This inspection took place on 4 and 5 January 2018 and was unannounced. At our last inspection in October 2015 we rated the service as good and there were no regulatory breaches.During this inspection we found breaches of Regulations 12, 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had not done all that was reasonably practicable to mitigate risks to people including the safe administration of people’s topical medicines and the cleanliness of equipment used in the home. We found wheelchairs in the home were not being used in a safe manner. The audits carried out failed to identify these issues and records were not always up to date and accurate.
Lindisfarne Newton Aycliffe is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Lindisfarne Newton Aycliffe provides accommodation for up to 56 people across three separate units. One of the units specialised in providing care to people living with dementia. At the time of our inspection there were 51 people residing in the home.
There was a registered manager in post at the time of our inspection. 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.
We found there were safe arrangements in place for the storage and disposal of people’s medicines. People had been prescribed topical medicines (creams applied to the skin). Guidance had not been given to staff on the frequency topical medicines needed to be applied.
Whilst the home was clean and tidy throughout risks to reduce cross infection had not always been carried out. During our inspection the registered manager made arrangements to make improvements.
We observed wheelchairs were not being used appropriately. Foot plates were missing. The registered manager carried out an audit of the wheelchairs in use during our inspection to reduce the risks to people using the wheelchairs.
People had care plans in place which contained personalised information. These were reviewed on a regular basis.
The service had in place a number of audits for monitoring quality. These audits resulted in actions required to improve or sustain the service. We found some of the audits had not uncovered the deficits in the service.
Risk assessments were in place to manage the environment and people’s personal risks.
During our inspection we reviewed seven staff files. We found the provider carried out robust checks on prospective staff members before they were permitted to start working in the home. Staff had received an induction and were provided with continuous support through training supervision and appraisals.
People were protected from the risk of abuse because the staff in the home understood their roles and responsibilities to keep people safe. Actions had been taken if staff were concerned a person was at risk of harm.
There were regular checks carried out on the building. These included fire checks and the monitoring of hot water temperatures to prevent people from being scalded. Checks were also carried out on beds and bedrails.
Kitchen staff understood people’s dietary requirements and how to provide food to people who were at risk of losing weight. We carried out observations on lunchtime on each of the three floors. People who needed full support to eat were provided with the required support to eat at their own pace. People who needed their food cut up for them did not always eat their meal. Staff later encouraged them to eat food which would have gone cold. We recommended the service review the meal time arrangements.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
The service had communication systems in place to ensure staff were aware of and kept up to date on people’s needs. These included daily notes, appointment diaries and handover notes between shifts.
Staff spoke to us about people’s personal preferences and were able to demonstrate they knew and understood people’s likes and dislikes.
We found staff were alert to and responsive to changes in people’s daily healthcare needs. Any changes were documented in a notebook for a nurse who regularly visited the home to review.
Activities were provided in the home. We found activities were advertised but did not take place. Following the inspection the regional support manager told us this was an error and the advertised activities should have been taken down. Staff told us they did not always have the time to support people with activities. A second activities’ coordinator was due to start work. We recommended the provider reviews the delivery of activities in the home.
The provider had a complaints policy and procedure in place. Complaints which had been made about the service had been investigated by the registered manager. Complainants had received an outcome for their complaints.
The views of relatives about the service had been sought. These had been reviewed and the registered manager sent a letter out to relatives providing explanations and telling them what actions had been taken.
The registered manager reviewed the service and sent weekly reports to the regional support manager to demonstrate what actions had been taken to support people’s needs.
You can see what action we told the provider to take at the back of the full version of the report.