The Links Care Centre

The Links Care Centre is a nursing home providing nursing and personal care to people with dementia and other complex mental health issues. The home accommodates up to 85 people over five self-contained units. At the time of the site visit there were 66 people living at the home.

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

Staff did not always follow the provider’s COVID-19 policy or infection and protection government guidelines. This posed a risk that staff could transfer infection. Risks to people’s health and safety were assessed. Plans were clear and up to date and contained person centred information. However, on the day we visited the service we saw they were not always followed. Audits and checks were in place to monitor the quality of the service. They had not identified the risks which were identified during the inspection.

People were supported by a consistent and experienced staff team. Recruitment was managed safely.

Staff understood the importance of safeguarding and the provider worked closely with local authorities.

Medicines were managed safely. There were close links with health professionals and other agencies to ensure people’s health needs were met and changes responded to promptly.

The registered manager had commenced in post in June 2020. They had introduced wide ranging changes. Staff, people and relatives spoke highly of the registered manager and described the changes that were underway as positive. One long standing care worker at The Links said, “ We have the continuity to create and maintain a new culture.”

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 17 April 2019) and there was one breach of regulation.The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 18 March 2019. A breach of legal requirements was found.

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has stayed the same. 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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.

Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The last rating for this service was requires improvement (published 17 April 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two inspections.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Links Care Centre 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 and good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

People’s experience of using this service:

People told us they felt safe and enjoyed living at the Links Care Centre. The service had submitted appropriate safeguarding notifications and staff had received safeguarding training. Some staff knowledge in this area needed improving although staff told us they would not hesitate to report concerns to their line manager. Assessments were in place to mitigate risks to people although some of these needed reviewing and consolidating to reflect current practice. Accident and incidents were analysed to check for themes and reduce the risk of reoccurrence.

Staff were recruited safely and a number of new staff were being recruited. However, there was still a reliance on agency staff. Staff expressed concerns about staffing levels at certain times of the day. We have made a recommendation around planning of staff deployment to ensure safe and consistent staff levels for people. Staff training was up to date or in the process of being completed. Most staff told us training was good and had equipped them for their role.

People told us they received prescribed medicines on time and we saw medicines were generally well managed. People’s health care and nutritional needs were met. Where concerns were raised about people, appropriate referrals were made.

The service was compliant with the legal requirements of the Mental Capacity Act. People’s consent was sought for care and treatment and advocates were in place where required. However, people were not involved with care plan reviews and more evidence was needed to show who was involved with best interest decisions.

There had been improvements with documentation since our last inspection, although some care plans required further work to ensure they reflected people’s current needs. Care plans now also needed to reflect person-centred care and supporting people’s independence.

People told us staff were kind and caring. Complaints were treated seriously and appropriately investigated. Regular staff knew people well. However, some staff interaction with people was predominantly task focussed. There was a lack of meaningful, person-centred activities in place.

The management team were keen to continue to drive improvements to the service and improvement action plans were in place. A new manager and clinical lead had been recruited since our last inspection. Most staff said this had made a positive impact on the service. Improvements had been made to checks around the service quality and there was increased provider oversight. The manager acknowledged changes had been difficult for some staff and staff morale was variable.

At this inspection, we found the service met the characteristics of Requires Improvement in all domains. We identified one breach of regulation relating to good governance. More information is contained in the full report.

Rating at last inspection: The service was rated Inadequate at the last inspection which was published in October 2018. We identified nine breaches of regulation which related to person centred care, dignity and respect, need for consent, premises and equipment, staffing, safeguarding people from abuse and improper treatment, meeting nutritional and hydration needs, safe care and treatment and good governance. The service was placed into Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe.

Why we inspected: This inspection was planned based on concerns found at the previous inspection and the service rating. During this inspection the service demonstrated improvements have been made and are ongoing. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. However, further improvements are required.

Enforcement: We identified one breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 around governance and documentation. Details of action we have asked the provider to take can be found at the end of this report.

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

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

The service provider registered with CQC on 8 February 2018. This was our first inspection of this location under the new care provider.

The Links Care Centre 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. This service accommodates up to 85 people across five separate units each of which have separate adapted facilities. At the time of this inspection there were 80 people living at the home. The service specialises in providing nursing and personal care to adults living with mental health conditions.

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.

Risks were not always assessed and monitored to ensure people were kept safe. Our review of records, discussions with staff and tour of the environment demonstrated appropriate action had not always been taken to reduce risk. This included key risks such as falls, pressure sores, choking, behaviour that challenged and smoking.

Accidents and incidents were not always robustly analysed. Where lessons could be learned to improve the service and make the care people received safer; these were not always identified and addressed. Accidents and incidents were not being consistently investigated and followed up.

Robust systems were not in place to ensure people were protected from the risk of abuse. Procedures regarding the use of restraint needed improving to ensure staff only used restraint when it was absolutely necessary, proportionate and lawful.

The environment was not kept clean and was not safely maintained. Risks around fire safety had not been appropriately identified, assessed and mitigated. The provider had not considered people’s individual needs when decorating and designing the environment.

Appropriate action was not always being taken to ensure equipment was safe and appropriate for peoples’ needs.

Sufficient staff were not always deployed to meet people's needs. Staff were task orientated and did not always provide people with the support they needed. Agency staff often worked at the home but were not always receiving the information they needed to deliver effective care.

Medicines management was not always safe and effective, which meant we could not be assured people always received their medicines as prescribed.

Staff told us and records showed that the training staff received needed to be improved.

Staff did not always support people in the least restrictive way possible; the policies and systems in the service do not support this practice.

People told us the food and drink they received was poor quality and did not always reflect their preferences. Risks relating to nutrition and hydration were poorly managed.

Some aspects of care delivery where not person centred. For example, meals and snacks were provided at set times which did not meet people’s needs.

People told us they felt safe living at the service and they provided positive feedback about the staff who supported them.

We saw some staff had developed strong relationships with people. However, staff did not always recognise and intervene where people needed support. We also found some staff lacked awareness and consideration about the things that mattered to people.

People did not always have their privacy and dignity maintained and respected.

Staff involved and consulted a range of health and social care professionals to ensure people’s healthcare needs were met. However, the advice given by these professionals was not always followed, put into practice or reflected in peoples care records.

People were not always provided with the information they needed to make informed choices about the care they received.

We saw no evidence of discrimination. However, staff did not always have the information they needed to meet people’s diverse needs including those relating to disability, gender, ethnicity, faith and sexual orientation.

The care planning around end of life care needed improvement so that peoples’ wishes were clearly recorded.

A complaints procedure was in place and complaints were investigated. However, it was not always clear that peoples’ views had been listened to.

Robust systems were not in place to ensure risks to people’s health and safety were assessed and mitigated. Key policies were not in place for areas such as smoking, drugs and alcohol. Where procedures were in place these were not always being followed.

People told us they enjoyed the activities which staff arranged for them but they were not always aware of the activities program. We were concerned that people with complex needs did not always have the opportunity to engage in meaningful occupation

Leadership and management of the service needed to improve. The provider's systems and processes did not enable them to effectively assess, monitor and improve the service and quality of care provided.

We found shortfalls in the care and service provided to people. We identified nine breaches of legal requirements. 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.

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.