Linford Grange

Linford Grange is a residential care home providing personal care to 13 people at the time of the

inspection. The service can support up to 20 people. The service supports a wide range of people including older people, people living with dementia and a learning disability.

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

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.

Right Support:

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.

People received care and support to maintain an environment that suited their needs and preferences. Staff supported people to make decisions following best practice in decision-making.

Staff supported people to access health and social care services. Staff supported people with their

medicines safely and in their preferred way.

Right Care:

Risks were fully assessed within people’s lives and staff worked safely with people.

People received care that was person-centred. Staff communicated with people in ways that met their individual needs.

Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it. The service employed skilled staff to meet people's needs and keep them safe.

Right Culture: The ethos, values, attitudes and behaviours of the management team and staff team ensured people lead confident, inclusive and empowered lives.

People received good quality care and support because trained staff and specialists could meet their needs and wishes.

People and those important to them, including social care professionals, were involved in planning their care. The manager and the staff team ensured people received support based on best practice, respect and inclusivity.

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 requires improvement published 10 August 2021.

Why we inspected

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.

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 requires improvement 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 Linford Grange on our website at www.cqc.org.uk.

Follow up

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

Linford Grange is a residential care home providing personal and nursing care to 14 people at the time of the inspection. The service can support up to 20 people. The service supports a wide range of people including older people, people living with dementia and a learning disability.

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

There were ongoing improvements being made to the premises to make them safe and suitable for people using the service. The manager prioritised the improvements needed to the laundry room to reduce the spread of infection. Staff wore appropriate PPE. There was regular COVID-19 testing and the government guidance had been followed.

People felt safe although further action was needed to promote their safety. Risk assessments and care plans had been updated to provide clear guidance for staff to follow. People received their medicines safely. Staff were trained to administer medicines and their competency continued to be assessed.

The staff recruitment processes had been strengthened to ensure pre-employment checks were carried out in full. People told us there were enough staff available to support them although on occasions there had been some delay.

Staff had completed safeguarding training and recognised the signs of abuse and knew how to report concerns of potential abuse or poor practice.

The manager had begun the process to be registered with the Care Quality Commission (CQC). People, relatives and staff spoke positively about the manager, who they described as approachable, supportive and addressed issues as soon as practicable.

The manager had identified improvements were needed to the service as the quality monitor oversight and governance systems had not been used effectively. A service improvement plan was developed, which covered all aspects of the service. Some improvements had been made to reduce risk to people’s safety however, further action was needed to fully embed these.

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.

The service was not fully able to demonstrate how they were meeting some of the underpinning principles of ‘Right support, right care, right culture’. This was because the service supported people with a range of needs and staff required further training to support people with a learning disability and autism. Care plans were being updated and personalised to enable staff to promote people’s dignity, rights, and support them to lead confident and inclusive lives. The provider was committed to investing in the service to improve the environment to promote people’s safety and wellbeing.

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 requires improvement (published 6 November 2019). 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. The inspection was prompted in part due to concerns received about risks to people, medicines management and leadership of the service. We decided to inspect and examine those risks. This report only covers our findings in relation to the key questions of Safe and Well-Led which contained the requirement.

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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained the same. 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 Linford Grange our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Linford Grange is a residential care home providing personal care to 14 people at the time of the inspection. The service can support up to 20 people. The service supports a wide range of people including older people, people with learning disabilities, and people with brain injuries.

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

The registered manager had not always notified the Care Quality Commission (CQC) of certain events as required by law.

The environment was not always safe. A fire escape was blocked with equipment and a fire door had been propped open, preventing it from closing. Wardrobes were not secured to walls, preventing them from falling over. Audits had not picked up on these issues.

Recruitment procedures were not always robust. Appropriate checks and assessments were not always carried out to ensure all staff were of suitable character to work with vulnerable people.

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.

Staff we spoke with understood safeguarding procedures and how to raise concerns and felt confident their concerns would be followed up. Risk assessments were in place to manage risks within people’s lives, and staff we spoke with felt safe supporting people with a wide range of needs.

Medicines were stored and administered safely, and people we spoke with were happy with the support they received in this area. Staffing support matched the level of assessed needs within the service during our inspection, and staff were trained to support people effectively. All staff felt well supervised and confident in their roles.

People told us they enjoyed the food prepared for them, and support was given to people to eat in communal areas or within their own rooms.

Healthcare needs were met, and people had access to health professionals as required. Care plans outlined any support people required to manage their healthcare needs. People's consent was gained before any care was provided, and they were supported to have maximum choice and control of their lives.

Staff treated people with kindness, dignity and respect and spent time getting to know them. People were supported in the least restrictive way possible. Care plans reflected people likes, dislikes and preferences. People were engaged with by staff and had the opportunity to take part in activities.

People and their family were involved in their own care planning as much as was possible, and a complaints system was in place and was used effectively.

The manager was open and honest, and worked in partnership with outside agencies to improve people’s support when required. The service had a registered manager in place, and staff felt well supported by them.

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 (9 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to Regulation 18 – Notification of other incidents, of the Care Quality Commission (Registration) Regulations 2009.

Please see the action we have told the provider to take at the end of this report.

Since the last inspection we recognised that the provider had failed to notify us of certain incidents they are required to. Notifications are information that the provider is required to send us by law. This was a breach of regulation. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Linford Grange provides accommodation and personal care for up to 19 people. The service provided this support to a wide range of people including people with learning disabilities, older people, people with physical disabilities, and people with mental health support needs. The residential service contained rooms, apartments, and self-contained flats that people lived in.

At the time of our inspection the provider confirmed they were providing personal care to 16 people.

There was a registered manager in post. 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 had an excellent understanding of abuse and the safeguarding procedures that should be followed to report abuse. The staff we spoke with were confident that if they reported anything of concern, it would be followed up promptly and efficiently. People had risk assessments in place that were personalised to cover the risks that were present in their lives. This enabled them to be as independent as possible.

Staffing levels were adequate to meet people's current needs. There were enough staff deployed to make sure people received the support they needed, and had the opportunity for one to one time with staff.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service.

Induction and on-going training was provided to ensure staff had the skills, knowledge and support they needed to perform their roles. Staff were able to access a wide variety of training and qualifications. Staff valued their training and felt that it improved their working practice.

People told us that their medicines were administered safely and on time. We saw that the medication administration systems in place were accurate and well maintained.

Staff were well supported by the registered manager and senior team, and had regular one to one

supervisions. Staff reported that they felt confident in their roles due to the support they received from their seniors, and could get support and help when they needed it.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 were met. People told us that staff gained their consent before providing support, and consent forms were signed.

People were able to choose the food and drink they wanted and staff supported people with this. People enjoyed the food on offer, and we saw that fresh food was cooked daily, and people had a choice of what they could eat.

People were supported to access health appointments when necessary. Health professionals visited people within the service for a variety of needs, and good relationships were formed between the service and health services in the community.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. The staff and management team displayed a complete respect for all the people living within the service, and had an excellent understanding of each person’s needs, personality, and background.

People were involved in their own care planning and were able to contribute to the way in which they were supported. People told us they were regularly consulted about their care, who would be supporting them, and what was happening.

The service had a complaints procedure in place to ensure that people and their families were able to provide feedback about their care and to help the service make improvements where required.The people we spoke with knew how to use it.

Quality monitoring systems and processes were used effectively to drive future improvement and identify where action was needed