Lindum Court

Lindum Court is a residential care home providing personal care to up to 24 people. The service provides support to older people, some of whom may be living with dementia. At the time of our inspection there were 21 people using the service. Personal care is also provided to 1 person living in the local community.

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

Governance systems were not always reliable or effective and there was limited evidence that learning had taken place to improve the quality of the service. The registered manager did not have a consistent approach to all safeguarding incidents. We have made a recommendation about safeguarding and lessons learnt.

Risks to people’s safety was managed well and were person centred. There were enough staff on duty with the right mix of skills to ensure practice was safe. Staff received supervision and appraisals to support them and identify their development needs. Recruitment systems were robust.

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.

Medicines were managed, stored and disposed of safely. Infection, prevention and control was managed well. Staff adhered to policies and procedures on infection control and followed national guidance.

The dining environment was pleasant, and the food was well presented. People were involved in planning menus of their choice. There was positive feedback from people and relatives about the dining experience.

Health and well-being were addressed in care plans and action taken for people to have positive outcomes. Appropriate and timely referrals to relevant health professionals was made and any recommendations acted on.

The service had a positive culture that was person centred, open and inclusive. The registered manager supported and motivated staff who were proud of the service they worked in.

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 22 November 2017).

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.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led section of this report. 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 based on the findings of this inspection.

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

Enforcement and Recommendations

We have identified a breach in relation to good governance at this inspection. We have also made recommendations the provider ensures safeguarding’s are reported and acted on consistently and lessons are learnt to improve the outcomes for people and the service.

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.

Please see the action we have told the provider to take at the end of this report.

At the last inspection of this service we found there was a breach of Regulation 12, safe care and treatment and regulation 17, good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found the management of the service was inadequate and we sent a warning notice to the provider because found issues with cleanliness, infection control, behavioural support records, and health and safety at the service. There was a lack of effective monitoring at the service and issues found were not addressed to make sure people’s health and wellbeing was protected. The provider was also undertaking a regulated activity which the service was not registered to provide. These issues had impacted upon the care and support people received. The provider sent us a detailed action plan to tell us how the issues we found were to be addressed. We found during this inspection their action plan had been followed and all issues had been rectified.

At this inspection, we looked to see if improvements had been made. We found all the shortfalls from the last inspection had been addressed and improvements had been made to meet the relevant requirements.

Lindum Court is registered with the Care Quality Commission (CQC) to provide residential care for up to 24 people, some of whom may be living with dementia. Personal care is also provided to one person living in the local community.

The service is centrally located in the village of Owston Ferry and is close to local shops and amenities. There is a ground and first floor, two communal lounge areas, an open plan conservatory/dining room, a number of toilet and bathroom facilities, a kitchen and a large outdoor garden area with a pond. The building is fully accessible with the provision of a passenger lift and there is on the street parking available directly outside the home. The service is registered to provide personal care to one person living in the local community.

The service had a registered manager in place. 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.

Following our last inspection we found improvements had been made in a number of areas; the service was clean and effective infection control measures were now in place. Health and safety issues were addressed; radiators were covered appropriately and trip hazards, new furniture and commodes had been provided for people's bedrooms. Trip hazards in the garden had been removed and the fence had been raised to prevent people from leaving the garden. Care records were detailed and clear about the behavioural support people needed to receive. The quality assurance system and audits had been strengthened to make sure issues were addressed in a timely way.

Since the last inspection the regulated activity of personal care has been added to the providers registration. This was required because one person living in the community was being supported by staff in their own home. This person was receiving appropriate care and support.

Staff knew how to recognise the signs of abuse and knew how to report issues. This helped to protect people from abuse. There were enough staff provided to meet people’s needs and recruitment procedures at the service were robust.

Induction training was provided for staff. Supervision's and appraisals were occurring to help to develop the staff's skills and knowledge.

People's nutritional needs were monitored and mealtimes were sociable occasions for everyone living at the service.

People's health was monitored and action was taken to gain help and advice from relevant health care professionals if people's needs changed. Medicine management was generally robust. However, there was an issue found during the inspection which was addressed straight away by the registered manager. People’s care records were personalised; information relating to behaviours that may challenge themselves or others were detailed and clear for staff to understand and follow.

People's mental capacity was assessed to ensure they were not being deprived of their liberty unlawfully. Staff gave people choices for their care and support and acted upon what they said. Documentation was in place regarding people’s capacity and best interest meetings were held to ensure people’s rights were protected when decisions were made on their behalf.

We saw improvements had been made to the environment to help to meet the needs of people living with dementia, further improvements were also planned to take place.

Staff were attentive and kind and supported people in a gentle enabling way which promoted people’s independence.

A range of activities were provided and people were invited to take part, if they wished.

A complaint policy was in place. This was made available to people and their relatives. Advocacy information was provided to people and their relatives. People were supported by advocates or family members to help raise their views.

The service was led effectively, audits were undertaken and action was taken to make sure the service remained a pleasant place for people to live. Notifications were made to the CQC to help to keep us informed of events that occurred within the service.

The service was last inspected on 24 November 2015, it was found to be compliant with the regulations that we looked, although three recommendations were made and an overall quality rating of ‘requires improvement’ was awarded.

Lindum Court is registered with the Care Quality Commission (CQC) to provide accommodation for up to 24 people who require nursing or personal care. The service can provide support to older people and those living with dementia. It is based in the centre of Owston Ferry on the Isle of Axholme.

This service has a registered manager in place. 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 the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

One of the recommendations made at the last inspection of this service had not been acted upon. This was in regard to the environment and auditing and monitoring of the service that needed to be more robust. During this inspection we saw the registered manager and registered provider had failed to monitor the quality of the service provided to people and have failed to provide a safe, well-led service. Some corrective action was taken following the first day of the inspection; however, not all of the issues found have been fully addressed.

There were issues with infection control, cleanliness and the environment throughout the service. Gloves, plastic bags prescribed creams and razors were not securely stored to help to prevent the risk of harm to people living with dementia.

We found the registered provider was providing a regulated activity that they were not registered for; they have taken action by making an application to the CQC to rectify this shortfall.

People who required assistance with eating and drinking were given their meals earlier than everyone else. This was being reviewed by the registered manager to ensure everyone was included in the social mealtimes held at the service. People’s nutritional needs were assessed and monitored and their preferences and special dietary needs were catered for. Staff encouraged and assisted people to eat and drink and advice was gained from relevant health care professionals to make sure people’s nutritional needs were met.

People’s care records required some minor updating; this was undertaken at the time of the inspection to make sure the records reflected people’s current needs. Risk assessments for some people lacked detail and direction and behavioural support plans were not fully detailed or prescriptive. We have also recommended that the care records regarding people’s capacity to consent and for providing care to people in their best interests are reviewed in line with current guidance.

Staff received training about protecting people from harm and abuse. Safeguarding issues were reported report to the local authority and CQC.

We observed the staffing levels provided during our inspection were adequate to meet people’s needs. Staff received training, supervision and appraisals which helped to support them and develop their skills. Recruitment procedures were robust.

People’s changing care needs were discussed with relevant health care professionals so that their needs could be reviewed to help maintain people’s wellbeing.

Staff reworded questions to help people living with dementia understand what was being said. This helped to ensure people were supported to make decisions and choices in their daily lives.

Spontaneous activities were provided. Visitors to people living at the service were made welcome.

Pictorial signage was in place to help people living with dementia find bathrooms, toilets and their own room. General maintenance occurred and service contracts were in place.

Resident and relative and staff meetings were held to gain people’s views about the service.

There was a complaints procedure in place. This was explained to people living with dementia or to their relatives so that they were informed.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded. You can see what action we told the registered provider to take at the back of the full version of the report.

People and their relatives spoke positively about their care. One person told us, 'It's all right; they are looking after me well. As far as I can see they are doing everything as they should do.' Another person said, 'It's smashing and you get well looked after.'

People were protected from the risk and spread of infection. One person told us, 'I think it is clean. The staff come in and clean while I am here, and I have no problem with that.' Another person said, 'It's spotless, and they make sure you are clean.' A relative told us, 'The cleanliness is fine overall; you are bound to get some things because it is a home, not a showpiece.' A visiting healthcare professional told us, 'It seems to be clean."

There were effective recruitment and selection processes in place and people spoke positively about the staff that worked with them. One person told us, 'The staff are very good; I have no problem with them at all.' Another person said, 'The staff are excellent.' A visiting healthcare professional said, 'Staff appear to use their judgement appropriately, and to act within their capabilities.'

People we spoke with were clear about how to make a complaint. One person who used the service told us, 'I have no complaint whatsoever but I would raise any complaint with the manager to start with, and if nothing was done I would need to take it higher.'