We carried out an unannounced/unannounced comprehensive inspection of this service on 9 and 10 October 2014. Breaches of legal requirements were found. As a result we undertook a focussed inspection on 4 February 2015 to follow up on whether action had been taken to deal with the enforcement action we had taken.
You can find a summary of our findings from both inspections below.
Linden House is a detached house which provides personal care and accommodation for six adults aged 18 years and over with mental health disorders, physical and learning difficulties. The primary aim of Linden House is to help people maintain or increase their independence. Staff support people to take part in activities away from the home, help people to plan and complete tasks around their home and provide emotional and psychological support. Some people occasionally required the support of two staff whilst others only needed staff to be present some of the time. At the time of our visit there were six people living at the home and most had lived there for over two years.
Comprehensive inspection of 9 and 10 October 2014
At the time of this inspection the provider did not have a registered manager in post. 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 and associated Regulations about how the service is run. There had been no registered manager at Linden House since 2011 although managers had been appointed and had applied for registration with CQC they had left before they were registered with us.
People were not kept safe at the home. At times there were not enough staff with the right skills, knowledge or training working in the home to keep people safe and to meet their individual needs. Staff did not have access to an effective system of support or annual reviews of their performance to reflect on their roles and responsibilities or training needs. When new staff were appointed robust recruitment processes had not been followed to make sure all the necessary checks had been completed.
People did not receive an effective service. Their health care needs were not responded to effectively so that they did not receive the care, support and treatment they needed to keep healthy and well.
People’s care was not responsive to their individual needs. Their care plans did not reflect their changing needs. The care they received was inconsistent or they did not always receive the care and support they needed.
The leadership and management of the home failed to effectively monitor the care provided. Risks and concerns were not reacted to promptly. The provider had failed to notify the Care Quality Commission about incidents affecting the wellbeing of people living in the home.
People told us they enjoyed learning new skills so they could be more independent. They were supported to take part in activities of their choice which reflected their interests. People’s cultural and religious beliefs were considered when planning their day. We observed people receiving visitors and choosing where to spend time with them. People made choices and decisions about their day to day lives and discussed with staff their wishes for the future. People told us they liked the food and helped to plan and prepare meals. We observed staff patiently and sensitively supporting people, reassuring them when needed and helping them to become calm. People, their relatives, staff and visitors were asked for their views about the home.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and of the Health and Social Care Act 2008 (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report. Some of these breaches are outstanding because the provider told us they would not meet them until April 2014.
Focused inspection of 4 February 2015
After our inspection of 9 and 10 October 2014 the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches and the enforcement action we had taken.
We undertook a focused inspection to check that they had followed their plan and to confirm that they are now meeting legal requirements. We found that they had submitted notifications to CQC informing us about accidents and incidents which affected people’s health and well-being. CQC monitors events affecting the welfare, health and safety of people living in the home through the notifications sent to us by providers. The provider had also scheduled monthly visits to the home to monitor the quality of the service being provided.
People living in the home and staff had been involved in monthly visits by the provider, giving their views about the service provided and the changes which had been made. Staff told us there had been significant improvements to the management of the home and the safety and well-being of people living there. Written reports evidenced any issues highlighted and the actions taken to address these. The next quality assurance visit followed up on these actions to make sure they had been completed. Staff said provider quality assurance visits were scheduled to take place each month. Action to address the other breaches highlighted in this report were in hand and on course to be completed within the provider’s timescales.
People’s health care needs were being addressed. Staff had the knowledge and understanding to help people stay well. Staff had contracts of employment and were more confident about their roles and responsibilities.
Fewer incidents had occurred because staff felt more supported and had greater understanding about how to support people. Notifications had been submitted to the CQC appropriately about any accidents or incidents.
A manager had been appointed and had submitted an application for registration with CQC. The provider had made resources available to maintain and improve the service being delivered.