Lindisfarne Crawcrook

Updated 15 September 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors and 1 Expert by Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Lindisfarne Crawcrook is a ‘care home’. People in care homes receive accommodation and nursing and personal care as a single package under one contractual agreement dependent on their registration with us. Lindisfarne Crawcrook is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 7 August 2023 and ended on 7 August 2023, when we visited the service.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

During the inspection we spoke with 13 people who used the service about their experience of the care provided and 4 relatives. We spoke with 13 members of staff including the regional manager, registered manager, 2 nurses, 7 care workers including 2 senior care workers and 1 laundry assistant.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records. This included 4 people’s care records and multiple medicines records. We looked at 4 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including training information and policies and procedures were reviewed.

Updated 15 September 2023

About the service

Lindisfarne Crawcrook is a care home providing accommodation and personal and nursing care to up to 60 older people, including people who may live with dementia, or a dementia related condition. At the time of our inspection there were 51 people using the service, living in one purpose-built building.

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

At our last inspection the provider did not have effective systems in place to monitor and improve the quality of the service and improvements were required to medicines records. At this inspection some improvements had been made, medicines were better managed and improvements had been made to medicines records, but other improvements were needed to the running of the service to ensure people received safe, timely and person-centred care.

Further action was required with regards to the provider’s quality monitoring system. We identified shortfalls with staffing levels and staff deployment, the provision of person-centred care, the environmental design, people’s mealtime experience and communication. These shortfalls had not all been identified or actioned in a timely manner by the provider’s governance system.

Improvements were required to the environment to ensure it was designed to meet the needs of people who live with dementia, to keep them orientated and engaged as they walked around. People’s mealtime experience was not well-managed to ensure, people were offered choice and encouragement to eat.

Staffing levels and staff deployment were not effective to ensure people received safe, timely and person-centred care. Care was task-centred rather than person-centred. Due to staff being busy they did not have time to spend with people. Throughout our observations some people sat silently or were not engaged or stimulated. We have made a recommendation staff receive training about person-centred care.

Risks to people’s safety was not well-managed, staff did not always identify, or take action to mitigate the risk of avoidable harm. Where people may become upset or agitated, their distress was not always understood or well-managed.

Records provided guidance to assist staff to deliver care and support to meet people’s needs. Staff recruitment was carried out safely and effectively. There was evidence of collaborative working and communication with other professionals to help meet people's needs. People and relatives had opportunities to give feedback about the service.

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.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 31 August 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that the provider continued to keep staffing levels under review to ensure people receive timely and person-centred care. We recommended to continue with a timely programme of refurbishment to keep people engaged and to maintain the cleanliness of the home. At this inspection we found the provider had not acted on all the recommendations to make improvements.

The service remains rated requires improvement. This service has been rated requires improvement for the last 3 consecutive inspections. We will describe what we will do about the repeat requires improvement in the follow up section below.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 13 July 2022. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance and the management of medicines records.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective and well-led which contain those requirements.

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 inspected and found there were concerns with people’s dining experience, environmental design and staff training, so we widened the scope of the inspection to include the key question effective.

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 remained requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

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 Lindisfarne Crawcrook on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to staffing, safe care and treatment and governance.

We have made a recommendation that staff receive further training to give them more insight into people's care and support needs.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.