Lindau Residential Home

Lindau Residential Home is a residential care home providing accommodation for persons who require nursing or personal care to up to 37 people. The service was not providing nursing care, people’s nursing needs were met by community nurses. The service provides support to older people, some of who lived with dementia and one person had a learning disability. At the time of our inspection there were 24 people using the service.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support

Staff did not provide people with a learning disability effective support to identify aspirations and goals and assist people to plan how these would be met. There was not a consistent approach to supporting people to learn new skills or maintain their skills for as long as possible, where this was appropriate. Staff encouraged people to be independent as much as possible. People’s communication needs were not always met, directional signs were not in place to help people orientate in the service. Easy read signage providing information and reminders was not always available.

Some areas of the service were not clean. The service was undergoing a programme of redecoration and repair. However, some safety aspects had not been identified and mitigated prior to the inspection. The risk to people from access to hot pipes, items that could cause harm and risks arising from people's diagnosed health needs had not been addressed. The service provided people with care and support in well-equipped environment.

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 policies and systems in the service supported this practice. We made a recommendation about this.

People prescribed 'as and when required' medicines did not always have the appropriate protocols in place to support staff to know how or when to administer these medicines. We made a recommendation about this. The service had systems and processes in place to safely administer and record medicines use. Medicines were administered in line with the prescription.

Right Care

People's care was not always person centred, some people did not have care plans and information about how staff could meet their needs. However, people told us they were treated with dignity and respect and their privacy was respected. People told us that staff were kind and caring. Comments included, “People [staff] are every so kind”; “It is brilliant here. The staff are lovely, they listen to what you want and say, they are always there” and “They are very good, kind and caring.”

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough staff to meet people's needs and keep them safe. However, staff had not always had the necessary training to meet people's assessed needs. Training to work with people who lived with epilepsy had not been provided.

Right Culture

The provider's quality monitoring processes had not always identified concerns and improvements in the service. People, their relatives and staff had been encouraged and supported to provide feedback about the service. People and their relatives felt listened to.

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 September 2017).

Why we inspected

We received concerns in relation to the management of medicines, management of people’s mental health needs and infection control. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 good to requires improvement. We have found evidence that the provider needs to make improvements.

After the inspection the registered manager provided assurances and some evidence to show that improvements had been made and were in progress.

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 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 Lindau Residential Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to risk management, planning and designing person centred care, good governance and notifications of incidents and events at this inspection. We have made a recommendation about the management of some medicines. We have made a recommendation about the management of MCA and DoLS.

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.

Lindau Residential Home is registered to provide nursing; personal care and accommodation for up to 37 people. There were 27 people using the service during our inspection; who were living with a range of health and support needs. These included; diabetes, catheter care and people who needed to be nursed in bed.

Lindau Residential Home is a large detached house situated in a residential area just outside New Romney. The service had a large communal lounge available with comfortable seating and a TV for people and separate, quieter areas. There was a secure enclosed garden to the rear of the premises.

The previous inspection on 2 and 3 June 2016 found three breaches of our regulations, an overall rating of requires improvement was given at that inspection. The provider had not ensured actions designed to address risk had been followed through into practice. This specifically related to people that required special air mattresses to help prevent pressure wounds. Medicines had not been administered, recorded, stored or managed in a safe way which posed a risk to the safety of people. People’s health care had not been managed effectively, specifically in relation to catheter care, drinks that required thickener, and wound care records. Not all audits had effectively picked up concerns which we had found during the inspection specifically in relation to the management of medicines. The provider had resolved the issues raised at the previous inspection which were no longer a concern at this inspection.

A registered manager was in post. A registered manager is a person who has registered with the care Quality Commission to manage the service. 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 the provider had displayed their latest ratings at the premises, they had failed to display their latest CQC inspection report ratings on their website which is a legal requirement. We asked the provider to address this and we will follow this up.

There were safe processes for storing, administering and returning medicines. People received their medicines in a person centred and appropriate way.

Accidents and incidents had been properly recorded and audited for trends to try to prevent further accidents. Risks to people were well monitored and action was taken when concerns were identified. People had individual personal emergency evacuation plans (PEEPs) that staff could follow to ensure people were supported to leave the service in the most appropriate way in the event of a fire.

Appropriate checks were made to keep people safe and safety checks were made regularly on equipment and the environment. There were enough staff to meet people's needs. Employment checks had been made to ensure staff were of good character and suitable for their roles.

Robust safeguarding and whistleblowing guidance and contact information was available for staff to refer to should they need to raise concerns about people’s safety. Staff had good understanding about their responsibilities in relation to this.

The registered manager demonstrated a clear understanding of the process that must be followed if people were deemed to lack capacity to make their own decisions and the Mental Capacity Act (MCA) 2005. They ensured people’s rights were protected by meeting the requirements of the Act.

Peoples health needs were well monitored and responded to promptly. External professional healthcare advice was sought and referrals made in a timely way. Staff had the knowledge and skills to complete their roles effectively. Staff had received training in mandatory and other areas.

People were supported to eat and drink and had choice around their meals.

Staff demonstrated caring attitudes towards people and spoke to them in a dignified and respectful way. Staff communicated with people in a person centred and individual way to meet their own specific needs. People were relaxed and happy in their home and at ease around staff. People were treated with dignity and respect and there was good humour and rapport between people and staff.

Care plans were meaningful and contained specific detail so staff could understand people better, care plans were a reflection of what happened in practice.

Complaints were recorded and responded to effectively. There were systems in place outlining timescales of the complaints process and details of what actions the complainant should expect throughout the investigation process.

The registered manager conducted numerous audits and analyses to maintain good oversight of the service and safety of the people using it. There were good communication processes between staff. The registered manager sought the views of people and action was taken in response to any areas identified as in need of improvement.

Lindau Residential Home is registered to provide nursing; personal care and accommodation for up to 37 people .There were 32 people using the service during our inspection; who were living with a range of health and support needs. These included; diabetes, catheter care and people who needed to be nursed in bed.

Lindau Residential Home is a large detached house situated in a residential area just outside New Romney. The service had a large communal lounge available with comfortable seating and a TV for people and separate, quieter areas. There was a secure enclosed garden to the rear of the premises.

A registered manager was in post. A registered manager is a person who has registered with the care Quality Commission to manage the service. 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 had not consistently been protected against identified risks to their health, safety or well-being. This included risks associated with medicines. However, environmental hazards such as fire and equipment had been properly addressed. People told us they felt safe living in the service.

There were enough staff on duty to support people promptly and staff had received training and regular supervision to ensure they were competent for their roles. There was a robust recruitment process in place and proper pre-employment checks had taken place.

Staff knew how to protect people from abuse and how to report any suspicions they might have. Accidents and incidents were documented and actions put in place to prevent reoccurrences.

People’s healthcare had not always been evidenced, making it difficult to tell if they had received appropriate care. Adaptations had not been made to the premises to help people living with dementia or memory loss to orientate themselves.

Staff were knowledgeable about the Mental Capacity Act (MCA) 2005 and gave people clear choices. Deprivation of Liberty Safeguards (DoLS) applications had been made by the registered manager and authorisations received in some cases.

People said they enjoyed their meals and dieticians were involved when people lost weight. Drinks were plentiful to ensure people remained hydrated.

Activities were not consistently available or meaningful and were carried out by care staff. People’s care plans, however were individualised and reflected people’s personalities and preferences. People and relatives knew how to complain and complaints had been managed effectively.

Auditing had been carried out to measure the safety and quality of the service, but this had not always been effective in identifying shortfalls. People and their relatives had been given opportunities to give their views about the service and the registered manager had responded by making changes where necessary.

Staff said they felt supported by the registered manager and there was an open culture in the service. People and relatives told us that the registered manager was visible and approachable.

We found a number of breaches 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 this report.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found.

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

Is the service safe?

People were supported in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available at all times of the waking day. An on call system for managerial support was in place for out of hours emergencies. There were evacuation plans and systems in place in the event of a fire, but documentation for checking the fire safety system was not always completed.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager provided a working description around assessing people's capacity to consent if there were any concern it was absent. They were able to demonstrate what steps that were taking to ensure they were not unlawfully depriving people of their liberty.

Is the service effective?

People were fully involved in their assessment and care planning. This meant that their true voice was heard and that all care and support was planned with their consent. With consent, family, friends and loved ones contributed to the care plan, which meant the service was able to better understand the person's needs. Where there was doubt about the legitimacy of a person to act on behalf of another person, steps were taken to obtain the right legal documentation. This meant that the person received the right level of support to remain as safe and as independent as possible.

Some recording around fire safety checks were missing, although several staff independently advised that the checks took place weekly. It is important that these checks are recorded as specified by the organisation's own policy and procedure. We observed that the staff took immediate action to remedy this oversight.

Is the service caring?

People were relaxed and happy in the company of staff. The manager introduced us to 19 of the 23 people at the home. We observed that everyone looked pleased and relaxed to see the manager, and were confident to speak about the service provided. One person told us about the caring support they had received since taking up residence in the home. They told us, 'Staff are excellent. I had given up on life really, but staff have got to know me, they know what I do and don't like. The manager could see that, and asked me to look after the chickens. It gave me a real purpose again, and I am so much happier'. Another person asked us, 'Have you seen our cats? We have two new ones; they are really friendly and sit on our laps, which is lovely'.

Is the service responsive?

Records showed that the manager and team worked together to keep people's health and support plans up to date. Records confirmed that medical professionals had been consulted without delay and that the action taken and what the outcome was were noted. We saw that the incident reporting system analysed any themes around falls or, for example increased urine infections. We saw that the manager used these data to inform them of what staff training was needed. We also saw that this was an effective way for the manager to implement environmental changes, such as hand-rail placements where they were most needed.

Is the service well led?

The people we spoke to said that the home was run very well. Several people said, 'I have no complaints, the food is good, the staff are nice'. One staff team member told us that they had formal supervision with the manager. They said that in addition, the, manager worked alongside the team to support and role model 'good care'. Feedback from staff surveys showed that the team were happy in their role and where concerns had been raised about inter-personal working relationships, the manager had addressed and resolved these.

At this inspection, we found that the home had undertaken a fire risk assessment to identify the fire safety arrangements that were required to minimise risks to people, staff and visitors. We found that the home had taken action to implement a range of measures and procedures in accordance with the requirements of the fire risk assessment.

We found that procedures had been implemented to help reduce the risks associated with bath and shower hot water outlets and information made available for staff guidance about recommended safe hot water temperature limits, to help protect people against the risks of scalding.

We found that the home had introduced an improvement plan to identify how repairs and re-decoration would be undertaken.

We spoke with four people who used the service and two visitors. People we spoke with who used the service told us that they were happy with the care and support they received and their comments were positive. One person said 'they are wonderful, lovely; I am so happy here'. A visiting relative told us 'the staff are wonderful, very good'.

We looked at people's care plans and saw that they were individualised and contained people's choices and preferences. Risk assessments were in place to identify and minimise risks as far as possible for people who used the service.

All the people we spoke with who used the service told us that they felt safe and that they would know what to do if they had any worries or concerns.

We found that people who lived in the home were happy with their accommodation. However, we had some concerns about the fire risk assessment and some of the safety tests the home had undertaken. There were also some areas of the home where maintenance had not been fully completed.

We found that there were enough staff on duty and they told us that they felt supported by the manager; one member of staff told us 'the manager is really excellent and will always help us'. We found that staff had undertaken essential training to keep their skills and knowledge up to date. A visitor told us 'the staff are well trained, wonderful and patient'.

We found that the home had a complaints policy and a procedure that clearly set out how people were able to make a complaint if they needed to.

We saw that people were offered choices and their dignity and independence was respected. We saw some positive interactions between staff and the people who lived at the service. Staff assisted people in a professional, yet warm manner and explained what they were doing when they supported them.

People we spoke with told us that they liked living in the service and that staff were friendly and caring. We saw that people looked relaxed. The people we spoke with told us that they were satisfied with the care and support received. One person said 'I have been here five years, I have no complaints they really look after your health'. Another said, 'Staff are pleasant and they discuss my care with me'.