Archived: Lindenwood Residential Care Home

Updated 23 May 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place over two days on 3 and 4 December 2018. The first day was unannounced, which meant the service did not know in advance we were coming. The second day was by arrangement.

A planned inspection of Lindenwood Residential Care Home was brought forward in response to information of concern received by the Care Quality Commission (CQC). These concerns were of a safeguarding nature. The inspection team comprised of two adult social care inspectors.

Due to the timeframe in which this inspection was completed, a Provider Information Return (PIR) was not requested to support us with our inspection planning. A PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. However, we reviewed information we already held, in the form of statutory notifications received from the service, including safeguarding incidents, deaths and serious injuries.

Due to the nature of the service provided, some people were unable to share their experiences with us; therefore, we completed a Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who cannot talk with us. In addition to this, we spoke with six people who used the service and two visiting relatives.

We also spoke with six members of staff, including the provider, manager, one senior and three care workers. We also spoke with a visiting professional from a local authority. We looked in detail at four care plans and associated documentation; five staff files including recruitment and selection records; training and development records; audit and quality assurance; policies and procedures and records relating to the safety the building, premises and equipment. We also reviewed records relating to the management of medicines at the home.

Updated 23 May 2019

We inspected Lindenwood Residential Care Home on 3 and 4 December 2018. The first day of the inspection was unannounced.

Lindenwood Residential Care Home provides accommodation and personal care for up to 16 older people, some of whom were living with dementia. 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. There were 16 people living at the service at the time of our inspection.

We last inspected Lindenwood Residential Care Home in July 2018. At that time, we found one breach of legal requirements and the home was rated 'requires improvement' overall. We had scheduled a date to return to Lindenwood Residential Care Home to check on progress. However, in the intervening period since our last inspection, CQC received information of concern that was of a safeguarding nature. In response to this, we raised a safeguarding alert with the local authority and brought forward this scheduled inspection.

We are currently considering our options in relation to enforcement and will update the section at the end of this report once any action has concluded.

At the time of this inspection there was a manager, however they had not yet registered. 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. The previous registered manager had left in November 2018 which the service had notified us of. The service has had several management changes over the previous two years. Shortly after our inspection the provider contacted us to say they had dismissed the manager. The provider confirmed they were actively seeking to recruit a new manager for the home.

We were not assured that systems and process for safeguarding people who used the service from abuse were operated effectively. We looked at the concerns raised and found the provider had not protected people from the risk of harm and abuse. CCTV footage had shown that four care workers were sleeping on duty. The provider had not taken timely decisive action. Furthermore, we found the provider had failed to make safeguarding referrals to the local authority and CQC had not been notified in line with regulatory requirements about this matter.

There had been multiple whistleblowers to CQC since our last inspection. Issues raised included concerns about new care workers not being recruited safely. We found the provider did not have robust recruitment procedures in place to ensure staff employed were of good character and to consider any potential risks in relation to their employment, as we found five staff had been working at the home without a Disclosure and Barring Service check (DBS).

People within the service were not always safe. During our tour of the home we found the fire exit was partially blocked by a stand aid and we found the lounge door presented a danger due to the door automatically swinging closed after 15 seconds. We found no evidence to show the homes passenger lift had been examined to ensure it was safe to use under the 'Lifting Operations and Lifting Equipment Regulations' 1998 (LOLER).

Although staff we spoke with said there were enough staff working in the home, we were not assured there were always sufficient numbers of staff deployed to meet people's needs at all times.

The management of medicine was not always safe, which put people at risk. We found inconsistencies in respect of record keeping and we found people did not always have detailed guidance in place for ‘when required’ medicines.

The provider had not ensured the service was being run in a manner that promoted a caring and respectful culture. Although some staff were attentive and caring in their interactions with people, they were not supporting people in a consistent and planned way. They did not always respond appropriately and in a timely manner to people's needs.

Staff were not always working within the principles of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Mental capacity assessments for specific decisions had not been completed and correct legal authorisation had not been sought to deprive people of their liberty.

Accidents and incidents were not always recorded, and appropriate analysis was not undertaken to look for trends to try to prevent future accidents.

People had access to health care professionals specific to their needs. However, we found missed opportunities to provide people with the appropriate advice and support when they were losing weight.

Care plans were difficult to navigate which meant that new staff or agency staff may not easily find the most up to date information on people's care needs. Staff had received training in relation to their role and had the opportunity to meet with their manager. However, we found care staff needed training in managing behaviours that challenged.

Throughout the inspection, we observed numerous examples of positive and caring interactions between staff and people who used the service. However, opportunities for such interactions were limited as staff primarily focused on the delivery of task-based care. Activities were not always person centred and people did not have appropriate opportunities to go out.

Although we were satisfied care and support was delivered in a non-discriminatory way and the rights of people with a protected characteristic were respected. We have made a recommendation that the service consults the CQC's public website and seeks further guidance from the online toolkit entitled 'Equally outstanding: Equality and human rights - good practice resource.'

Complaints were recorded and responded to. The provider had a complaints book that recorded verbal complaints.

The provider was unaware of their responsibilities in relation to the duty of candour, which requires services operate in an open and transparent way. We also received evidence that staff within the service had not always acted open and transparently in relation to issues arising in the service, such as staff sleeping on duty.

There was a lack of leadership and governance at the home. There was a lack of support and coaching for staff and this was reflected in the care they provided. Auditing systems were not robust enough to ensure that the service was compliant with the Health and Social Care Act 2008 and as a result these had not identified the concerns that we found during our inspection. The provider had also failed to notify CQC of important incidents and events.

The overall rating for this service is 'Inadequate' and the service has been placed into '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.

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.