24 January 2023
During an inspection looking at part of the service
Lindau Residential Home is a residential care home providing accommodation for persons who require nursing or personal care to up to 37 people. The service was not providing nursing care, people’s nursing needs were met by community nurses. The service provides support to older people, some of who lived with dementia and one person had a learning disability. At the time of our inspection there were 24 people using the service.
People’s experience of using this service and what we found
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.
Right Support
Staff did not provide people with a learning disability effective support to identify aspirations and goals and assist people to plan how these would be met. There was not a consistent approach to supporting people to learn new skills or maintain their skills for as long as possible, where this was appropriate. Staff encouraged people to be independent as much as possible. People’s communication needs were not always met, directional signs were not in place to help people orientate in the service. Easy read signage providing information and reminders was not always available.
Some areas of the service were not clean. The service was undergoing a programme of redecoration and repair. However, some safety aspects had not been identified and mitigated prior to the inspection. The risk to people from access to hot pipes, items that could cause harm and risks arising from people's diagnosed health needs had not been addressed. The service provided people with care and support in well-equipped environment.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. We made a recommendation about this.
People prescribed 'as and when required' medicines did not always have the appropriate protocols in place to support staff to know how or when to administer these medicines. We made a recommendation about this. The service had systems and processes in place to safely administer and record medicines use. Medicines were administered in line with the prescription.
Right Care
People's care was not always person centred, some people did not have care plans and information about how staff could meet their needs. However, people told us they were treated with dignity and respect and their privacy was respected. People told us that staff were kind and caring. Comments included, “People [staff] are every so kind”; “It is brilliant here. The staff are lovely, they listen to what you want and say, they are always there” and “They are very good, kind and caring.”
Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough staff to meet people's needs and keep them safe. However, staff had not always had the necessary training to meet people's assessed needs. Training to work with people who lived with epilepsy had not been provided.
Right Culture
The provider's quality monitoring processes had not always identified concerns and improvements in the service. People, their relatives and staff had been encouraged and supported to provide feedback about the service. People and their relatives felt listened to.
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 19 September 2017).
Why we inspected
We received concerns in relation to the management of medicines, management of people’s mental health needs and infection control. 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. We have found evidence that the provider needs to make improvements.
After the inspection the registered manager provided assurances and some evidence to show that improvements had been made and were in progress.
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.
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 Lindau Residential Home on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified breaches in relation to risk management, planning and designing person centred care, good governance and notifications of incidents and events at this inspection. We have made a recommendation about the management of some medicines. We have made a recommendation about the management of MCA and DoLS.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.