The Lindens Care Home

The Lindens is a residential care home providing accommodation and personal care to up to 60 people. The service provides support to older people. At the time of our inspection there were 52 people using the service.

The Lindens accommodates people across three units, which includes the main house and two wings. People have their own ensuite facilities. The home have three double bedrooms available to couples or family members who wish to share. The service have a large dining room, separate smaller dining area and a variety of sitting areas throughout the home.

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

People and their relatives were happy with the care provided. They felt they received safe care from a consistent staff team. Relatives commented “My mum is very happy at 'The Lindens'. I have confidence in mum’s care. The care staff are very attentive and provide mum with all her physical and emotional needs,” and “The care for mum, in my opinion, is excellent. The facilities and surroundings of 'The Lindens' are lovely and kept very clean and well maintained. I have noticed that staff attitude towards residents is always positive and kind, despite the challenges of this type of job. There is a warm feeling to the home every time I visit.”

Improvements were made to safeguarding processes to safeguard people. However, safeguarding incidents had not been reported to the Local Authority safeguarding team in line with the Multi- Agency safeguarding policy. Alongside this we had not been notified of incidents involving injury to people.

People’s care plans and associated records were in the process of moving over to electronic records. Whilst improvements were made to many records relating to the running of the service, people’s records were not suitably maintained and reflective of their needs.

Systems were in place to manage accidents, incidents and prevent reoccurrence. Safe medicine practices were promoted. Risks to people were identified and actions taken to mitigate risks, including infection control risks. Staff had a good knowledge of the people they supported which further reduced risks to them.

Safe recruitment practices were established, and staff were better supported, inducted and trained to support people. Sufficient staff was provided with management support provided as required, including on call support to staff.

People were supported to have maximum choice and control of their lives and staff supported did them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The registered manager had brought about positive changes to the service. They had improved communication within the team and with relatives. Relatives were welcomed and encouraged to be involved in their family members care. The registered manager had commenced auditing of practices and was aware what improvements were needed to further improve the delivery of person-centred care.

Staff, people and relatives were complimentary of the registered manager who was described as “Approachable, kind, caring and acted as a positive role model to staff.” A relative commented “Changes in the home since the last inspection have all seemed positive and a noticeable improvement. There is now a regime that; respects and welcomes contact with relatives and establishes good working practices in administration and staff organisation, while still giving an aura of friendly care.”

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 inadequate (published 2 April 2022) and there were breaches of regulations. 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 although the provider remained in breach of two regulations.

This service has been in Special Measures since April 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced focused inspection of this service on 25 January, 2 and 3 February 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve person centred care, need for consent, safe care and treatment, safeguarding service users from abuse or improper treatment, good governance, notification of other incidents and ensuring fit and proper persons were employed.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 changed from inadequate to requires improvement. This is based on the findings at this inspection.

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 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.

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

Enforcement and Recommendations

We have identified breaches in relation to failures to make the required notifications to us and record management at this inspection. We have made a recommendation to further improve safeguarding reporting.

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.

The Lindens is a residential care home providing accommodation and personal care to up to 60 people. The service provides support to older people. At the time of our inspection there were 56 people using the service.

The Lindens accommodates people across three units, which includes the main house and two wings. People have their own ensuite facilities. The home have three double bedrooms available to couples or family members who wish to share. The service have a large dining room, separate smaller dining area and a variety of sitting areas throughout the home.

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

Risks to people were not mitigated and the safeguarding policy and procedures did not safeguard people. Medicines were not always given as prescribed and guidance was not provided for when “As required” medicines were to be administered.

Whilst the service was clean and hygienic, the service did not work to government guidance in relation to wearing personal protective equipment (PPE).

Staff were not suitably recruited, and the registered manager had no oversight of staff inductions, training and supervisions to assure themselves that staff were suitably trained and supported for their roles.

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.

Person centred care was not always provided, and people’s preferences was not taken into account in relation to their needs, which included decisions on visiting.

The service was not effectively managed and monitored to ensure safe and effective care was provided. Policies were not developed in line with national guidance and best practice to support staff in the delivery of care. Records were not suitably maintained, accurate and fit for purpose.

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 good (6 March 2019).

At our last inspection we recommended that the provider seeks support from a reputable source about the record management of controlled medicines. We also recommended the service seeks support from a reputable source regarding good governance and quality assurance processes. At this inspection we found record management for controlled medicines had improved. However, good governance and quality assurance processes were not effective.

Why we inspected

We undertook a focused inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about visiting arrangements. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with visiting arrangements, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

The overall rating for the service has changed from good to inadequate 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 The Lindens Care 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 treatment, safeguarding people, recruitment processes, consent, notifications and governance of the service 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 for 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.

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.

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

The Lindens Care Home is a residential care home in a rural part of Buckinghamshire. At the time of the inspection 56 older people some of whom were living with dementia lived at the home.

People’s experience of using this service:

People and their relatives gave us positive feedback about the care and support they received. Comments included “They [Staff] are so friendly and warm and treat him with respect. There are some excellent examples of connecting with him. For example, one carer speaks Italian (Father is Italian) and makes a point of speaking to him in his language. They also have a sense of humour” and “They’re [Staff] generally quite caring.” Other comments included “I feel safe living here, I am 85 but I am comfortable and I wouldn’t want to be anywhere else” and “Yes, I feel safe living here, it is not a bad home and I get well looked after, it is all clean and I get what I need and I have nothing to moan about at all.”

There was a lack of good governance at the home. Quality assurance processes did not always drive improvement. The provider failed to ensure staff followed policies and procedures. Record management required improvement. Risk assessments were required to be in place, however, staff did not have enough information recorded to help them manage potential risks. We have made a recommendation about this in the report.

People’s care needs were not always detailed in writing. However, when we spoke with staff they were knowledgeable about people’s needs. We have made a recommendation about this in the report.

People were supported to receive their prescribed medicines on time. We have made a recommendation about record management for medicines that required additional protection due to the potential for abuse of them.

People were supported by staff who required training and support. However, the support provided was not in line with the provider's policies. We have made a recommendation about this in the report.

We found the home to be light, clean and consideration had been given to the environment so people living with dementia were not disadvantaged.

People were supported by staff who demonstrated compassion and were kind. People’s dignity and privacy was maintained.

People were supported to maintain important relationship with family and friends.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Rating at last inspection:

The previous inspection was carried out on 5 January 2016 we published the report from that visit on 26 February 2016. The service was rated Good at the time.

Why we inspected:

The inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Inspections will be carried out to enable us to have an overview of the service, we will use information we receive to inform future inspections.

We made recommendations in our inspection report. We will check any actions taken by the provider at our next inspection.

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

The Lindens Care Home provides accommodation and personal care for up to 58 older people and people with dementia care needs. At the time of our inspection, the service was providing support to 45 people.

The service had a registered manager. 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 felt safe. Staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse and people had risk assessments in place to enable them to be as independent as possible.

Effective recruitment processes were in place and followed by the service and there were sufficient numbers of staff available to meet people’s care and support needs

Medicines were stored, handled and administered safely within the service.

Staff members had induction training when joining the service, as well as regular on going training.

Staff were well supported by the registered manager and had regular one to one supervisions.

People’s consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 were met.

People were able to choose the food and drink they wanted and staff supported people with this.

People were supported to access health appointments when necessary.

Staff supported people in a caring manner. They knew the people they were supporting well and understood their requirements for care.

People were involved in their own care planning and were able to contribute to the way in which they were supported.

People’s privacy and dignity was maintained at all times.

People were encouraged to take part in a range of activities and social interests of their choice.

The service had a complaints procedure in place and people knew how to use it.

Quality monitoring systems and processes were used effectively to drive future improvement and identify where action was needed.