We inspected Lindisfarne Seaham on 17 December 2014. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting. We started the visit during the early hours of the morning and worked through the day.
Lindisfarne Seaham is a purpose-built nursing home, which can accommodate up to 62 people. The nursing home provides services for people living with a dementia who may also display behaviour that challenges.
The home had a registered manager in place who was appointed to this post in February 2012. 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.
In August 2014 we completed an inspection and issued a formal warning telling the provider that by 10 November 2014 they must improve the following areas.
• Regulation 9, (Outcome 4): Care and welfare of people who use services, as the service was failing to ensure people were protected against the risks of receiving inappropriate or unsafe care or treatment.
• Regulation 12, (Outcome 8): Cleanliness and infection control, as the service was failing to ensure people were protected from the identifiable risks of acquiring a health care associated infection.
• Regulation 15, (Outcome 10): Safety and suitability of premises, as the service was failing to ensure people at its property were protected against the risks associated with unsafe or unsuitable premises.
Whilst completing the visit we reviewed the action the provider had taken to address the above breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We also checked what action had been taken to rectify the breach of regulation 22 (Staffing) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
We found that the provider had ensured improvements were made in these areas and these had led to the home meeting the above regulations.
During the inspection we found that the provider had commenced completing a range of processes designed to monitor and assess the on-going performance of home such as audits. However these had recently been introduced and many had yet to be completed. Those we saw such as the medication audit were comprehensive and critically evaluated the service. We found that this review had led to action plans being developed. However we had insufficient evidence to determine whether all of the processes that had been introduced would be effective in sustaining on-going compliance with the regulations.
We found that at times staff needed to physically intervene but had not received appropriate training to deal with any behaviour that challenged. The provider did not have a policy in place to support staff identify the actions that needed to be taken when any intervention occurred. Staff at times worked with people who may pose risks to others on their own but means for calling for assistance were not at hand. During the course of the inspection the regional manager ensured alarms were purchased to replenish the stocks at the home.
Staff had been reviewing and updating all of the records maintained at the home such as care records, audits, policies and training information but this work was not complete. We found that where records such as care files had been reviewed these provided accurate information and were very informative. Those records which had not yet be completed, such as over a third of the care files, provided insufficient and inconsistent information needed to met people’s needs.
People who lived at the home required staff to provide support to manage their day-to-day care needs and their behaviour. We found that the registered manager had taken appropriate steps to ensure staff reviewed their behaviour; analysed what worked or not; and took action to ensure the home could continue to meet the individual’s needs.
Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards training and the registered manager understood the requirements of the Act. This meant they were working within the law to support people who may lack capacity to make their own decisions.
People told us that they made their own choices and decisions, which were respected by staff but they found staff provided really helpful advice. We observed that staff had developed very positive relationships with the people who used the service. Where people had difficulty making decisions we saw that staff gently worked with them to work out what they felt was best option. We saw that when people lacked the capacity to make decisions staff routinely used the ‘Best Interests’ framework to ensure the support they provided was appropriate.
The interactions between people and staff that were jovial and supportive. Staff were kind and respectful, we saw that they were aware of how to respect people’s privacy and dignity.
People told us they were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight and nutritional needs.
People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments.
People told us they liked living at the home and that the staff were kind and helped them a lot.
Staff had received a range of training, which covered mandatory courses such as fire safety as well as condition specific training such as diabetes and other physical health needs. We found that the staff had the skills and knowledge to provide support to the people who lived at the home. People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. We saw that eleven staff routinely provided support to people who used the service during the day and eight staff provided cover overnight.
Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
We reviewed the systems for the management of medicines and found that people received their medicines safely.
We saw that people living at Lindisfarne Seaham were supported to maintain good health and had access a range healthcare professionals and services. We saw that people had plenty to eat. We saw that each individual’s preference was catered for and staff ensured that each individual’s nutritional needs were met. Staff monitored each person’s weight and took appropriate action if concerns arose.
We saw that the provider had a system in place for dealing with people’s concerns and complaints. People we spoke with told us that they knew how to complain and but did not have any concerns about the service.
We found the provider was breaching three of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These related to use of physical interventions, assessing and monitoring the performance of the home; and record keeping. You can see what action we took at the back of the full version of this report.