Linden House Care Home

Linden House Care Home is a residential care home providing accommodation for people who require personal care for up to 63 people in a single storey building. The service provides support to younger adults, people with physical disabilities, mental health needs, older people and dementia care. At the time of our inspection there were 42 people using the service.

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

Although the service had improved practices around thickeners, which was a recommendation at the last inspection, processes and procedures around medications were not always being followed, we made a recommendation around this. The service had made improvements around staffing and people felt there was enough staff. Recruitment checks were not always robust, we made a recommendation around this. Infection prevention and control practices were in place and we noted improvement in this area since the last inspection. Systems were in place to keep people safe. Peoples individual risks were being assessed and managed. Environmental checks were being completed.

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.

Governance systems were in place and had improved since our last inspection. Staff gave mixed views around management support. We made a recommendation around ensuring systems are developed and are effective. Views of people and staff were being sought, and the service was making improvements from lessons learned. The service was working in partnership with others.

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 27 April 2022). 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.

At our last inspection we made recommendations regarding staffing, infection prevention and control practice, and guidance and knowledge of staff around thickener. At this inspection we found the provider had acted on these recommendations.

Why we inspected

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 carried out an unannounced comprehensive inspection of this service on 17 March 2022. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve governance. 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 Requires Improvements to Good. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Linden House Care Home is a residential care home providing accommodation and personal care for up to 63 people. There was 44 people living in the service at the time of the inspection. The service accommodates people across two separate units, each of which has separate facilities both with access to a large lounge and dining area. All bedrooms were of single occupancy and 47 of these had ensuite facilities.

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

The service was clean, tidy and people had access to PPE to protect them from infection risks. The registered manager confirmed supplies were made available to staff around the service. Policies and guidance was in place to support the risks associated with COVID-19. However, more up to date information was available. People and relatives could not confirm face to face visits were taking place and they had not been told about the current outbreak. Some people and staff told us the staffing numbers was a concern. The provider confirmed they would review the dependency tool as soon as possible to ensure staffing numbers reflected people’s needs.

Systems were in place to deal with abuse allegations, and most people told us they felt safe. Risks were assessed and managed. Records had been completed in relation to incidents and accidents. However, one incident had not been reported to the management. We found medicines were managed safely across the home. Staff did not have access to guidance for the management of thickeners and thickeners were not stored safely. The registered manager took actions to ensure thickeners were stored safely and that guidance was available for the staff team.

Some people fedback that reviews by professionals were taking place. Staff had received training to support them in their role and most people, relatives and staff confirmed they were confident in their skills.

Most people were happy with the meals provided, and we saw people being offered choices during the inspection. The feedback was that sometimes there was a delay in people having breakfast due to support for them to rise. There was an ongoing refurbishment in the service and the provider confirmed they would ensure the refurbishment plan was detailed as to the improvements in the service. 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.

The feedback was that people on the whole received good care and were treated with dignity, respect and their diverse needs were considered. People had access to communal areas however, these were not always monitored by the staff team. The registered manager confirmed that they would ensure all staff responded to people’s needs in a timely manner to prevent delays to people’s care. Care records contained information about their likes, choice and needs.

We received feedback that activities had not been consistent since the pandemic, the provider said they were in the process of advertising for an activities co-ordinator. Care records contained detailed information to support the care delivery to people. People’s end of life care needs were supported. Complaints were managed and staff knew what to do in response to complaints.

The management and staff were supportive of the inspection and provided information requested. People were in the main positive about the registered manager. Some staff told us morale was poor at present. Regular audits were being undertaken on a range of areas. The provider confirmed some notifications had been submitted to the Care Quality Commission retrospectively. The service acted when things went wrong. Some people told us they were asked for their views, we saw feedback from surveys on display, team meetings were taking place.

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 the service was requires improvement (published 8 April 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At our last inspection we recommended that the provider and registered manager revise oversight practices and look at implementing effective checks based on best practice and current guidance. At this inspection we found improvements had been made in relation to regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. As a result of the findings from this inspection, there was an ongoing breach of regulation 17 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected

This was a planned inspection based on the previous ratings

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.

Enforcement and Recommendations

We have identified an ongoing breach in relation to regulation 17(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider responded immediately during and after the inspection.

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

We made recommendations in relation to, ensuring there are sufficient amounts of staff to meet people’s needs. Also that action is taken to ensure infection prevention and control measures are in place and managed safely. As well as ensuring staff have up to date guidance to understand how to manage thickeners and that thickeners are stored safely.

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.

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 home accommodates people across two separate wings, each of which has separate facilities. One of the wings specialises in providing care to people living with dementia.

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

Some staff members had not been recruited safely and recruitment processes needed to be improved.

At inspection, a provider representative had allowed a compliance document to be considered they knew was false when appropriate recruitment checks had not been made.

People were supported to be safe. Staff received safeguarding training and had a good understanding of the principals involved in acting when abuse was suspected.

People's needs were met through assessments and support planning. The service worked with healthcare professionals to achieve positive outcomes for people. Staff and management had good knowledge and skills and this ensured people's needs were well met.

People's medicines were managed and administered safely.

Infection prevention and control measures were robust.

Staff described being supported by the registered manager and provider. Although there were quality assurance systems and processes to monitor the service and drive improvements, we found that some of these needed to be improved to capture the issues seen at this inspection.

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 18 September 2020). At this inspection, the provider was in breach of regulations and remains rated requires improvement.

Why we inspected

We undertook this targeted 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 people's support and staffing. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We inspected and found concerns changed to issues with staff recruitment and management/provider oversight. We widened the scope of the inspection to become a focused inspection which included the key questions of 'Good' and 'Well-led'.

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 found evidence the provider needs to make improvements and embed them into practice. The provider is aware of where improvements are needed. At inspection, action was taken to mitigate any risks. 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 Linden House on our website at www.cqc.org.uk.

Linden House Care Home is a residential care home that was providing accommodation, care and support to 38 people at the time of the inspection. The service can support up to 63 people in one purpose-built building. The service is split into two units; a residential unit and a unit for people living with dementia. Bedrooms had en-suite facilities. People had access to communal bathrooms, lounges and dining areas, as well as outside areas.

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

People who lived in the home and their family members were very happy with the care provided in Linden House. People told us they felt safe and there were sufficient staff to meet their needs.

Staff had completed safeguarding training and knew the correct action to take to protect people from the risk of abuse. Staff had been safely recruited.

Risk assessment and management processes had improved. Care records included detailed information about people’s needs, risks and preferences. People had been involved in reviewing and commenting on the care they received.

Infection control practices were generally robust. All care staff wore personal protective equipment (PPE) in line with government guidance for the pandemic. We observed two domestic staff would benefit from refresher training regarding the correct use of PPE. Following the inspection, we received confirmation this had been carried out. The provider was taking action to ensure relatives would be able to visit people safely in a designated ‘pod’ to be installed in the garden.

The management team had worked hard to address the shortfalls found at the last inspection. Improvements had been made to the quality monitoring systems. The registered manager carried out regular checks, observations and discussions with people to ensure they were being provided with high quality care. We received positive feedback about the way the home was run from people living there and their relatives.

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 18 February 2020). There were multiple breaches of regulation and the service was placed in special measures. This meant the service was kept under review and an inspection would be undertaken within six months to ensure significant improvements have been made. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection the provider demonstrated improvements have been made in Safe and Well-Led. 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 comprehensive inspection of this service on 16 and 17 December 2019. Breaches of legal requirements were found in safe, effective, responsive and well-led. Warning notices were served in relation to Regulation 17 - Good Governance, Regulation 18 - Staffing and Regulation 12 - Safe Care and Treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also issued requirement notices in relation to Regulation 9 – Person-centred care, Regulation 16 – Receiving and acting on complaints and Regulation 19 – Fit and proper persons employed of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.The service was placed in special measures. We also made recommendations about staffing, infection control, involving people in decisions about their care, and learning lessons when things go wrong.

We undertook this focused inspection to follow up on whether the warning and requirement notices we previously served had been met. In order to ensure people were safe and the service was well-led, we gathered evidence in relation to all the previous breaches of regulations, including those documented in the effective and responsive domains of the last inspection report, but have reported on these within the Safe and Well-led domains of this report.

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. These key questions were all previously rated as requires improvement due to the breaches of regulations covered in this report as well as additional areas for improvement identified during the last inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

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

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.

Linden House Care Home is a residential care home providing personal care to 52 people at the time of the inspection. The service can support up to 63 people in one purpose-built building. The service was split into two units; a residential unit and a dementia unit. Bedrooms had en-suite facilities. People had access to communal bathrooms, lounges and dining areas, as well as outside areas.

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

The service was not safe. Medicines were not managed safely. Risks were not always assessed, monitored or managed safely and effectively. Staff had not always been trained in moving and handling techniques. Accidents and incidents were not sufficiently recorded or investigated. Recruitment systems and processes were not robust. People and their relatives did not always feel there was enough staff on duty. Safe infection control systems and processes were not always in place. There was no evidence to show how lessons learned were shared and used to make improvements. We have made recommendations about staffing levels, infection prevention and control and lessons learned.

The service was not always effective. Staff were not in receipt of adequate training and support to meet people’s needs. For example, not all staff had undertaken moving and handling training but were undertaking this task. There was a lack of guidance for kitchen staff on modified diets. We have made a recommendation about modified diets.

The service was not always caring. People were not always supported to make decisions about their care. The provider had not appropriately considered the impact of using closed circuit television (CCTV) within the service. We have made recommendations about involving people in decisions and the use of CCTV.

The service was not always responsive. Care was not planned in a personalised way to ensure people had choices to meet their needs and preferences. Care plans did not always reflect people’s current health needs. People told us they were not involved in care planning. End of life care plans were not always in place for those deemed at the end of their life. Complaints were not sufficiently recorded and were not managed in line with policies and procedures.

The service was not well led. The registered manager was not a visible presence within the service. They failed to identify and manage risks appropriately and did not ensure a person-centred approach was in place. Audits that were in place were not sufficiently robust and the registered manager failed to have effective oversight of the service. We have made a recommendation about duty of candour.

People told us they felt safe from the risk of abuse. People received a healthy and balanced diet. 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. The design and adaptation of the service met people’s needs.

People told us staff were kind and caring. The service ensured people had access to advocacy services as and when required. People were supported to be independent and most felt staff respected their privacy and dignity. People had access to activities and visitors were permitted into the home without restriction.

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

Rating at last inspection

The last rating for this service was good (published 27 February 2018). Since this rating was awarded the provider has altered its legal entity. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the date the legal entity was changed.

Enforcement

We have identified breaches in relation to medicines, risk assessments, safety monitoring, accidents and incidents, recruitment, training and support, person-centred care, end of life, complaints and good governance.

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

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.

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.