Archived: Linda Lodge

Updated 22 April 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by two inspectors working on site and one inspector working remotely.

Service and service type

Linda Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We met with local authority commissioning and safeguarding teams and with representatives from the local clinical commissioning group (CCG) to discuss concerns about the service. We reviewed information we already held about the service, including reports from previous inspections and data we received about a COVID-19 outbreak at the service. We used all of this information to plan our inspection.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke with the registered manager, deputy manager and eight members of staff including two members of agency staff working at the service. We spoke with three relatives of people who used the service. We checked eight people’s care records, three staff files and a range of other records including health and safety records such as cleaning checklists.

After the inspection

We met remotely with the registered manager and deputy manager to discuss the management of the service. We spoke with a healthcare professional who regularly visited the service. We continued to work alongside the local authority to share information about risks to people who used the service. We reviewed additional records we had asked the provider to send us.

Updated 22 April 2021

About the service

Linda Lodge is a residential care home providing personal care to 16 people aged 65 and over at the time of the inspection. The service can support up to 26 people in one adapted building

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

We were unable to speak with people who used the service during this inspection because 15 out of the 16 people had tested positive for COVID-19 and it was not safe for us to do so. We contacted people’s relatives by telephone and their feedback about the service was mostly positive. However, we needed to consider that the service had not been able to allow relatives inside for almost a year. Relatives may not have had an up to date impression of what the service was like at the time of the inspection as we found standards had deteriorated significantly since our previous inspection in December 2018.

The service was not safe. We found widespread and serious shortfalls in the prevention and control of infection. Staff did not always use PPE effectively, practise safe social distancing or complete cleaning tasks in line with current guidance. Waste and laundry were not always handled safely. People who tested positive for COVID-19 were not supported to self-isolate effectively.

Systems to assess and manage risks relating to both the home environment and individual people were not effective. We had particular concerns about risks relating to pressure ulcers and fire safety. Medicines were not always managed safely. There were no effective systems in place to follow up and learn lessons from incidents or safeguard people from abuse and neglect.

There were not always enough staff to support people safely and there was not an appropriate system in place to calculate appropriate staffing levels according to people’s needs. Recruitment systems were not robust enough to ensure all the necessary checks were completed on new staff as required by law.

The provider did not fully understand their responsibilities and statutory requirements in terms of leadership and governance. Managers did not undergo appropriate training to ensure their leadership skills and knowledge were up to date. The provider had not told us about things they are required by law to notify us of, such as deaths of people who used the service. However, we received positive feedback about the registered manager from staff and people’s relatives.

Record keeping was poor and systems did not allow the provider to maintain adequate oversight of the safety and quality of the service. The provider did not carry out or had not maintained a number of important safety and quality checks. They had therefore not identified several of the serious issues we found during our inspection or were not aware these were their responsibility.

When things went wrong or problems were identified, the provider did not always follow these up appropriately and there was no evidence of action taken to improve things. There were emergency contingency plans but these were ineffective and had failed to prevent a serious deterioration in several aspects of the quality and safety of the service when an outbreak of COVID-19 affected the home.

People’s needs were assessed before they started using the service but these assessments did not capture enough detail to produce person-centred care or ensure the service was able to meet their needs on an ongoing basis. People’s care and support did not always line up with current best practice and guidance. Staff did not always have up to date training and support to enable them to do this.

The provider did not always do enough to ensure people had enough to eat and drink from a choice of varied and nutritious food. Unplanned weight loss was not always followed up promptly. There was not sufficient evidence to assure us people consistently received the support they needed to manage long term health conditions, although people did have access to healthcare professionals when needed and the service worked well with healthcare providers when they identified the need to do so.

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 did not support this practice.

People’s care did not always take into account their individual preferences and needs. Care plans were task focused and the routine of the service was often based on staff convenience and time constraints rather than people’s preferences. People’s cultural and religious needs and communication needs were not always fully considered. End of life care did not consider all aspects of people’s preferences for the support they wished to receive at this time and information about this was not always gathered in good time for staff to be sufficiently prepared to provide personalised end of life care.

Staff enabled people to maintain relationships and contact with their relatives and loved ones as much as possible during the restrictions imposed on the service by the COVID-19 pandemic. We received positive feedback from people’s relatives about this.

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 15 January 2019).

Why we inspected

The inspection was prompted in part due to concerns received about infection control, staffing, risk of neglect including malnutrition and dehydration, and leadership. A decision was made for us to inspect and examine those risks. 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 initially undertook a focused inspection to review the key questions of safe, effective and well-led only. We also planned a targeted approach to look at only part of the responsive key question but during the inspection we found there was a concern with planning personalised care so we widened the scope of the inspection to include the whole of the responsive key question.

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

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive 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.

We received information from the provider after the inspection about action they were taking to reduce risks. However, we were not satisfied that this was sufficient.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Linda Lodge 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, need for consent, person centred care, safeguarding service users from abuse and improper treatment, good governance, staffing, fit and proper persons employed and notification of deaths and other events at this inspection.

After this inspection we wrote to the provider to tell them we intended to take urgent enforcement action unless we received assurance that people were no longer at immediate risk of harm. Although we were not assured by the provider's response to this, we were satisfied that the support given to the provider by the local authority was sufficient to keep people safe until the action we planned to take was complete.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from 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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.