Archived: Linthorpe Nursing Home

Linthorpe Nursing Home is a care home which provides nursing and residential care for up to 28 adults. At the time of inspection 20 people were using the service. Linthorpe Nursing Home is set out over two floors.

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

At the last inspection the provider failed to have effective systems in place to monitor the quality of the service. At this inspection we found improvements had been made. The registered manager and provider undertook a range of audits and checks on the service. However, further work was needed to improve their recording systems to evidence continuous improvement. We have made a recommendation about this.

People and their relatives told us they felt safe and staff providing support knew them well. One relative said, “[Person] is safe. It’s the staff and ethos of the home that reassures me. I’m always contacted if there are any concerns.”

Staff understood how to safeguard people from abuse. People's privacy and dignity was seen to be maintained. The staff team had the necessary skills to support people appropriately. Enough staff were on duty to respond to people's needs in a timely manner. The registered manager used information from accidents and incidents to learn lessons.

People's care and support needs were assessed. Records reflected people’s current needs. Medicines were managed safely and there were close links with health and social care professionals to ensure people's physical and mental health needs were met and changes responded to quickly.

The home had a dedicated infection prevention and control champion who ensured national guidance was being followed. The registered manager monitored all areas of the home ensuring high standards of infection prevention and control were delivered and that suitable supplies of personal protective equipment were available. Additional activities had been planned within the home during lockdown to positively support people. People were supported to have socially distanced outdoor visitors. The home was in the process of developing other methods to support people in keeping in touch with their relatives 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 upheld this practice.

The manager and staff team were praised by people, their relatives and staff, for their supportive approach. One relative said, “The manager is great, medically qualified and very professional. There is a low turnover of staff and they all appear to be knowledgeable and skilled.”

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 requires improvement (published 3 October 2019). 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 been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check the provider 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, effective 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 changed from requires improvement 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 Linthorpe Nursing 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.

Linthorpe Nursing Home is a care home which provides nursing and residential care for up to 28 older people. At the time of inspection 17 people were using the service. Linthorpe Nursing Home is set out over two floors.

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

At the last inspection the provider failed to have effective systems in place to monitor the quality of the service. At this inspection we found some improvements had been made in this area. The registered manager and provider had started to carry out a range of audits and checks. However, the changes made did not identify the issues we found on inspection. The changes made to the service’s auditing processes needed embedding into practice.

At our last inspection the provider failed to assess and reduce health and safety risks to people. At this inspection we found that improvements had been made in this area but some further work was required to assess and mitigate risks.

People told us they felt safe living at Linthorpe Nursing Home. People and relatives told us staff were very caring.

Staff knew how to safeguard people from abuse. Recruitment processes reduced the risk of unsuitable candidates being employed. Medicines were managed safely. People told us call bells were answered promptly.

Staff had the skills and knowledge to deliver care and support in a person-centred way. They were supported through induction, training and supervision. People’s care needs were assessed and the support needs identified for people were provided.

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. We found however, some additional recording was required in this area.

Limited activities were available to people at the time of inspection due to the absence of the activities coordinator. We have made a recommendation about activities.

People’s health needs were met. The service worked with other professionals to best meet people’s needs.

A complaints system was in place. Lessons were learnt from adverse incidents.

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 September 2018). There were two 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 this inspection not enough improvement had not been made and the provider was still in breach of regulation.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach of regulation in relation to the governance of the service. 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.

Linthorpe Nursing Home accommodates up to 28 people in one adapted building set across two floors. At time of our inspection there were 20 people using the service.

Linthorpe Nursing Home 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.

When we inspected the service the manager was going through the process of becoming 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 person’s'. 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.

Linthorpe Nursing Home was last inspected in January 2018 and was rated overall as Inadequate. We identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were related to need for consent, safe care and treatment, premises and equipment, good governance, fit and proper persons employed and staffing.

Following the inspection in January 2018 we asked the provider to complete an action plan to show what they would do, and by when, to improve. We received an action plan from the provider which set out a timeframe for making improvements in all of the key questions. At this inspection we found improvements had been made and many of the concerns we had identified at the previous inspection had been addressed. The service has however, continued to remain in breach of two regulations relating to safe care and treatment and good governance. You can see what action we have asked the provider to take at the back of the full version of this report.

During this visit we identified that some important safety checks and assessments had not been carried out. Including those to prevent legionella and risk assessments in relation to people and staff.

We found some risk assessments for people and for tasks carried out by all staff had not been completed.

This is a breach of Regulation 12 of the Health and Social Care 2008 (Regulated Activities) Regulations 2014 related to Safe care and treatment.

The provider’s governance system was not robust. The manager carried out a range of audits however there were no records available of quality assurance audits carried out by the provider or their representative.

This is a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to Good governance.

Whilst medicine systems had improved greatly we found there were still some gaps in systems and recordings.

Equipment and premises checks were undertaken to help ensure the environment was safe. We have made a recommendation about window safety within the building.

Infection prevention and control practices were followed by staff to reduce the risk of infection spreading. Contingency plans were in place to deal with emergency situations.

Policies and procedures were in place to protect people from harm such as safeguarding and whistleblowing polices. Staff knew how to identify and report suspected abuse. People and their relatives told us they felt the service was safe.

There were suitable numbers of staff on duty to ensure people’s needs were met. Safe recruitment practices were in place. Pre-employment checks were made to reduce the likelihood of employing staff who were unsuitable to work with vulnerable people.

The manager had ensured that staff were scheduled to have or had received training to be able to carry out their role.

Staff were supported through regular supervision and an annual appraisal.

Learning took place following reviews of accidents and incidents where themes and trends were addressed.

People had access to a range of healthcare such as GPs, hospital departments and dentists. People’s nutritional needs were met and they enjoyed a varied, nutritional diet that met their preferences. People told us they enjoyed the food.

We have made a recommendation about the records maintained relating to the Mental Capacity Act 2005.

Activities were taking place within the home and the manager was planning to develop these further.

The premises were clean and tidy and were suitable for the people currently living within the home.

People were supported by a regular team of staff who were knowledgeable about their likes, dislikes and preferences. Staff members were kind and caring towards people. People’s privacy, dignity and independence were respected. People were supported to maintain personal relationships. The policies and practices of the home helped to ensure that everyone was treated equally. End of life care procedures were in place.

Meetings for staff and people took place regularly. This enabled people to be involved in decisions about how the service was run. The service worked with a range of health and social care professionals to ensure individual’s needs were being met. Feedback was sought to monitor and improve the service.

Staff were very positive about the manager. They confirmed they felt supported and were able to raise concerns. A complaints policy and procedure process was in place.

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 had been made and it is no longer rated as inadequate overall or in any of the key questions. Therefore, the service is now out of Special Measures.

Linthorpe Nursing Home 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.

Linthorpe Nursing Home accommodates up to 28 people in one adapted building across two floors for people with residential and nursing care needs. On the days of our inspection there were 21 people using the service.

The home had a registered manager in place. A registered manager is a person who has registered with CQC 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 registered manager was not present during our visit however the deputy manager was present and was acting as manager at the time of the inspection.

Linthorpe Nursing Home was last inspected by CQC on 25 May, 6 and 17 June 2016 and was rated Good.

At this inspection, we found the provider did not have the oversight needed to ensure people continued to receive good care. They did not have a robust quality assurance system in place and did not gather information about the quality of their service from a variety of sources. Audits and quality assurance systems did not always identify shortfalls in the requirements of the regulations being met.

Care plans did not reflect a reasonable standard of assessment, planning, implementation and evaluation of care and as a result were not person-centred. People did not have access to meaningful activities in the home or within the local community which reflected their personal preferences and interests. The provider had a complaints policy in place however did not record complaints.

Effective recruitment and selection procedures were not in place and the provider did not carry out relevant checks when they employed staff. Staff used a range of assessment and monitoring tools however these were not always consistently or accurately completed.

Staff mandatory training was not up to date and staff did not receive regular supervisions and an annual appraisal. This meant staff were not support to carry out their roles effectively.

The provider did not have a good understanding of their legal responsibilities with regard to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and staff had not received training in the MCA and DoLS.

There were sufficient numbers of staff on duty in order to meet the needs of people using the service. However we have made a recommendation the provider implements a dependency tool to support staffing levels. Staff demonstrated a good awareness of safeguarding. Medicines were safely administered however the procedures for managing medicines needed to be improved.

People had access to food and drink throughout the day and we saw staff supporting people at meal times when required. People had access to healthcare services and received ongoing healthcare support.

The layout of the building provided adequate space for people with walking aids or wheelchairs to mobilise safely around the home. Facilities included twelve en-suite bedrooms, several lounges, a dining room, communal bathrooms, shower rooms and toilets and a large communal garden. Entry to the premises was via a locked door and all visitors were required to sign in. The service was clean and tidy.

People who used the service and their relatives were complimentary about the standard of care at Linthorpe Nursing Home. We saw staff supporting and helping to maintain people’s independence. People were encouraged to care for themselves where possible. Staff treated people with dignity and respect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. The service 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.

During our inspection we found a number breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.

Linthorpe Nursing Home is registered to provide personal and nursing care for up to 28 older people. The home has bedrooms across the two floors. There are two lounges, a dining room, and a small room where people could sit and read. Linthorpe Nursing Home also had the benefit of an enclosed landscaped garden. At the time of our inspection there were 28 people living at the home.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were happy and felt safe. We heard how people felt the home was extremely well-run and that the registered manager was extremely effective.

We found that a range of stimulating and engaging activities were provided at the home. There were enough staff to support people to undertake activities in the community. People were supported to go out independently. The registered provider and registered manager had recently installed a chicken coop in the garden and this was a great focal point for people.

People’s care plans were tailored for them as individuals and created with them and their family involvement. People were cared for by staff that knew them really well and understood how to support them. We observed that staff had developed very positive relationships with the people who used the service. The interactions between people and staff were jovial and supportive. Staff were kind and respectful. We saw that they were aware of how to respect people’s privacy and dignity. Staff also sensitively supported people to deal with their personal care needs.

Staff were supported and had the benefit of a programme of training that enabled them to ensure they could provide the best possible care and support. Staff were all clear that they worked as a team and for the benefit of the people living at Linthorpe Nursing Home. Their comments and feedback fed into the continuous improvement of the service.

The registered manager understood the complaints process and detailed how they would investigate any concerns. They also told us about situations such as people’s treatment in hospital where they had raised complaints on individual’s behalf.

The registered manager and staff had a clear understanding of safeguarding. The registered manager acted as a champion for people and would raise complaints and safeguarding matters when this was needed. One person and their family told us how grateful they were that the registered manager had taken up their corner and ensured action was taken to improve their experience of care. The registered manager also spoke with the safeguarding team at all stages and regularly checked that they were taking appropriate action to deal with any concerns. Also when necessary they took additional action to ensure staff who were not fit to work with people were barred from working in the health and social care field.

People who used the service and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. The registered provider and registered manager had closely considered people’s needs and ensured there were sufficient numbers of staff. For the 28 people using the service there was routinely a nurse, a senior carer and five to six care staff on duty during the day and then a nurse and three care staff overnight.

Where people had difficulty making decisions we saw that staff worked with them to work out what they felt was best. Staff understood the requirements of the Mental Capacity Act 2005 and had appropriately requested Deprivation of Liberty Safeguard (DoLS) authorisations.

We reviewed the systems for the management of medicines and found that people received their medicines safely. Medicines were closely managed and this ensured people received their medication exactly as prescribed.

People told us they were offered plenty to eat and we observed staff to assist individuals to have sufficient healthy food and drinks to ensure that their nutritional needs were met. The cook also provided a range of fortified meals for people who needed extra calories to ensure they maintained their weight. People were supported to manage their weight and nutritional needs.

People were supported to maintain good health. The staff had formed good links with the speech and language therapists, community nurses and the falls team.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people. The staff team was stable and a number of the staff had worked at the home for over ten years.

The service had a strong leadership presence with a registered manager who had a clear vision about the direction of the service. They were committed and passionate about the people they supported and were constantly looking for ways to improve. Thorough and frequent quality assurance processes and audits ensured that all care and support was delivered in the safest and most effective way possible.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they were listened to. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made, and how to submit one. This meant that people would be safeguarded as required.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

The registered manager sets the staff rotas, they took people's care needs into account when making decisions about the numbers, qualifications, skills and experience of staff members required. This ensured that people's needs were met.

Recruitment practice was safe and thorough. No staff had been subject to disciplinary action. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

People's health and care needs were assessed with them and their relatives, and wherever possible they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. The care plans were reviewed monthly as well as when needed to reflect people's current needs.

Visitors confirmed that they were able to see people in private and that visiting times were flexible allowing them to come and go as they please.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, 'I could not ask for better', 'It is a wonderful place' and 'They could do nothing better'. A relative said, 'My mother is spoilt'.

People using the service and their relatives, completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed with an action plan, however the action plan needed to be more robust to show what action is needed, who was responsible for the action and when the action should be completed by.

People who used the service had their problems such as anxiety and mobility recorded in their care plans, with a goal and how they were going to achieve this goal, these were updated on a monthly basis or as needed.

Is the service responsive?

People knew how to make a complaint if they were unhappy although no one asked had made a complaint. We looked at how these complaints had been dealt with, and found that the responses had been open, thorough, and timely. People can therefore be assured that complaints were investigated and action was taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system, records viewed showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We were able to observe the experiences of people who used the service. Staff were attentive and interacted well with people. We saw that people had their needs assessed and that care plans were in place.

We asked people about the food that was provided. People confirmed that that they were always offered a choice of food and drink at each meal time. People said that the portion sizes were good. One person said, 'The food is good. I've put on loads of weight.'

We found medicines were safely handled.

We saw that the service had appropriate medical and non-medical equipment. We saw that regular checks and servicing of equipment had been undertaken to ensure that it was in safe working order.

We found there was an effective complaints system in place at the home.