Archived: Linda Lodge

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.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the CQC 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.

People told us they felt they were safe living at Linda Lodge and they said they were treated with dignity and respect. Risk assessments were in place to minimise the potential risk of harm to people during the delivery of their care while still encouraging people to be independent.

Staff knew how to keep people safe and the staff members demonstrated a good knowledge of how to recognise abuse and how to report any concerns. Staff understood their responsibilities to safeguard people from abuse. Staff were aware of the provider’s whistleblowing procedures and told us they would not hesitate to report any concerns they might have.

There were systems in place for the safe storage, administration and recording of medicines. Each person's medicine was stored securely and trained staff whose competencies were assessed administered people’s medicines safely.

Staff were recruited safely with appropriate checks on their backgrounds completed. All staff had completed an induction programme and on-going training was provided to ensure skills and knowledge were kept up to date.

There were sufficient numbers of staff on duty for each shift at the time of this inspection.

Necessary improvements were underway with the provider’s infection control procedures. We saw areas of the service were clean and well maintained. Cleaning schedules were in place and staff had access to personal protective equipment when required.

People's healthcare needs were met and staff supported them to attend medical appointments.

People lived in a comfortable environment which was clean and free of hazards. They were able to personalise their bedrooms as they wished.

Staff had undertaken training in the Mental Capacity Act 2005 and were aware of their responsibilities in relation to people who might be deprived of their liberty. They ensured people were given choices and the opportunity to make decisions.

Throughout the inspection, we observed staff caring for people in a way that took into account their diversity, values and human rights. People were supported to make decisions about their activities in the home and in the community.

Information about how to make a complaint was available to people and their families, and they felt confident that any complaint would be addressed.

Work was being progressed to ensure people had a choice about what happened to them in the event of their death and that staff had the information they needed to make sure people’s final wishes would be respected.

There was a clear management structure at the service, and people and staff told us that the registered manager and deputy manager were supportive and approachable. There was a transparent and open culture within the service and people and staff were supported to raise concerns and make suggestions about where improvements could be made.

The provider had effective systems in place to monitor the quality of the service and where issues were identified, they were addressed promptly.

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

Linda Lodge accommodates up to 25 older people in one adapted building. Some of whom have mental health needs. At the time of this inspection there were 23 people living at the home with two vacancies.

The service has a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 the associated Regulations about how a service is run.

People told us they felt they were safe living at Linda Lodge and this was also the view of the relatives we spoke with.

People were at risk of not receiving sufficient levels of support that was appropriate to meet their needs. The care plan reviews we inspected did not reflect people’s personal preferences or any progress made with care plan objectives set out in earlier care plans. The deputy manager confirmed with us they would ensure all people’s care plans would be reviewed immediately together with people living in the home or their relatives. This is in line with the provider’s own policies and procedures. The deputy manager also told us that staff will receive additional training with this to ensure they fully understand their responsibilities and carry them out as required. The example above showed the provider was not assessing or mitigating risks to people’s safety effectively. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People and their relatives told us they thought there were enough staff to meet people’s needs. We looked at staff rotas and observed care being provided for people and we found there were sufficient levels of staff available to meet people’s needs. Relatives told us staff kept them well informed about people’s needs and preferences about their care.

People received their medicines as prescribed and staff knew how to manage medicines safely. Those people who were able to, took their medicines themselves with minimal assistance from staff.

Staff were suitably trained and supported to carry out their work effectively. The deputy manager told us that the provider’s training schedule helped to ensure all staff received appropriate training and support for their roles and their work in the home. We saw evidence of this. Staff told us they were well supported with appropriate training and were able to discuss any concerns or issues with the managers whenever they needed to do so.

People had a varied and nutritious diet and choice of meals. Staff supported people to keep healthy and well through regular monitoring of their general health and wellbeing.

During our inspection we saw people were treated with kindness and compassion. Our observations and discussions showed staff to have a good knowledge and understanding of the people they were supporting. Staff told us they enjoyed working with the people they cared for.

On a day to day basis people told us they were able to express their views and make decisions about their care and support. Staff told us people’s likes, dislikes and their preferences were seen by them as an important part of people’s care but this was not recorded in the care plans we inspected and there was no evidence this was a part of the care plan reviews.

Relatives of people were involved in developing their family member’s initial care plans and we saw people were supported to make decisions about their care and support.

People told us that there was a good range of activities provided for them. Relatives said they were always made welcome when visiting the service.

People using the service and their relatives were encouraged to give feedback to help to improve the service for people. The complaints system in place meant people’s complaints were dealt with effectively and people were satisfied with the outcomes.

Staff told us they were clear about their roles and responsibilities. They understood the ethos of the service which meant people living at Linda Lodge received a good quality service.

Systems were in place to monitor the safety and quality of the service and to get the views of people about the service. Where there were concerns about quality or safety, appropriate action was taken to address the issues identified.

Was the service safe?

People who use the services were treated with respect and dignity by the staff. They told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. There were mechanisms in place to help to safeguard people from the risks of abuse.

Systems were in place to make sure that the manager and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This has reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made.

The manager had ensured there were sufficient numbers of staff on duty, appropriately qualified to meet the support needs of people who used the services. This has helped to ensure that people's needs were met.

The manager set the staff rotas. They took people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. This has helped to ensure that people's needs are met.

Was the service effective?

People's health and care needs were assessed together with them, and they were involved in their care and support planning. People told us that they had been involved in their care and support plans and that the plans reflected their needs. One person said, 'I was asked about my care plan some time ago. I am looked after well, it's like a good hotel. I get everything I need; I wouldn't want to live anywhere else'. We inspected four people's care files. They included essential information about the person, needs and risk assessment information, care plans and records of health care appointments.

Was the service caring?

People who use the services were assisted by kind and supportive staff. We saw that staff showed patience and professionalism and gave appropriate encouragement when supporting people. The people we talked to said the staff treated them well and respected their wishes, dignity and privacy. One person said about their relative's care, 'my mother is well looked after here, she's been here for over a year now, long enough to know its good, actually they are all well looked after'.

We observed that staff knocked on the people's doors before entering their rooms and asked if it was convenient for them to go in. This reflected the caring environment that we found on the day of the inspection.

Was the service responsive?

Relatives of people who use the services told us that if a person's needs changed, their care and support would be tailored to those changed needs. We saw that care plans were reviewed regularly and changed appropriately. This was important as this helped staff understand what people wanted or needed or how they were feeling.

All the people who use the services we spoke with knew how to make a complaint. There was an appropriate complaints procedure in place and discussions we had with relatives and staff indicated that they would be supportive of anyone who needed to complain. People can therefore be assured that complaints would be investigated and action taken as necessary.

Is the service well-led?

The managers carried out regular checks to assess and monitor the quality of services provided and took appropriate action to address any issues or concerns raised about service quality.

The views of people who use the services, their representatives and staff were listened to by the managers. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home. This helped to ensure that people received a good quality service.

With regards to staff supervision a new policy and procedure had been drawn up and all staff had been made aware of this. We were shown information that set out the new policy and procedure. We also saw information that indicated all staff would start the new supervision in January 2014.

People who use the service told us they generally liked living at the home. People said the staff were friendly and knew what they liked. However, some people said they would like to have more activities to do.

We found that people were at risk where their needs had not been fully identified and planned for. The deployment of staff at the home meant there was not enough staff to ensure that the regulated activity was being carried out and that the needs of the people who use the service were not being adequately met. The service did also not have any systems for monitoring the quality of the service provided to people.