in place to manage the environment and people’s personal risks.

During our inspection we reviewed seven staff files. We found the provider carried out robust checks on prospective staff members before they were permitted to start working in the home. Staff had received an induction and were provided with continuous support through training supervision and appraisals.

People were protected from the risk of abuse because the staff in the home understood their roles and responsibilities to keep people safe. Actions had been taken if staff were concerned a person was at risk of harm.

There were regular checks carried out on the building. These included fire checks and the monitoring of hot water temperatures to prevent people from being scalded. Checks were also carried out on beds and bedrails.

Kitchen staff understood people’s dietary requirements and how to provide food to people who were at risk of losing weight. We carried out observations on lunchtime on each of the three floors. People who needed full support to eat were provided with the required support to eat at their own pace. People who needed their food cut up for them did not always eat their meal. Staff later encouraged them to eat food which would have gone cold. We recommended the service review the meal time arrangements.

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.

The service had communication systems in place to ensure staff were aware of and kept up to date on people’s needs. These included daily notes, appointment diaries and handover notes between shifts.

Staff spoke to us about people’s personal preferences and were able to demonstrate they knew and understood people’s likes and dislikes.

We found staff were alert to and responsive to changes in people’s daily healthcare needs. Any changes were documented in a notebook for a nurse who regularly visited the home to review.

Activities were provided in the home. We found activities were advertised but did not take place. Following the inspection the regional support manager told us this was an error and the advertised activities should have been taken down. Staff told us they did not always have the time to support people with activities. A second activities’ coordinator was due to start work. We recommended the provider reviews the delivery of activities in the home.

The provider had a complaints policy and procedure in place. Complaints which had been made about the service had been investigated by the registered manager. Complainants had received an outcome for their complaints.

The views of relatives about the service had been sought. These had been reviewed and the registered manager sent a letter out to relatives providing explanations and telling them what actions had been taken.

The registered manager reviewed the service and sent weekly reports to the regional support manager to demonstrate what actions had been taken to support people’s needs.

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

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, 'The staff and the manager are very good. The nurses are very friendly and I find this is one of the nicest places I've lived at.' One visitor told us, 'I've been visiting my (relative) for two years now and I can honestly say she is well looked after and has all of her needs met by staff who really care for her and everyone else who lives here.'

The provider had made suitable arrangements to protect vulnerable people and respond appropriately to any 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.

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.

We found care and treatment at the home was planned and delivered in a way which ensured people's safety and welfare. One person said, 'It feels like they know me very well and I would say I'm very well cared for.'

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 relative said, 'The staff have a very good approach to people here.'

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 with people at the home they said their care was 'just what they expected' and they were 'happy with the help from staff.'