The Lindsay

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.

We found the following examples of good practice.

People, staff and visitors to The Lindsay were protected from risks of infection as policies and staff practices reflected best practice guidance. This included admissions to the home, staff deployment and people required to self-isolate, for example if returning from hospital.

There were robust procedures in place for all visitors. Visits were by appointment only and supported by trained staff. Visitors had to complete a health declaration, have their temperature taken and have a rapid Covid-19 test. This indicated a positive or negative test result within 30 minutes. There was a designated visitors pod with sound loop for those hard of hearing. Personal protective equipment (PPE) was supplied as necessary. Video calls, emails and telephones were used as alternatives when visits were not possible.

The home looked visibly clean and hygienic throughout. There was a regular cleaning schedule in place which included a checklist for frequently touched areas such as door handles, handrails and keypads. There was a full complement of domestic staff. Spot checks were undertaken to ensure standards were maintained and the risk of infection minimised. The home used cleaning products as recommended by the local NHS Clinical Commissioning Group. All staff had received training in infection prevention and control (IPC).

The home had a plentiful supply of all required PPE and staff were observed wearing this correctly. Staff had received links to videos advising how to put on and take off their PPE. This helped ensure a consistency of approach.

People and staff were tested in line with government guidance and were participating in the national Covid-19 vaccination programme. The home had secured people’s consent for this in line with the Mental Capacity Act 2005 (MCA). Where people did not have capacity to consent to Covid-19 related procedures contact had been made with relevant person’s including legal representatives.

The registered manager and provider understood the importance of supporting people and staff member’s mental wellbeing during the pandemic. People had individual Covid-19 risk assessments and had regular one to one sessions to keep socially stimulated. Staff were supported to shield where they had been identified as extremely clinically vulnerable. Where staff had experienced hardship, they had been supported to access a provider hardship fund.

The service was registered in January 2017 and this was therefore the first inspection of The Lindsay.

The Lindsay is a purpose built home and is registered to accommodate a maximum of 62 people who require either nursing or personal care. There were 31 people living there at the time of our inspection. The home is well equipped and has good communal facilities, which include a café, cinema and hairdressing salon.

The home was being led by an acting manager who confirmed that they had applied to be registered with the Care QualityCommission. They had previously been registered at another BUPA service. 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.

All of the people living at the home and visitors told us that they felt safe and well cared for. We received only positive comments about The Lindsay throughout our inspection. Staff were also positive about the home and the service they provided. They told us they felt well supported by the management team that was in place.

People told us that their care and support needs were met and that staff were kind, caring and respectful. People also said they felt safe and had confidence in the staff. There were appropriate numbers of staff on duty to meet people’s needs. People’s needs were assessed and plans were in place to ensure that 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 that there was always information for staff to refer to when providing care for people.

The provider had satisfactory systems in place to recruit and train staff in a way that ensured relevant checks and references were carried out and staff were competent to undertake the tasks required of them. The number of staff employed at The Lindsay, and the skills they had, were sufficient to meet the needs of the people they supported and keep them safe.

People were protected from harm and abuse wherever possible. There were systems in place to reduce and manage identified risks and to ensure medicines were managed and administered safely. Staff understood how to protect people from possible abuse and how to whistle blow. People knew how to raise concerns and complaints and records showed that these were investigated and responded to.

Observations and feedback from staff, relatives and professionals showed us that the home had an open and positive culture. There was a clear management structure in place. People and staff said was the acting manager was approachable and supportive.

There were systems in place to monitor the safety and quality of the service. This included the use of audits and surveying the people who used the service and their representatives.