St John of God Care Services Lindisfarne

St John of God Care Services Lindisfarne known as Lindisfarne Court is a residential care home providing personal care to 12 people at the time of the inspection, The service can support up to 13 people. The service comprises of three purpose built bungalows.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support

People were supported by staff to pursue their interests. People took part in activities at home and within their local area. Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcomes.

The service made reasonable adjustments for people so they could be fully involved in discussions about how they received support, including engagement and having a voice regionally within the registered provider. People in the service told us that staff supported them well to be independent. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life.

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.

Right Care

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so.

Right Culture

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. People’s care, treatment and support plans had clear guidance on what people’s goals and aspirations were. The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people’s views. We received positive feedback from people and their family members about the service. Staff members were positive about working at the service and felt supported by the manager and the provider.

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

Rating at the last inspection and update

The last rating for the service was outstanding, published on 28 April 2018.

Why we inspected

This inspection was prompted by a review of the information we held about this service and due to the length of time since the previous inspection. 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 outstanding to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for

St John of God Lindisfarne on our website at www.cqc.org.uk

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.

Follow up

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

We last inspected the service on 18 February 2016 and rated the service as Good. At this inspection we found the service had improved to Outstanding.

St John of God Care Services Lindisfarne [usually called Lindisfarne Court] care home provides accommodation with personal care for up to 13 people. The service provides care to people with learning disabilities, acquired brain injury and physical disabilities. At the time of this inspection there were 12 people living at the home, with one person in hospital.

The service had a registered manager in place. 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.

Staff were exceptional in their caring approach to people using the service and in their support to people’s families. People and relatives we spoke with told us the staff team were dedicated and wanted the best for people they were caring for. Healthcare professionals told us of the "tireless work" the service undertook to ensure peoples' rights were upheld.

We were told of how the service had supported people, their families and other people living at the home in an extremely caring way when someone had passed away this year. The registered manager continued to involve and offer support to this person’s family by inviting them to events at the home and maintaining meaningful contact with them.

Staff went out of their way to promote dignity and respect for people. Staff took exceptional pride in ensuring people’s personal care was carried out to the highest standards. Even when people had no verbal communication and limited understanding, we witnessed staff asking permission and talking with people all the time about what they were assisting them with.

The service had used an innovative recruitment drive since our last inspection and we saw that the registered manager had built a strong and consistent staff team. The recruitment had fully involved people using the service through the whole process from being involved in flyers to advertise vacancies to informing candidates when they had been successful in post. Morale amongst the staff we spoke with was very high and people, families and the staff team spoke of the outstanding leadership by the registered manager.

The registered manager was a passionate advocate for people in terms of promoting their health and well-being with other statutory services. Many people at the service had very complex healthcare needs. We saw how they and the staff team provided person centred care for people not just whilst people were at home but also if due to health needs they required hospital services. Everyone at the service was committed to supporting people to uphold their wishes and to ensure they received the best possible care wherever they were.

The service had worked to develop excellent community links and increased community presence for people. Feedback we received from professionals was highly praising of the registered manager and staff team and demonstrated supportive joint working arrangements.

Staff and the management team understood their responsibilities with regard to safeguarding and had been trained in safeguarding vulnerable adults. People we spoke with and their families told us they felt safe at the home.

Where potential risks had been identified an assessment had been completed to keep people as safe as possible. Accidents and incidents were logged and investigated with appropriate action taken to help keep people safe. Health and safety checks were completed and procedures were in place to deal with emergency situations.

Medicines were managed safely and administered to people in a safe and caring way. We saw that people received their medicines at the correct times.

We found there were sufficient care staff deployed to provide people’s care in a timely manner. Recruitment checks were carried out to ensure that staff were suitable to work with vulnerable people.

Staff received the support and training they required. Records confirmed training, supervisions and appraisals were up to date and forward planned. Staff told us they felt very supported by the management team at the service.

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.

People gave positive feedback about the meals they were served at the home. People received the support they needed with eating and drinking and people who had specialist dietary needs were closely monitored and supported by the staff team.

People’s needs were assessed before they came to live at the service by the management team and a transition plan put in place. Personalised care plans were then developed and regularly reviewed to support staff in caring for people the way they preferred.

The service had developed activities and worked with external organisations to provide people with access to social clubs and to access therapies to improve well-being.

The provider had an effective complaints procedure in place. People who used the service and family members were aware of how to make a complaint.

Lindisfarne Court provides care and accommodation for 13 people who require personal care in a residential area of Darlington. The people living at the service which comprises of three purpose built adjoining bungalows, have physical and some also have learning disabilities.

We last inspected the service on 7 November 2013, the service was not in breach of any regulations at that time.

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. The registered manager at Lindisfarne Court had worked at the service for over five years.

We observed the care and support people received as due to the nature of people’s disability, some people could not communicate directly with us and we spoke with two people who could communicate directly with us. We discussed safeguarding with staff and all were knowledgeable about the procedures to follow if they suspected abuse. Staff were clear that their role was to protect people and knew how to report abuse including the actions to take to raise this with external agencies.

There were policies and procedures in place in relation to the Mental Capacity Act and Deprivations of Liberty Safeguards (DoLS). The registered manager and staff had the appropriate knowledge to know how to apply the MCA and when an application should be made and how to submit one. This meant people were safeguarded.

The staff we spoke with told us that there were enough staff on duty to meet people’s needs. We saw that six staff plus the registered manager or senior support worker routinely provided support to people during the day with three staff being available throughout the night. The service told us they had staffing issues during 2015 and tackled recruiting difficulties with an innovative advertising campaign that had led to 11 new staff being employed.

We saw that staff were recruited safely and were given appropriate training before they commenced employment. Staff had also received more specific training in managing the needs of people who used the service such as medicines training and enteral feeding. Enteral feeding refers to the delivery of a nutritionally complete feed directly into the stomach.

Medicines were stored and administered in a safe manner.

There was a regular programme of staff supervision in place and records of these were detailed and showed the home worked with staff to identify their personal and professional development.

We saw people’s care plans had been well assessed. The home had developed care plans to help people be involved in how they wanted their care and support to be delivered. We saw people were being given choices and encouraged to take part in all aspects of day to day life at the home, from menu planning to planning holidays and activities.

Staff had a good awareness of people’s dietary needs and staff also knew people’s food preferences well. We saw everyone’s nutritional needs were monitored and mealtimes were well supported. We saw from records and talking with staff that specialist advice was sought quickly where necessary not only for nutritional support but any healthcare related concerns.

We observed that all staff were very caring in their interactions with people at the service. People clearly felt very comfortable with all staff members. There was a warm and caring atmosphere in the service and people were very relaxed. We saw people were treated with dignity and respect. People told us that staff were kind and professional.

We also saw a regular programme of staff meetings where issues where shared and raised. The service had a complaints procedure and staff told us how they could recognise if someone was unhappy and how to report it.

Any accidents and incidents were monitored by the registered manager to ensure any trends were identified. This system helped to ensure that any patterns of accidents and incidents could be identified and action taken to reduce any identified risks.

The service had a comprehensive range of audits in place to check the quality and safety of the service and equipment at Lindisfarne Court. They also sought the views of people using the service and their families on a regular basis and used any information to improve the service provided. This had led to the systems being effective and the service being well led.

Care plans were written from the point of view of the person using the service and two people we spoke with told us they had been involved in writing their care plans and reviewed them.

People were supported to have their nutritional needs met. One person told us; 'I like the choice you have here'.

The service had policies and procedures to ensure the safe recruitment of staff and people using the service and their families were also involved in the selection of new staff.

The service had a regular audit programme in place to make sure the service was safe and provided good quality care and support. People using the service and their families were regularly asked their views and how the service could improve.

There was a complaints process in place and people told us they could talk to the staff. One person told us they would speak up if 'something was going on'.