The Lindsay

Updated 15 December 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 3 inspectors.

Service and service type

The Lindsay is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Lindsay 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 not a registered manager in post. A new manager had been in post for two months and intends to submit an application to register with us.

Notice of inspection

This inspection was unannounced.

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

We spoke with 19 people who used the service and 7 relatives about their experience of the care provided. We spoke with 11 members of staff including the manager, regional director, clinical deputy managers, senior carer, carers, nurses, housekeeping, maintenance and chef. We also spoke with the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We received written feedback from 14 staff and 2 health professionals who work closely with the home.

We reviewed a range of records. This included 7 people’s care records and multiple medication records. We looked at 3 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

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.

Updated 15 December 2023

About the service

The Lindsay is a residential care home providing personal and nursing care to up to 70 people. The service provides support to younger adults and older people, some of whom are living with dementia. At the time of our inspection there were 57 people using the service.

The home is a purpose-built building covering five separate floors, with access to all areas by stairs and lift. Two of the floors specialise in providing care to people living with dementia. The home has good communal facilities on the ground floor, which include a café, cinema and hairdressing salon.

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

People and their relatives told us they felt The Lindsay was a safe place to be. We identified some areas where the home could do better, and we have made recommendations about staffing, mental capacity and management checks within the home. We discussed these with the manager, they acted immediately and sought to rectify the issues found. We will assess these improvements at the next inspection.

People were not always supported by enough staff to meet their needs. Some people told us staff did not always answer the call bell in a timely manner. One relative told us, "Staff are good, would like more of them because it takes them so long to get to my [loved one], but they are good." We discussed this with the manager, and they immediately sought to assess and increase staffing within the home.

People did not always have their capacity assessed when required. People had not signed their care records to show that they consented to the care and support they were being provided. We raised this with the provider, and they took an immediate action to address this.

People's needs were assessed, and plans were in place to help ensure their needs were met. People's choices and decisions were respected, and staff enabled people to retain their independence.

Staff knew people well and understood their needs. Care plans were detailed and regularly reviewed. This meant there was always information for staff to refer to when providing care for people. There were inconsistencies for the delivery of care including oral care. We raised this with the manager who took immediate action to address this.

The provider completed appropriate risk assessments to ensure risks to people's health, safety and wellbeing had been identified and actions taken to reduce the likelihood of harm. Risks to people were assessed, recorded and regularly reviewed.

Staff demonstrated a good understanding of the signs and symptoms that could indicate people were experiencing abuse or harm. Staff knew how to report concerns both internally and externally.

Staff received a comprehensive induction and ongoing training to help them understand and meet people’s needs.

People were supported to access health services whenever required. This included GP surgeries, physiotherapists, specialist nurses like tissue viability nurses and hospitals.

Staff had the correct level of skills and training to undertake the responsibilities of their role effectively.

Frequent changes in management had led to low staff morale. The provider had recognised the impact of this and was working with the staffing team to make improvements.

The home worked well with other organisations which provided specialist support to people, involving their families and other professionals such as GP surgeries, hospital discharge teams and social services, where appropriate. The home also understood the importance and benefit of links with the wider community through social events.

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.

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 16 August 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service. 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 based on the findings of this inspection.

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

Recommendations

We recommend the provider continually assesses the needs of people using the service to ensure safe staffing levels are maintained.

We recommend the provider seeks guidance from a reputable source to ensure the rights of people are always maintained in line with the Mental Capacity Act 2005.

We recommend the provider follows up best practice guidance and their oral care policy to ensure people’s oral health needs are fully met.

We recommend the provider continues to strengthen their governance systems to ensure they are always operating effectively; they seek to continually improve, and feedback is always used to shape the service.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.