Link House

Link House is a residential care home that can provide nursing and personal care for up to 52 people. At the time of our inspection 49 people were living at the care home. The building comprising of 3 separate floors, each of which has its own separate adapted facilities. The service provides support to older people, most of whom are living with dementia. Approximately half the people residing at the care home have nursing needs.

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

People living at the care home and staff working there all told us the service had improved in the last 12 months and was now well-led by the newly registered manager and the area manager. 1 person said, “I am very happy living here and I think the new managers have done a really good job improving things for everyone who lives and works here.”

At our last inspection we found the provider had failed to always ensure people were not placed at risk of harm. This was because the care home was inconsistently led as they continued to experience high levels of management turnover and had been without a registered manager for well over a year. We also found staff did not always have access to clear enough guidance in relation to how to keep people safe from identified risks they might face and how their prescribed medicines were stored. Furthermore, staff did not always have the right level of training and support they needed to effectively perform their roles and responsibilities.

At this inspection we saw enough improvement had been made by the provider in relation to the way the care home was now led by suitably competent and skilled managers, how staff prevented and managed risks people might face, safely stored medicines, were trained and supported, and how they operated their established governance systems.

People were kept safe and were confident any concerns they raised would be listened to. Staff understood how to safeguard people. People were cared for and supported by staff who knew how to manage risks they might face. The premises were kept hygienically clean and staff followed current best practice guidelines regarding the prevention and control of infection including, those associated with COVID-19. Medicines systems were well-organised, and people received their prescribed medicines as and when they should. The service was adequately staffed by people whose suitability and fitness to work there had been thoroughly assessed.

Staff had the right levels of training, support and experience to deliver effective care and support to people living in the care home. People had access to a wide variety of food and drink that met their dietary needs and wishes. People were helped to stay healthy and well. 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 lived in a suitably adapted care home that had been decorated and furnished to a very high standard.

People living at the care home and staff working there were all complimentary about the way the relatively new managers ran the service, and how approachable they both were. The provider promoted an open and inclusive culture which sought the views of people living there, their relatives, community-based professionals and staff. The provider worked in close partnership with various community-based health and social care professionals and agencies to plan and deliver people's packages of care and support.

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 14 April 2022) and there was a breach of regulation.

Why we inspected

We carried out an unannounced focused inspection of this service on 14 April 2022. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show us what they would do and by when to improve how staff prevented and managed risks people might face.

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 and issues we discussed with the provider at their last inspection.

We also 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.

Based on the findings at this inspection we found improvements had been made and the provider was no longer in breach of regulation. The overall rating for the service has therefore changed from requires improvement to good.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Link House 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. If we receive any concerning information, we may inspect sooner.

People’s experience of using this service

The care home remained inconsistently led. This was because as identified at the care home’s last inspection, the provider still did not have a manager registered with us and had continued to experience higher than expected rates of manager turnover.

The care home was not always safe. We found some people had been placed at risk of harm, as staff did not always have access to clear guidance on how to keep people safe. Medicines were not always stored safely.

The care home was not always effective. This was because staff did not always have the right levels of training and support they required to effectively meet people’s needs and keep them safe. We discussed these staff training and support issues with the new managers at the time of our inspection, who showed us an action plan they had already developed and started to implement to ensure all staff were adequately trained, supported and appraised by 1 May 2022. Progress made by the provider to achieve these stated goals will be closely monitored by the CQC.

The care home had experienced a staffing level crisis during the winter due to staff pressures associated with COVID-19 but were now adequately staffed. The new manager told us they planned to increase staffing numbers on duty across the day from 1 April 2022. The provider had put adequate measures in place to mitigate risks associated with these staff pressures. Prospective new staff continued to undergo robust pre-employment checks to ensure their suitability for their suitability and fitness to work in the care home.

People were protected against the risk of abuse and neglect. Staff followed current best practice guidelines regarding the prevention and control of infection, including those associated with COVID-19.

Assessments of people’s support needs and wishes were carried out before they moved into the care home. 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 were supported to access food and drink that met their dietary needs and wishes. People were supported to stay healthy and well, and to access relevant community health and social care services as and when required. People lived in a suitably adapted, decorated and furnished care home that was well-maintained.

People living in the care home, their relatives and staff were all complimentary about the way the relatively new management team now ran Link House, and how approachable and accessible they were. The quality and safety of the service people received was routinely monitored by the new management team who clearly recognised the importance of learning lessons when things went wrong. The manager promoted an open and inclusive culture which sought the views of people living in the care home, their relatives and staff who worked there. The provider worked in close partnership with other external health and social care professionals and agencies to plan and deliver people’s packages of care.

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

Rating at the last inspection

The last overall rating for this service was good (published 6 January 2021), but requires improvement for the well-led key question.

Why we inspected

At our last inspection we discussed with the provider issues they experienced retaining competent staff to manage the care home. We continued to receive concerns in relation to how the service was managed. 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.

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 read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Link House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

At this inspection we found the provider still needs to make improvements in relation to having a manager registered with us. We also identified a breach in relation to how the provider assessed, prevented and managed identified risks people might face. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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

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.

Link House is a residential care home that was providing personal and nursing care to 40 people aged 65 and over at the time of our inspection. The care home can support up to a maximum of 52 people. The premises are purpose built and is divided into three separate units/floors, each of which has separate adapted facilities. Approximately half the people currently residing in the care home are living with dementia.

The service has also been identified for use by the Local Authority as a designated care setting in response to the Winter Plan for people discharged from hospital with a positive Covid-19 status. This 13 bedded ground floor unit, now known as the Temporary Alternative Discharge Destination (TADD), has been designated solely for use by people discharged from hospital with a positive Covid-19 status. Two people were using the TADD unit at the time of our inspection.

People’s experience of using this service

People told us they were happy with the standard of care and support provided at this care home.

However, we received mixed comments from people about the higher than expected turnover of managers the service had experienced in the last 21 months.

We discussed this management issue with the provider at the time of our inspection who acknowledged Link House had experienced difficulties retaining registered managers since they took over in April 2019. However, the provider is confident with a newly appointed manager starting soon in Mid-December 2020, this will ensure the service is more consistently managed moving forward. Progress made by the provider to achieve this aim will be closely monitored by the Care Quality Commission (CQC).

People were cared for and supported by staff who knew how to manage risk and keep them safe. The premises were kept hygienically clean and staff followed relevant current best practice guidelines regarding the prevention and control of infection. Medicines systems were well-organised, and people received their prescribed medicines as and when they should. The service was adequately staffed by people whose suitability and fitness to work in an adult social care setting had been properly assessed.

The provider ensured staff had the right levels of training and support they needed to deliver effective care to people living at Link House. 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 lived in a suitably adapted care home that met their needs. The care home had recently been totally refurnished and decorated to a good standard. People were supported to access food and drink that met their dietary needs and wishes. People were supported to stay healthy and access relevant community health care professionals as and when required.

People were treated equally and had their human rights and diversity respected. Staff treated people with respect and dignity and upheld their right to privacy. People typically described the staff as “caring” and “kind”. People were encouraged and supported to maintain their independent living skills. People were encouraged to make informed choices about the care and support they received.

People's electronic care plans were person centred, which helped staff provide them with personalised care and support. Staff ensured they communicated and shared information with people in a way people could easily understand. People were encouraged to make decisions about the care and support they received and had their choices respected. People were supported to participate in activities that reflected their social interests and to maintain relationships with family and friends to avoid social isolation. People’s concerns and complaints were listened to and investigated by the provider. When people were nearing the end of their life, they received compassionate and supportive care.

The provider recognised the importance of learning lessons when things went wrong and were keen to continuously improve the service. The quality and safety of the service people received was routinely monitored by managers and nursing staff at both a provider and service level. The provider promoted an open and inclusive culture which sought the views of people using the service, their relatives and staff. The provider worked in close partnership with other health and social care professionals and agencies to plan and deliver people’s packages of care and support.

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

Rating at the last inspection

The last overall rating for this service was good (published 4 September 2018). Since that rating was awarded the registered provider of the service has changed. This was the first overall rating under the new provider since its reregistration in April 2019. The overall rating for the service remains good.

This newly registered service has been inspected once before in October 2020 but was not rated because we undertook a targeted thematic inspection that looked specifically at their infection prevention and control measures. We were assured at the time the service met good infection prevention and control guidelines.

Why we inspected

The inspection was prompted in part due to concerns received about the high turnover rate of managers running this service since it reregistered with us. A decision was made for us to inspect and examine those risks.

Follow up

We will continue to monitor the service and information we receive about them. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

In-person visits to the care home by family and friends were only allowed in exceptional circumstances. Alternative forms of maintaining social contact were used for visiting, which included video and phone calls. Where visits were permitted, for example for people at the end of their life, there were clear visiting procedures in place to prevent onward transmission of the virus. We observed essential visitors to the service were asked to wear appropriate personal protective equipment (PPE), have their temperature checked and to wash their hands before being allowed into a unit.

The 13 bedded unit the service had designated in response to the Winter Plan for people discharged from hospital with a positive Covid-19 status was self-contained and physically separated from the other two units. For example, access to this unit, now known as TADD (Temporary Alternative Discharge Destination), would be restricted to staff who needed to enter to perform their duties. Managers told us staff, including their own bank staff, were only allowed to work in a single designated unit within the care home and no other unit or care home. Managers also confirmed the service did not currently use any agency staff. People were accommodated in single occupancy bedrooms, each with their own en-suite bathroom and toilet facilities.

There were suitable arrangements in place to ensure patients discharged from hospital and people from the community were all tested for COVID-19 before being admitted to the service. Any new admissions were isolated for 14 days within their own room. People living in the care home were tested at least monthly and staff weekly for COVID-19 or without delay if they or anyone in their own household bubble became symptomatic. Managers knew how to apply for coronavirus testing kits for people living in the care home and staff.

We observed staff using PPE correctly and in accordance with current guidance. Staff had received up to date internal and external training in relating to COVID-19, infection control and wearing PPE. There were clear arrangements for putting on and taking off (donning/doffing) PPE, including designated areas for this and relevant signage conspicuously displayed throughout the service. The service had adequate supplies of PPE. Managers told us staff handovers at the end of each shift were done virtually on electronic handheld devices.

The premises looked clean and hygienic throughout. There was a designated lead for cleaning and decontamination within the service who demonstrated a good understanding of their infection prevention and control (IPC) role and responsibilities. Domestic staff had cleaning schedules to follow, which included the routine cleaning of high touch areas such as handrails, light switches, door handles and mobile hoists. There were laundry processes so clothes were not mixed and washed together, and the laundry room was subject to daily enhanced cleaning.

Infection risks to people living at the care home and staff working there were thoroughly assessed and managed. There was a designated infection prevention and control lead who demonstrated good awareness of their role and responsibilities. For example, they supported people and their relatives to understand the isolation processes and how the service could help to alleviate them feeling lonely.

There were a range of policies and procedures which had been reviewed and updated since the pandemic started. These included contingency plans for managing adverse events, such as COVID-19 outbreaks and related staff shortages. The provider regularly monitored and audited compliance with the infection prevention and control measures they had put in place. For example, managers routinely carried out daily tours of the building to check the premises were kept clean and staff wore their PPE correctly.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.