Archived: Linson Court

Linson Court is a residential care home which provides accommodation and personal or nursing care to adults with a range of support needs. The home can accommodate up to 40 people in an adapted building, across two floors. Each bedroom has en-suite facilities and there are lounges, dining rooms and bathrooms on both floors. At the time of this inspection there were 27 people using the service.

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

People told us they felt safe living at the home. People received support from a staff team who were recruited safely and knew how to safeguard people from the risk of abuse. People’s medicines were managed safely. There were enough staff to keep people safe, though some people told us there were occasions when they had to wait for support. Infection prevention and control measures were in place.

We have made a recommendation about the provider’s use of PPE in the kitchen area.

Staff received an induction and ongoing training, to ensure they had the right knowledge to support people effectively. 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 were supported by kind and caring staff, who knew people well. People were actively encouraged to be involved in decision making around their care. People’s privacy and dignity was respected, and their independence promoted.

People received personalised care, which staff delivered in line with people’s preferences. The provider had an appropriate system in place to manage and respond to complaints. People’s relatives were being supported to visit the home, in line with government guidance.

The service had an open and positive culture. The provider regularly sought feedback from people and staff, in order to continuously drive improvement. The provider had appropriate governance arrangements in place, to assess the quality of the service.

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 20 December 2018).

Why we inspected

This was a planned inspection based on the previous 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.

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.

During this inspection we identified the home had made improvements. The home was clean and in a good state of repair. Appropriate infection control practices were followed. The home had undertaken regular involvement of people and relatives in the running of the home. Regular audits were undertaken.

Linson Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Linson Court provides nursing care and support to people, some of whom are living with dementia. The home has a maximum occupancy of 40 people. On the day of our inspection there were 37 people living at the home.

The service had a registered manager in place. 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 they felt safe living at Linson Court. The registered manager and staff were aware of relevant procedures to help keep people safe and staff could describe signs that may indicate someone was at risk of abuse or harm. Staff had received safeguarding training.

Staff were recruited safely and systems were in place to reduce the risk of employing staff who may not be suitable to work with vulnerable people. Sufficient numbers of staff were deployed to keep people safe and the home manager had gained approval for and implemented additional staffing resources.

Care plans contained individualised risk assessments and adequate information to ensure people’s care and support was safe, however these had not been updated regularly. People had up to date personal emergency evacuation plans and fire risks were well-managed.

Premises were safely maintained and appropriate checks to ensure this were completed. A recent refurbishment of the lift had taken place to ensure this was safe.

Medicines administration records (MAR) were in place to monitor and manage the administration of medicines. This system was used safely and recorded consistently.

New staff received an induction to the home which included mandatory training and shadowing more experienced colleagues. Staff received ongoing training and a programme of regular supervisions and appraisals had been planned, however not all staff had received a regular supervision in the months prior to the inspection.

Mental capacity assessments were decision specific and people were deprived of their liberty lawfully. Staff were aware of how to promote independence.

People were offered a good choice of meals. Their nutritional risks were assessed and weight loss monitored and appropriate action taken when necessary.

People had good and timely access to external healthcare professionals.

People told us staff were caring and kind. Staff were knowledgeable about people and encouraged people to make choices about their daily lives and retain a level of independence. Staff were aware of the need to maintain people’s privacy, dignity and confidentiality.

People’s care plans were person-centred and detailed. Regular reviews of people’s care had not taken place however the manager had implemented a programme of reviewing each and every care and support record. This had not been fully completed at the time of our inspection.

There was access to a range of activities, including inter-generational projects, and people received some one-to-one activity.

People were aware of how to complain and the registered manager responded and documented any concerns raised.

People were asked about their end of life care wishes and these were recorded. The registered manager and staff were knowledgeable about supporting people and their relatives at this time.

Staff were positive about the registered manager and the deputy manager. Staff meetings took place and staff were actively involved in these.

A range of audits were completed on a regular basis by senior staff, the registered manager and senior regional managers and areas of concern identified during these had actions identified and completed.

The registered manager compiled a monthly report which recorded a variety of information relating to the day to day running of the home. A senior manager regularly visited the home and audited the quality of the service people received.

This service has been in 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. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Linson Court is registered to provide residential and nursing care for up to 40 people in single rooms with en-suite facilities. The bedrooms are situated on two levels with a lift and stairs for people to access the first floor. Each floor has a communal lounge and dining area. There were 30 people living at the home at the time of our inspection.

There was 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.

People told us they felt safe living at Linson Court. The registered manager and staff were aware of relevant procedures to help keep people safe and staff could describe signs that may indicate someone was at risk of abuse or harm. Staff had received safeguarding training.

Staff were recruited safely, with appropriate pre-employment checks taking place. Sufficient numbers of staff were deployed to keep people safe, however, most staff felt improved quality of care could be provided if additional staff were deployed.

Risks had been assessed, such as those relating to choking, falling and moving and handling. Measures had been introduced to reduce risk and we saw moving and handling plans were in place which provided staff with information in order to safely assist people to move.

Regular safety checks took place and fire, gas and electrical systems had been tested. Plans and evacuation equipment were in place to safely evacuate people in the case of emergencies. Staff had been trained to use evacuation equipment effectively.

Since the last inspection, the deputy manager had been responsible for introducing new, improved systems for the management of medicines. Improved systems were in place for managing, storing and administering medicines. Staff responsible for the management and administration of medicines had received training and their competency had been assessed. However, we found not all protocols for ‘as required’ medicines were accessible on the first day of our inspection. This had been rectified by the second day.

Although the home appeared clean and staff were observed using personal protective equipment, which reduced risks associated with infection prevention and control, a recent audit had identified actions required in order to improve infection control.

Staff had received training in relation to the Mental Capacity Act 2005 and demonstrated a good understanding of the requirements of the Act. Decision specific mental capacity assessments had been completed for people who lacked capacity to make specific decisions, as required by the Mental Capacity Act 2005.

Our observations were that, for the majority of people, they were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, we saw one instance where this practice could be improved and we shared our findings with the registered manager.

Care and support staff told us they felt supported and they received regular supervision. Staff received ongoing training and clinical staff received additional training to support them in their roles.

People received appropriate support in order to have their nutrition and hydration needs met. Mealtimes were a pleasant experience and people told us they enjoyed the food.

Our observations indicated staff treated people with kindness and compassion. People told us staff were caring and we observed people’s privacy and dignity being respected. There was a pleasant atmosphere in the home. Diversity was embraced and the cultural and religious needs of people living at Linson Court were met.

End of life care plans had been developed where appropriate and our discussions with visitors highlighted good, effective end of life care had been provided.

Care plans contained person centred information, including people’s preferences, likes and dislikes. Staff were aware of people’s individual needs and preferences and we observed care was provided in line with care plans.

Audits and quality assurance systems had developed and improved since the previous inspection and these had identified areas for improvement. Continued work was required to ensure these were robust and to ensure the registered provider’s action plans were met.

Staff, people and relatives spoke highly of the registered manager. The registered manager was visible in the home and knew people’s needs.

Following the last inspection, requirement notices for regulations 9, 11,12 and 13 and a warning notice for regulation 17, good governance had been issued to the provider. Several aspects of the warning notice had not been sufficiently addressed by the provider and significant concerns remained at this inspection.

Linson Court is registered to provide residential and nursing care for up to 40 people in single rooms with en-suite facilities. The bedrooms are situated on two levels with a lift and stairs for people to access the first floor.

The home had been without a registered manager and a manager had been in post since August 2016. They were in the process of registering with the Care Quality Commission to become the 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.

Linson Court was welcoming and provided a homely environment. Staff had an understanding of how to keep people safe and knew the safeguarding procedures to follow in the event of a concern or allegation of abuse.

Individual risks to people were not always assessed and there was little analysis of accidents or incidents. There was poor oversight of clinical risks to those people who required nursing care and we found weaknesses in medicines management.

Staffing levels were managed appropriately to meet people's needs, although induction for new staff lacked recorded detail and recruitment was not consistently robust. There were gaps in staff training, knowledge and supervision and there was little evidence staff competencies were checked, particularly around skills required for providing nursing care.

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. Staff had received training on the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards and staff understood this. Where people had care plans completed thoroughly there were recorded details of mental capacity and some best interest discussions. However, not all people’s information was recorded appropriately and some people did not have a care plan in place or any assessment of mental capacity.

Food provision was of good quality and people enjoyed the meals overall. There was a designated chef who understood the importance of diet and nutrition and was involved in the serving of the meals, so knew people's preferences. However, there was poor monitoring of people's dietary and fluid intake. Records of weight monitoring were not maintained regularly; the records that were available showed several people had lost weight, yet there was no oversight of this or evidence of action taken.

Staff had good relationships with people and they knew each person well. There was plenty of friendly banter and a happy atmosphere in the home. Staff respected people's privacy and dignity in care practice although some confidential information was on view in communal areas.

Where people were approaching the end of their life, staff were attentive and compassionate, however, relevant care planning was not always given due consideration.

Staff offered person centred care in the way they interacted with people and supported their needs. Activities were meaningful and staff made frequent checks on people who stayed in their rooms. Care records were variable in quality; some had more detail than others, although some lacked essential information.

Complaints were not always responded to appropriately; where people complained verbally this was not recorded and there was no evidence matters had been satisfactorily addressed.

The management of the home was unsettled and staff lacked clear direction in their work, although staff said they had better support than before the manager was in post. There was no clinical leadership or oversight of nursing care in the home.

This inspection highlighted continued breaches in four out of five regulations identified at the previous inspection and three further breaches.

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.

You can see what action we told the provider to take at the back of this report.