7 August 2023
During an inspection looking at part of 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.