Linwood

Linwood is a residential care home for up to 67 in one adapted building across three floors. Linwood provides care to older people who may have a physical disability or may be living with dementia. On the day of the inspection there were 44 people living at the service.

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

People’s medicines and risks associated with their care were not always managed in a safe way.

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.

Care was not always provided that met people's individual and most current needs. This included the lack of accurate care plans, the lack of activities for people and the environment not set up to meet the needs of people living with dementia. Staff were not always familiar with people’s needs and supervisions were not taking place with staff to assess their performance. Although there were sufficient numbers of staff, they were not always deployed effectively to ensure good delivery of care. We have made a recommendation around this.

We observed examples of people not always being treated with respect and dignity. Although people and their families did feedback there were staff that were kind and caring. People and relatives fed back they were not happy with the quality of the meals although there were steps being taken to address this. People choices around care delivery and meals choices were not always considered. We have made a recommendation around this.

There was not always a record of the investigation into complaints that had been made. We have made a recommendation around this. There were other complaints that had been addressed to the person and relatives’ satisfaction. There was a lack of communication between staff at the service which was impacting on the delivery of care. The provider had not ensured systems and processes were established and operated effectively. Audits were not always identifying areas that required improvement. People fed back they liked the manager who had recently joined and could see they were making positive changes at the service.

Rating at last inspection and update

The last full rating for this service was requires improvement (published 8 October 2019). We undertook a focused inspection more recently however we only looked at Safe and Well Led. Both of these domains were rated good (published 13 July 2021)

Why we inspected

The inspection was prompted in part due to concerns received about the management of medicines, staffing and incidents of accidents and incidents. 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 have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, 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. After the inspection the provider took action to mitigate risks to people.

Enforcement and Recommendations

We have identified breaches in relation to the safe management of medicines and risks to people’s care, lack of detailed care planning and activities and the requirements of the mental capacity act. We found breaches in relation to people not always being treated with dignity and respect, staff not being supervised in their role and lack of robust governance at 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 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

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

Linwood is a residential care home for up to 67 in one adapted building across three floors. Linwood provides care to older people who may have a physical disability or may be living with dementia. On the day of the inspection there were 46 people living at the service.

People’s experience of using this service:

People told us they felt safe with staff at the service. Staff were aware of what they needed to do if they suspected abuse and the registered manager took robust action if any concerns were raised. There were sufficient staff at the service to support people with their needs.

Staff were aware of the risks associated with people and ensured they were provided the most appropriate care. Safety checks were undertaken at the service and there were plans in place to protect people in the event of a fire. People received their medicines when needed.

People and staff said that the leadership at the service was good and that they felt supported. People were given opportunities to feedback how they wanted their care to be delivered. Audits regularly took place to look at the quality of care.

Rating at last inspection:

The last rating for this service was Requires Improvement (published 1 October 2019). However, there were no breaches of regulation.

Why we inspected:

We undertook a focused inspection to look at concerns we received that related to people not being protected from the risk of abuse. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Well Led sections of this full report.

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.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner. We will continue to work with the local authority to monitor progress.

We found the following examples of good practice.

Staff had created badges with their names and a recent photograph of themselves. This meant that people could be reassured who was supporting them when staff were wearing masks.

The provider had employed ‘Welfare Assistants’ at the start of the pandemic to ensure people were able to engage in meaningful activities, such as one-to-one activities, when community access was limited due to COVID-19 restrictions.

Linwood is a residential care home that was providing personal care to 41 people aged 65 and over at the time of the inspection. The service can support up to 67 people. Linwood accommodates 41 people in one adapted building across three separate floors, each of which has separate adapted facilities. One of the floors specialises in providing care to people living with dementia.

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

People were happy and cared for by a friendly and supportive care team. The home had a warm atmosphere which enabled people to enjoy the gardens and socialise. The first floor was in the process of being developed and adapted to meet the needs of people with dementia, but the improvements had not impacted positively upon people yet. The registered manager’s plan to improve this area was being implemented at the time of the inspection.

People told us they felt there were enough staff to support them. Staff were knowledgeable about risks and how to support people safely. People’s medicines were managed and administered safely and people’s healthcare needs were met. Staff had received training and supervision for their roles and staff spoke positively about the support they got from management.

People and staff said they got on well with the management team and had confidence that any issues they raised would be addressed. There were systems to involve people in their care as well as in the running of the service. People were consulted on food and activities and we received positive feedback on these aspects of their care. There were a variety of activities at the service as well as outings, events and regular fundraising initiatives the provider was involved with.

The management team had successfully implemented the majority of the action plan for improvement since the last inspection.

Rating at last inspection

The last rating for this service was Inadequate (25 Jan 2019).

Since this rating 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

This was a planned inspection based on the previous rating.

Follow up

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

Linwood 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.

Linwood accommodates up to 67 people in one purpose built building. The service provides residential care to older people with physical disabilities and long term medical conditions. They also provide support to people living with dementia. At the time of our visit, there were 54 people living at the home.

There was not a registered manager in post. The manager had been recently recruited and was in the process of registering with CQC. 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.

People told us that the staff who supported them were not always kind or caring. We heard examples of staff being rushed, failing to interact with people or not being kind. We observed instances where staff did not consider how best to protect people’s dignity and where people had made specific requests, they had not been responded to. There was a lack of interaction and staff did not always respond to changes in people’s wellbeing and circumstances.

There was not a positive culture at the service. Staff felt unsupported by management and recent changes had been implemented in a way that had impacted upon people negatively. People, relatives and staff told us that there were insufficient numbers of staff deployed to meet people’s needs. Where this had been raised repeatedly, it had not been addressed and people’s experience had not changed. The information about people’s needs that was used to calculate staffing numbers was not accurate.

People’s concerns were not responded to and records of complaints were not accurate. There were a variety of checks and audits taking place, but they did not identify shortfalls in risk management and record keeping that this inspection identified. Staff were not receiving regular one to one support and training to support them in their roles. There was a lack of systems to encourage communication between staff.

Risks to people were not always safely monitored. We identified inconsistencies and shortfalls in charts to monitor risks and where plans were made to reduce risks, we identified instances where the measures were not being followed. People’s care plans sometimes lacked information about how they liked to receive their care, their preferences and needs relating to medical conditions. The records relating to people’s healthcare appointments were inconsistent and lacked accuracy.

People told us they sometimes felt bored and whilst there was a programme of activities in place, we identified missed opportunities to involve people. People’s wishes and preferences regarding end of life care were not always documented and where people had specific clinical needs, records relating to these were not clear for staff.

Staff understood how to respond to safeguarding concerns and the provider kept a record of any incidents or accidents which they monitored. The home environment was suited to people’s mobility needs and there was a plan to improve communal areas for people living with dementia. We saw positive examples of work with the local community which was impacting positively on people at the service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Linwood is a residential care home providing support to up to 67 older people across three floors. At the time of our inspection, there were 59 people living at the home, many of whom were living with dementia.

Our last inspection was in April 2016 where we found breaches of regulations. We found that risks to people were not being managed effectively and the care that people received was not always person-centred. At this inspection, the provider had made the necessary improvements to meet the requirements of the regulations.

There was not 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. The manager had recently left and the provider was in the process of recruiting a new manager.

Risks to people were assessed and staff identified plans to keep people safe. The provider carried out checks to ensure that the environment was safe for people. There were systems and plans in place to keep people safe in the event of an emergency.

Where any accidents or incidents occurred, staff took action to prevent the same incident happening again. Staff understood their roles in safeguarding people from abuse and took appropriate action when required. People’s legal rights were protected because staff followed the Mental Capacity Act (2005).

The provider carried out appropriate checks to ensure that staff were suitable for their roles. There were sufficient numbers of staff present to meet people’s needs. We did note an inconsistency in care on one unit and one time of day. We recommended that the provider reviews their staff deployment in this area.

People’s care plans were person centred and reflected their needs and interests. People’s records were up to date, except in two instances where recent information had not been added to people’s care plans. We recommended that the provider reviews their systems for updating records.

People had access to healthcare when they needed it. Where healthcare professionals were involved, staff worked alongside them to meet people’s needs. People’s medicines were managed and administered safely by trained staff.

Staff had the training that they needed to carry out their roles. Staff told us that they felt supported and had regular supervision meetings with their line managers. Staff were involved in the running of the home through regular meetings and the provider had effective communication systems in place.

We observed a number of caring interactions throughout the inspection. People were supported by staff that knew them well and promoted their independence. Staff respected people’s privacy and dignity when providing care to them. People were offered choices and staff involved people in their care.

People were given food in line with their preferences and dietary requirements. Important information on people’s diets was in their care records. There was a range of activities taking place at the home and the home and garden environment provided people with areas where they could spend time.

People’s feedback was regularly sought by the provider. Where people raised complaints, these were responded to appropriately. The provider carried out regular checks to ensure the quality of the care that people received. Where any areas for improvement were identified, these were actioned by staff.

We previously carried out an unannounced comprehensive inspection of this service on 11 June 2015. At that inspection a number of breaches of legal requirements were found. As result the service was rated inadequate overall and the provider was placed into special measures by CQC. In addition to making a number of legal requirement actions for the service to improve, we also issued two Warning Notices which required the provider to take immediate action in relation to staffing levels and the governance of the home. We undertook a further focussed inspection on 28 September 2015 which found that the provider had taken immediate action to rectify the serious concerns we raised about the service in June 2015. Improvements to staffing levels and the way the home was being managed meant that the provider had complied with the Warning Notices we had issued. We also saw that work was continuing to address the other breaches in legal requirements, although we also identified some new breaches in respect of the way medicines were managed, recruitment processes and the standard of record keeping within the service.

Since our last inspection we have continued to engage with the provider. We asked the provider to submit regular action plans that updated us about the steps they had taken to improve the service. This inspection confirmed that the provider had taken the action they told us they had. Significant improvements to the way the home was being managed meant that the provider had complied with the requirements we had previously issued and we have now taken Linwood out of Special Measures.

The service 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 2008 and associated Regulations about how the service is run. A new manager had been appointed in February 2016 and was in the process of registering with the CQC.

Since our last inspection, the service had experienced a period of considerable change. Whilst it was evident that the quality of care had improved, the new leadership of the home now needed to be embedded and sustained. In particular, we highlighted that communication was not always effective across the service and the manager required greater support from those working below him to ensure changes were delivered effectively and consistently across the service.

Each person had a plan of care, however risks to people had not always been appropriately assessed and managed. For example, one person who had recently moved to Linwood had not been properly assessed either prior or post admission. As such staff were supporting this person with only limited information about their needs. We also found that plans in place to support staff to evacuate people in the event of an emergency did not reflect people’s individual needs.

Whilst staff had a greater understanding about the need to involve people in decisions about their care and gain consent, they lacked a good understanding of the Deprivation of Liberty Safeguards. As a consequence people were not always cared for in the least restrictive way.

We found that people were supported to have better choice and control over their care, but that their social needs were not always met. Whilst the service had a programme of activities available, this did not always match people’s own expectations and provide them with sufficient opportunities to engage in activities that were meaningful to them. Staffing levels had improved and were now sufficient to provide safe care. People reflected however that they wished staff had more time to sit and chat with them.

Staff felt well supported by the new manager and had access to regular supervision and staff meetings. Whilst staff completed a range of mandatory training courses, not all staff had the necessary experience and confidence to support people living with a dementia type illness.

The service now had good systems in place to safeguard people from the risk of harm. Appropriate checks were undertaken to ensure suitable staff were recruited and staff understood their role in protecting people from the risk of abuse.

The service had a relaxed and friendly atmosphere. Staff were kind and caring towards people and upheld their privacy and dignity at all times. Staff had a good understanding of people’s needs and engaged with and supported them effectively.

People were supported to maintain good health and appropriate referrals were made to involve other healthcare professionals in a timely way. Most people told us that they had choice and control over their meals and were effectively supported to maintain a healthy and balanced diet.

The service had taken appropriate steps to address the previous concerns with regards to the management of medicines. There were now processes in place to ensure people received the right medication at the right time.

Systems for monitoring quality and auditing the service had recently improved and were being used to continually develop the service. There were now effective systems in place to ensure that when people raised issues that they were listened to and that complaints were investigated thoroughly.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of this report. We have also made two recommendations in relation to areas in which the provider may wish to consider making additional improvements to the service.

Our inspection team was made up of two inspectors. We asked our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw that people were treated with respect and in a dignified way by the staff.

People and their relatives told us they felt safe.

There were systems in place to record accidents and incidents, complaints, concerns, whistleblowing and investigations.

We saw the service was safe, clean and hygienic.

Recruitment practices were safe.

Is the service effective?

People's health and care needs were assessed with them.

Specialist dietary, mobility and equipment needs had been identified and implemented in care plans where required.

People's needs were taken into account with the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical impairments.

Is the service caring?

People were supported by kind and attentive staff. We saw staff gave encouragement when supporting people. People commented, "This is a good home with kind staff.' A relative said, 'I am happy with the care and support that is given to my family member.'

A sample of people who used the service and their relatives, involved with the service completed monthly satisfaction surveys. This was because the manager was new to the home and wanted to monitor progress. Where shortfalls or concerns were raised these were addressed.

Feedback and comment forms were available in reception. We saw a selection of comments made for March, April and May this year. These comments included 'Staff friendly and welcoming' and 'Linwood is a very professional place.'

Staff were able to tell us about the people they supported. They knew people's individual support needs without having to refer to the care records. Staff were seen to take time to talk and listen to what people said.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

We saw that people completed a range of activities.

People were able to keep in contact with friends and relatives.

People knew how to make a complaint if they were unhappy. Information about how to do this was displayed in the reception area. The people we spoke with told us they had never felt the need to complain.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service has a quality assurance system that checked a number of aspects of the service. We saw that where a need for improvement had been identified these were corrected quickly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the values of the home and the organisation they worked for.

Quality assurance processes were in place. The manager regularly checked on how the service was performing. This helped to ensure that people received a good quality service at all times.

Senior managers regularly visited the home to make sure that people and staff were happy.

You can see our judgements on the front page of this report.

We found that people received the meals that they had chosen. We saw that regular residents meetings were held. However not all of the people's clothes were ironed. We could still smell smoke in one corridor where one person smoked in their room.

We saw that staff were kind and caring towards people. Staff gave an understanding of people's needs and we saw that people responded positively to staff. One person told us 'The staff are very good ' if you ask them they try and help you.'

We found that on most days there were sufficient numbers of staff for people's needs.

We looked to see that staff had received all of the training appropriate to their roles and confirmed that they had.

There were some systems in place that assessed and monitored the quality of the service. We were shown evidence of some annual audits and actions plans that addressed any issues raised. However we found that these were not always followed up.

We took enforcement action that ensured the provider protected people's safety and welfare in relation to the following outcomes: staffing and supporting workers.

This inspection on the 04 June 2013 was carried out to check whether the provider had taken action to protect people's safety and welfare and to achieve compliance.

During this inspection we spoke to 4 relatives and 2 people who used the service. We also observed care being given. Comments from people and relatives included 'I'm not totally displeased with the service', 'Things are definitely better', 'The (staff) improvements are not consistent.'

We found that the provider had taken action to improve the levels of staff to meet people's needs, However we found that people still remained at risk as the service did not always have the minimum amounts of staff required on duty.

We found on this inspection that whilst we saw that some staff had undergone some mandatory training and 1-1 supervisions with their manager since the last inspection this was not consistent. We found that meetings had increased for staff and that these provided regular support.

We saw during our inspection that staff were kind and caring with people. People and relatives told us that the staff were caring towards them. One relative told us 'They are very, very good.' However all of the people and relatives told us that the food at the home was not good. We also found that some peoples care plans did not reflect the care that was given. For example in relation to personal care.

We found that there were persistent problems with staffing and covering for staff when they were off sick or on leave. We saw from the staffing rotas that there were not always the correct number of staff on duty to meet people's needs.

There were systems in place to assess and monitor the quality of the service. We were shown evidence of annual audits and actions plans that addressed any issues raised. However we found that actions were not always followed up.