Linden Lodge Residential Home

Linden Lodge Residential Home is a care home providing accommodation and personal care for up to 34 people. At the time of the inspection 29 people were living there including older people who may be frail due to older age or people with dementia. The home is a purpose built three storey building with ensuite bedrooms and care across the three floors. Each floor has a communal lounge and dining areas. There is a communal garden area.

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

At our last inspection we found some concerns related to how the risks to people's health, safety and welfare were managed and this did not meet the regulations. Improvement was needed to the effectiveness of the oversight of the service. Following our last inspection, the provider sent us an action plan telling us what actions they were going to take to improve the service.

At this inspection we found some improvements had been made and some governance systems had been improved, however, the safety of the service and governance were not yet fully effective because they had not identified issues we found during this inspection.

Whilst people and relatives were happy with the care and service they received, we found risks were not always well managed and staff did not always identify or act on risks of potential harm or injury. Risk assessments had not always been completed accurately. We could not always be assured actions to mitigate harm or injury to people had been taken by staff because they had not completed important records.

Some improvements had been made in some areas of the safe handling of medicines, but further improvements were needed. We could not always be assured people received their medicines as prescribed due to discrepancies in stock.

Where incidents had occurred, learning had not always taken place to reduce risks of reoccurrence. Quality checks were in place but these had not always been effective.

Improvements had been made to fire safety and people were protected from the risks of abuse.

The home was clean and tidy and systems and processes were in place to protect people from the risks of infection. Staff observed and followed infection control procedures in line with national guidance for reducing the spread of COVID-19.

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.

There were sufficient staff on shift and staff felt well supported in their roles. There was a positive culture at the home and people living there were involved in their care and able to give feedback.

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 15 November 2019) and there was a breach of regulation 12. 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 the provider remained in breach of the regulations.

Why we inspected

This inspection was carried out to follow up on an action plan we told the provider to take at the last inspection. The provider had contacted us to inform us they had improved and felt their current rating was no longer reflective of the service they provided. We undertook a focused inspection in the areas of Safe and Well Led as these were the areas that had required improvements.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained unchanged at Requires Improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Linden Lodge Residential Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

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.

We have identified breaches in relation to safe care and good governance at this inspection.

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

Follow up

Following our inspection feedback, the registered manager and provider shared evidence of some immediate actions they had taken to make improvements.

We will send the provider a formal letter requesting an action plan to understand what they will do to further improve their quality assurance systems. 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.

We found the following examples of good practice.

The home was currently closed to visitors except in exceptional circumstances. A large marquee was used for outdoor visits when the weather was more favourable and a booking system was used to manage visitor numbers. During times of visiting restrictions people were supported to stay in touch with their family through video calls, letters and phone calls.

To minimise movement around the home, changes had been made to staff breaks which stopped the additional flow of staff as a result of them clocking on and off.

A brick built outbuilding was turned into a staff changing room so staff could change and store their clothes at the beginning and end of their shifts. A notice was displayed on the door which reinforced the expectation that only one member of staff should use the building at any one time and face masks should be worn before entering. A hand sanitiser dispensing machine was available.

Further information is in the detailed findings below.

Linden Lodge is a ‘care home’, which provides accommodation and personal care for up to 34 older people, some of whom are living with dementia. The home has three floors, each with communal lounge and dining areas. People had their own en-suite bedrooms. There is a communal garden area. At the time of our inspection there were 32 people living at Linden Lodge.

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

The service continued to be effective, caring and responsive in meeting people’s needs. People told us they were happy living at Linden Lodge and described staff as having a kind approach to them and supporting them when needed.

Staff understood the importance of giving people choices. 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’s needs were assessed, and information was used to form plans of care. Personalised information informed staff of people’s preferences. Planned activities took place and staff used activities to manage people’s distressed behaviour when needed.

Overall, staff knew people well and steps they should take to minimise risks of harm or injury. However, this was inconsistent, and improvements were needed to ensure staff used safe moving and handling techniques.

Risk management plans did not always contain the level of detail staff needed. Where people experienced falls, these had not triggered a review of the person’s risk management plan so additional actions could be taken to minimise risks of reoccurrence.

People had their prescribed medicine available to them and were supported by trained staff. When people received their medicines covertly, best practice was not followed. The home was well-maintained and good cleanliness reduced risks of cross infection.

There were enough staff on shift to meet people’s needs.

There had been a change in manager since our last inspection. The previous registered manager had recently retired, and the deputy manager had been promoted to home manager and commenced their role during October 2019. They had applied to become registered with us and their application was in progress.

The manager was supported in their new role and acknowledged they still had things to learn. They had identified some areas where improvements were needed and shared their plans with us.

There were systems for people and relatives to give their feedback on the service, and comments were acted on. The provider had a system to deal with complaints.

There were processes to audit the quality and safety of the service. Some issues had been identified as requiring improvements and work was ‘in progress’. However, some checks and analysis’ done was not always robust and had not identified where other improvements were needed.

Following our inspection feedback, the manager took immediate actions to make improvements. This included refreshing staff’s moving and handling training and assessing their competencies to ensure people’s safety was maintained.

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 rating for this service was Good (published 22 June 2017). During this inspection we found the safety and quality of the service had deteriorated and some people's care outcomes were not of a good standard. The service is now rated Requires Improvement. We identified a breach of the Health and Social Care Act 2014 (Regulated Activities)):

Regulation 12 Safe care and treatment

Why we inspected

This was a planned inspection based on the rating of the last inspection.

Follow up

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

The service is one of three homes provided by the Linden Care Homes Limited and provides accommodation and personal care for up to 34 older people over three floors. Thirty-four people were living at the home on the day of our inspection.

The registered manager had been in post for two and a half years. 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.

At our previous inspection in August 2016, we identified improvements were required in keeping people safe, in delivering effective care and treatment, in promoting people’s privacy and dignity, in responsiveness and in the management of the service. We gave the home an overall rating of requires improvement. The provider created an action plan, setting out the actions they planned to take to improve the quality of the service. At this inspection, we checked whether the actions they had taken were effective.

Since our previous inspection the provider had made improvements to the advice and guidance available to staff to enable them to support people with specific health conditions effectively.

The provider had improved the training and support available for staff to ensure there were enough suitably skilled and experienced staff on duty, with the confidence to meet people’s care and support needs safely and effectively.

People were safe from the risks of harm, because the registered manager checked staff’s suitability to deliver care and support during the recruitment process. Staff understood their responsibilities to protect people from harm and were encouraged and supported to raise concerns under the provider’s safeguarding and whistleblowing policies.

The registered manager had made improvements to the advice and guidance available to staff to ensure people’s medicines were managed and administered safely and in line with best practice and in accordance with the Mental Capacity Act 2006.

The registered manager understood their responsibility to comply with the requirements of the Deprivation of Liberty Safeguards (DoLS). They had applied to the Supervisory Body for the authority to restrict people’s rights, choices or liberty in their best interests. Staff’s understanding of their obligations under the Act had improved through the changes the registered manager had made to people’s care plan records.

People were offered meals that were suitable for their individual dietary needs and met their preferences. The provider had made sure staff were given advice and guidance about how to support people to maintain a healthy and balanced diet.

Staff monitored people who were at risk of poor health and obtained advice and support from healthcare professionals to maintain and improve their health.

People were cared for by kind and thoughtful staff who knew their individual preferences for care and their likes and dislikes. The registered manager had taken action to enable staff to protect people’s privacy and promote their dignity in shared bedrooms

People and relatives were involved in planning their care and care plans were regularly reviewed and updated when people’s needs changed. People were satisfied with the care and support they received and told us they had not made any complaints.

People made their own decisions about their day-to-day care and how they spent their time. There were planned and spontaneous individual and group activities for people to take part in if they wished to do so.

The registered manager’s quality audit checks included reviews of people’s care plans and checking that the premises and equipment were suitable, safe and only used for their designated purposes.

People and relatives were encouraged to express their views and suggest improvements to the quality of the service through regular meetings and surveys. Further improvements were planned in the process for obtaining the views of people who were not able to express themselves verbally.

Linden Lodge is one of three homes provided by the Linden Care Homes Limited and provides accommodation and personal care for up to 34 older people; over three floors. At the time of the inspection 32 people lived at the home. Linden Lodge was last inspected by us in May 2013 and we found the regulations were met.

The home is required to have 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 and associated Regulations about how the service is run. At the time of this inspection the home had a registered manager in post. Since our last inspection, there has been a change of manager, with the new manager registering with us in December 2014.

People felt safe living at the home because staff were there to support them when needed. Staff were trained to know what abuse was and how to report any concerns to the registered manager. People were supported to take their prescribed medicines by trained staff, however guidance was not always available for staff to ensure people received their medicines in a safe way.

Some risks were assessed but actions were not always put into place to reduce the risk of harm or injury to people. Staff did not have the information available to refer to, if needed, to know how to keep people safe from identified risks.

Staff worked within the principles of the Mental Capacity Act 2005 when supporting people with personal care but did not always act in accordance with the requirements of the Act when supporting people with their medicines. People had choices offered to them about what they wanted to eat and drink and were supported to maintain their health and, when needed, were referred to health professionals.

Staff had received some training but did not always feel this gave them the skills and knowledge they needed to effectively meet people’s needs.

People said staff were kind to them and involved them in making decisions about their day to day care and how they spent their time. There were planned group activities for people to take part in if they wished to do so.

Staff promoted people’s dignity where they were able to, but the registered manager and provider had not given consideration to promoting people’s privacy and dignity in shared bedrooms.

Systems were in place to assess the quality of the service provided but audits were not always effective. Risks of cross infection had not been identified by checks undertaken and care plan reviews had not identified where improvement was needed. Feedback was sought from relatives, however people living at the home were not always given the opportunity to give their feedback on the service they received.

We found a breach in the regulation relating to the governance of the home. You can see what action we told the provider to take at the back of the full version of the report.

People living at the home and their relatives all told us they were happy living at Linden Lodge and they got plenty of choices about their daily living. They all felt there were enough staff to help them and that the staff were 'helpful and kind.' One person told us, 'It's a nice place to be. All the staff are nice and I've got friends here.' Another person said, 'I'm very happy here.' A relative said, 'I have complete confidence in the staff because they're so kind and attentive.'

Staff we spoke with felt confident the care provided to people living at the home was good. They told us they felt well-supported by the manager and deputy manager.

The people and visitors we spoke with did not express any concern about the care they had received. We saw the service had a reliable system for receiving and resolving complaints.