Archived: Lindsay Hall Nursing Home

There was no registered manager in post. An appointed manager was in post and had submitted their application to register with the CQC. We have confirmed that this is in progress. 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 and associated regulations about how the service is run.

At a comprehensive inspection in March 2015 the overall rating for this service was Inadequate. At this time we took enforcement action. During a further inspection in August 2015 improvements had been made, breaches in regulation had been met and the overall rating was Requires Improvement.

Due to a high number of concerns raised with us we undertook a comprehensive inspection in July 2016, so we could ensure that people were safe. We found that people's safety was being compromised in a number of areas. The service was placed into special measures and we served warning notices for Regulations 12 and 18 of the Health and Social Care Act 2008 (Regulated Activities).

We undertook a focussed inspection on the 01 and 03 November to look at the safe domain. We found improvements had been made, the breaches of Regulation 12 and 18 were not fully met.

At this inspection we found the breaches of Regulations 11, 12 and 17 were not fully met. There was a clear commitment from the manager and staff to continue with the improvements, developments and learning that had already taken place. The provider’s leadership team acknowledged that this would take some time. They told us they wanted improvements to be fully embedded and would take their time to ensure this was done properly. Staff were now aware of their roles and responsibilities, they had a clear understanding of the vision and direction of the home. This was regularly discussed with them at interview, staff meetings and supervision.

Although there was a quality assurance system and a range of audits and checks took place this had not identified all the shortfalls we found. However, the manager had a good oversight of what was required to ensure the service continued to improve and meet the regulations.

Staff told us they felt supported by the new manager, they could talk to her and raise issues at any time. They felt listened to and knew any concerns would be taken seriously and acted on appropriately. Staff were committed to helping the service improve and develop.

There were a range of risk assessments in place. However, not all risks had been identified in relation to pressure damage. There was lack of information to show that appropriate steps had been taken to ensure people’s risks had been safely managed.

There were systems in place to manage people’s medicines. However, improvements were required to ensure people received their ‘as required’ medicines consistently. Improvements were also required to ensure people received their body creams as prescribed.

Although some activities took place at times, there was a lack of meaningful activities for people to participate in as groups or individually throughout the day. People’s care plans did not include all the information about the care people needed or received. However, people were supported by staff who knew them well and they had a good understanding of people’s individual needs, choices and preferences. Staff were kind and compassionate and worked hard to improve people’s quality of live and provided them with the person-centred care and support they required.

Recruitment had taken place to ensure there were enough suitably qualified and experienced staff to meet people's needs. Recruitment records demonstrated there were systems in place to ensure staff were suitable to work at the home. There was an ongoing training and supervision programme in place. This included observations of staff in practice and assessment of their competencies.

Staff were able to recognise different types of abuse and told us what actions they would take if they believed someone was at risk. Staff were confident they would raise any concerns to the senior person on duty or if appropriate to the local safeguarding team or CQC.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) had been submitted when required. However, there was limited information about how people who lacked capacity were able to make decisions.

The mealtime experience for people had improved and this was ongoing to ensure changes were fully embedded into practice. Nutritional assessments were in place and action was taken when people were identified as being at risk. People were offered choices and supported to eat and drink throughout the day. Staff were also encouraged to eat with people to help people identify it was a mealtime.

People were supported to have access to healthcare services and referrals were made appropriately. This included the GP, mental health team and tissue viability nurses.

The manager had worked hard to develop an open and positive culture. This was focussed on ensuring people received good person-centred care that met their individual needs.

We found a number of breaches of the Regulations of the Health and Social Care Act 2008 (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.

Lindsay Hall Nursing Home provides accommodation and nursing care for up to 38 people living with differing stages of dementia who have nursing needs, such as diabetes and strokes. There were 20 people living at the home on the days of our inspections.

Lindsay Hall Nursing Home is owned by Galleon Care Homes Limited, who have two other homes in the South East. Accommodation was provided over three floors with a passenger lift that provided level access to all parts of the home. The lower ground floor was closed for refurbishment.

There was no registered manager in post. An appointed manager was in post and had submitted their application to register with the CQC. We have confirmed that this is in process. 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 and associated regulations about how the service is run.

At a comprehensive inspection in March 2015 the overall rating for this service was Inadequate. At this time we took enforcement action. Seven breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified.

During our inspection in August 2015, we looked to see if improvements had been made. We found that improvements had been made and breaches in regulation had been met. However as the improvements needed further time to be fully established into everyday care delivery the overall rating was Requires Improvement. Due to a high number of concerns raised with us about the safety of people, the meal service and staffing levels, we undertook a comprehensive inspection on the 5, 6 and 7July 2016, so we could ensure that people were safe. We found that people's safety was being compromised in a number of areas. As part of our enforcement process, the service was placed into special measures and we served warning notices for Regulations 12 and 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014 with a specific date for compliance so we could be assured that the provider had taken urgent action to mitigate the risk to people. We received an action plan from the provider that told us that they had taken immediate action to ensure the safety of people who lived at Lindsay Hall Nursing Home.

This focussed inspection on the 01 and 03 November was specifically to look at “Is the service safe”. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lindsay Hall Nursing Home on our website at www.cqc.org.uk. We found that whilst there had been significant improvements made, the breaches of Regulation 12 and 18 were not fully met. It was clear that the organisation was committed to improve the service and more time was needed to fully embed the improvements to care delivery and build up the staff team. This will be reviewed at our next comprehensive inspection which will be in the New Year.

Care plans and risk assessments had been updated to reflect people’s assessed level of care needs. There was some confusion found on specific care plans as there had been amendments made to care delivery but the changes were not always clear and could potentially lead staff to deliver inappropriate care. We found that people with specific health problems such as diabetes did not have sufficient guidance in place for staff to deliver safe treatment. Inaccurate recording of fluids placed people potentially at risk from dehydration. Medicine practices had improved and people received their prescribed medicines on time. However organisational policies in respect of covert medicines were not always being followed and there was a lack of monitoring of those who receive mood altering medicines. Incidents and accidents were recorded and there was evidence of auditing but there were some irregularities in October 2016 that had no recorded investigation and outcome. The overall cleanliness of the home had improved considerably, but there were areas that we identified as a concern, such as strong odours in specific bedrooms.

The lack of suitably qualified and experienced staff impacted on the care delivery on the 01 November 2016 and staff were under pressure to deliver the care in a timely fashion. Shortcuts in care delivery were identified. However on the second day of the inspection we saw that care was delivered by suitably experienced staff which meant that the care delivery was safe and more person centred.

People were protected, as far as possible, by a safe recruitment system. Each personnel file had a completed application form listing their work history as wells as their skills and qualifications. Nurses employed by Lindsay Hall Nursing Home and bank nurses all had registration with the nursing midwifery council (NMC), which was up to date.

Safeguarding policies and procedures were in place and were up to date and appropriate. Staff had received training in safeguarding adults at risk, and they felt confident that they would recognise and report unsafe care.

Risks to the environment were managed and there was an appropriate maintenance schedule in place to make sure the environment remained safe for people, such as gas and electricity checks and fire equipment.

Lindsay Hall provides accommodation and nursing care for up to 38 people living with differing stages of dementia who have nursing needs, such as diabetes and strokes. There were 26 people living at the home on the days of our inspections.

Lindsay Hall Nursing Home is owned by Galleon Care Homes Limited and who have two other homes in the South East. Accommodation was provided over three floors with a passenger lift that provided level access to all parts of the home. People spoke well of the home and visiting relatives confirmed they felt confident leaving their loved ones in the care of Lindsay Hall Nursing Home.

There was no registered manager in post. A manager was in post and was in the process of registering with the CQC. 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 and associated regulations about how the service is run.

At a comprehensive inspection in March 2015 the overall rating for this service was Inadequate. At this time we took enforcement action. Seven breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. The inspection in March 2015 found significant risks to people due to the poor management of medicines and people not receiving appropriate person centred care. Where people’s health needs had changed considerably, care plans had not been updated. Staff did not have the most up to date information about people’s health. This meant there was a risk that people’s health could deteriorate and go unnoticed. Risk assessments did not reflect people’s changing needs in respect of wounds and pressure damage. Accidents and incidents had not been recorded appropriately and steps had not been taken by the staff to minimise the risk of similar events happening in the future. Risks associated with the cleanliness of the environment and equipment had been not been identified and managed effectively. People had not been protected against unsafe treatment by the quality assurance systems. We also found that training had not been delivered where identified as needed and administrative processes to support training, staff supervision and appraisal were inaccurate and incomplete.

Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance by June 2015. During our inspection in August 2015, we looked to see if improvements had been made. The inspection found that improvements had been made and breaches in regulation had been met. However the improvements were not fully embedded in practice and they need further time to be fully established in to everyday care delivery.

Due to a high number of concerns raised about the safety of people, the meal service and staffing levels we brought forward the scheduled inspection to the 5, 6 and 7July 2016, so we could ensure that people were safe.

This inspection found that people’s safety was being compromised in a number of areas. Care plans did not reflect people’s assessed level of care needs and care delivery was not person specific or holistic. We found that people with specific health problems such as pressure ulcers and wounds were not up to date and did not have sufficient guidance in place for staff to deliver safe treatment. The lack of suitably qualified and experienced staff impacted on the care delivery and staff were under pressure to deliver care in a timely fashion. Shortcuts in care delivery were identified. We also found the provider was not meeting the requirements of the Mental Capacity Act (MCA) 2005. Mental capacity assessments were not completed in line with legal requirements. Staff were not following the principles of the MCA. We found there were restrictions imposed on people that did not consider their ability to make individual decisions for themselves, as required under the MCA Code of Practice.

The delivery of care suited staff routine rather than individual choice. Care plans lacked sufficient information on people’s likes and dislikes. Information in respect of people’s lifestyle choices was not readily available for staff. The lack of meaningful activities impacted negatively on people’s well-being.

People, staff and visitors were not always complimentary about the meal service at Lindsay Hall Nursing Home. They thought the closing of the kitchen and the meals coming from the sister home had caused delays, cold food and missed meals. The dining experience was not a social and enjoyable experience for people. People were not always supported to eat and drink enough to meet their needs.

Quality assurance systems were in place but had not identified the shortfalls in care delivery and record keeping. We were told that incidents and accidents were recorded but six months of completed accident records were not available for viewing and the accident and incident audit was not up to date. We could not be assured that accidents and incidents were consistently investigated with a robust action plan to prevent a re-occurrence.

People’s medicines were stored safely and in line with legal regulations. However people did not always receive their medicines on time and we found that some people’s essential medicine was out of stock for six days. There were missing signatures for medicines. These had not been followed up to ensure that people received their prescribed medicines. We also found poor recording of topical creams, dietary supplements and ‘as required’ medication.

People and visitors we spoke with were complimentary about the caring nature of some of the staff. But said that the constant changes to staff, use of agency staff and staff leaving had impacted on how the home was run. Many people were supported with little verbal interaction, and many spent time isolated in their rooms.

Feedback had been sought from people, relatives and staff in 2015 but had not been undertaken since changes to the running of the home were implemented and the new management had been introduced. ‘Residents’ and staff meetings were held on a regular basis which provided a forum for people to raise concerns and discuss ideas. However an action plan for ideas suggested and concerns had not been shared with people and visitors.

Staff told us they thought that communication systems needed to be improved and they required more support to deliver good care, they felt that the lack of permanent staff and high staff turnover had raised issues. Their comments included “We work well but need to build up the staff team, we can’t do everything.”

People had access to appropriate healthcare professionals. Staff told us how they would contact the GP if they had concerns about people’s health. However care plans did not include all the information about people’s health related needs.

People were protected, as far as possible, by a safe recruitment system. Each personnel file had a completed application form listing their work history as wells as their skills and qualifications. Nurses employed by Lindsay Hall Nursing Home and bank nurses all had registration with the nursing midwifery council (NMC), which was up to date.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

We found a number of breaches of the Regulations of the Health and Social Care Act 2008 (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.

Staff told us that they now felt supported and worked well as a team. One staff member said "I love it here." Another said, "We have really worked hard to improve."

We found that people who used the service had been involved as far as possible in care decisions and in life choices. Care was being delivered in a way that ensured their dignity was promoted. Care plans and delivery of care was person centred and individualised. We saw that people were cared for by a sufficient number of staff who had received the training and professional development necessary to meet people's needs.

We saw that the organisation had worked hard to meet the compliance actions set at the previous inspection on the 21 December 2012. The improvements seen assured us that they were compliant but the improvements were not yet fully embedded.

We were told by the people who used the service, 'They are so kind, they really know how to treat me.' Another said 'Wonderful place and the staff are compassionate,' and 'The food is very nicely presented and good and the staff are just so caring.'

Staff told us that they worked as a team, and that they felt supported by the senior staff. One staff member said 'I enjoy working here.' Another said 'We need more staff sometimes.'

We found that people who used the service were not fully involved in care decisions and in life choices. Care was not always being delivered in a way that ensured their dignity was promoted. Care plans and delivery of care for some people was more task orientated than person centred.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We saw that staff were not promoting safe infection control practices in respect of soiled laundry.

People were cared for by staff who had received the training and professional development necessary to meet their needs.