Archived: The Links Care Centre

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

Is the service safe-

Each person's care file had risk assessments in place which covered areas of potential risk such as managing behaviour which could be challenging, mobility, falls, pressure sores and nutrition.

Our observations of care, examination of care plans and discussions with staff demonstrated to us that the provider was delivering a service which was safe but was not fully sympathetic to people's individual emotional and psychological needs. We have asked the provider to tell us what action they will take to improve this aspect of the service.

We found people were supported to take their prescribed medications correctly and safely and the medication administration records were accurate and up to date.

The required checks were carried out before new staff started work in the service and this protected people against the risk of being cared for by staff that were not suitable to work in the caring profession.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We were told that one person using the service was subject to authorised deprivation of liberty. We found that the requirements of the Mental Capacity Act 2005 deprivation of liberty safeguards and imposed conditions in the authorisation were being met. In addition we saw that further applications were in the process of being made to the local authority.

Is the service effective -

People had an individual care plan which set out their care needs. We saw wherever possible people had been involved in the assessment of their health and care needs and had contributed to developing their care plan.

The input of other health care professionals involved in people's care and treatment was not always clearly recorded in their care plans. This meant there was a risk people would receive inappropriate or unsafe care and treatment.

The people we spoke with told us, within the limits of their ability, that they were able to choose what they wanted to do, what they wanted to eat and drink and where they wanted to spend their time. They also told us there were periods where they were bored.

Is the service caring '

We found the staff we spoke with demonstrated a good knowledge of people's needs and were able to explain how individuals preferred their care and support to be delivered.

During our visit we saw a number of positive interactions between people and the staff. We asked people if they liked living at the home and they told us that they did. One person said, "Yes it's OK here but I want my own place as soon as possible'.

Throughout the day we observed staff interaction with people in the High Dependency Unit. Most staff were gentle, patient and respectful, however we witnessed people being spoken to in an unhelpful and authoritarian manner by one member of staff. We brought this to the attention of the manager before we left. We observed some people lacked motivation with staff giving little encouragement on a one-to-one basis. We observed on a number of occasions staff standing in the door-way to one of the lounges giving the impression of guarding people rather than caring for them. The opportunities for good one-to-one interaction were ever present but not fully utilised.

Generally staff provided appropriate support to people who required help to eat. However, we overheard one of the staff referring people who required support to eat as 'the feeders', this does not help to promote or protect people's dignity because it does not recognise people's individual needs.

Is the service responsive '

Wherever possible people who used the service and/or their relatives were involved in discussions about their care and the risk factors associated with this. Individual choices and decisions were documented in the care plans and reviewed on a regular basis.

The training records showed that some care staff had been trained in dementia care and registered nurses had the correct skills and knowledge to maintain their registration yet the therapeutic value of care was sub-optimal. Our discussions with care staff demonstrated they had the knowledge to deliver good care to people with a mental illness but they lacked direction.

Most of the people we spoke with said the food was generally good. However, one person said 'The food is not up to much; it's too plain for my liking and they could do much better'. We found the provider did not have suitable arrangements in place to cater for people's dietary needs arising from their cultural and/or religious beliefs.

Our observations of the meal service at lunch time indicated that eating lunch was a process rather than a social occasion which could have benefits of improving people's feelings of wellbeing and inclusivity. The opportunity to facilitate mealtimes being an opportunity for people to feel connected with others was lost.

We have asked the provider to tell us what action they are going to take to meet the requirements of the law in relation to people's care and welfare and in relation to catering for people's individual dietary needs.

Well led '

We spoke with fourteen staff employed as care workers and/or nurses. The majority told us they liked working at The Links Care Centre. They said they felt completely supported by their manager and felt confident in raising concerns should they need to. However, four members of staff said they felt marginalised, did not feel supported by the manager and were fearful of raising concerns.

The records showed that while staff appraisals had been carried out in the past there had been virtually none in the 18 months preceding the inspection. We also found there was a lack of regular and meaningful formal supervision. This meant the provider was not able to demonstrate that they were identifying the needs of staff, based on the needs of people who used the service, to ensure essential standards of quality and safety were being met.

We saw evidence that checks (audits) were carried out on various aspects of the service. However, in the course of the inspection we found a number of areas where the service did not meet the required standards of quality and safety. This demonstrated to us that the provider did not have effective systems and processes in place for monitoring and assessing the quality of the service.

We have asked the provider to tell us what action they are going to take to meet the requirements of the law in relation to monitoring and assessing the quality of the services provided.

We found the provider had taken appropriate action to make sure care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We found the provider had taken appropriate action to make sure they had suitable arrangements in place to protect people from the risks associated with medicines.

We found the provider had taken action to make sure people who used the service were protected from the risks of unsafe or inappropriate care and treatment by maintaining accurate and appropriate records.

People told they knew about their care plans and had a say about what went in them. They said they didn't know how long their records were kept for or why. We found improvements were needed to the way records were maintained.

People told us they felt safe and knew about abuse. However, they said the service had not provided them with any information about abuse. People told us they knew who to speak to if they had a problem and said staff would speak to them privately if needed. People said they had never experienced or witnessed restraint. However, some people said the night staff generally were not as supportive and were not always willing to listen to them.

We found the service was cleaner than when we last inspected. However, some people expressed concerns about people smoking in their rooms. We found improvements were needed to the way people's care and treatment was planned and delivered and to the way people's medicines were managed.

We observed the manager knew everyone who used the service by name and people told us would not hesitate to talk to the manager if they had any concerns.They said they were confident the manager would deal with any concerns they raised.

We found the home was generally well maintained and the d'cor and furnishings were to a satisfactory standard. One person we spoke with told us they felt the home was not particularly well planned for people who used wheelchairs, for example the height of the worktops meant that they could not always prepare food and drinks in the kitchen.

We identified some concerns relating to infection control and the management of odours. Immediate action was taken by the management team to address these concerns.

The people we spoke with did not express any concerns about their safety. However, we had some concerns about the way the safeguarding procedures were applied in practice.

We found staff were checked before they were offered employment and there was a complaints procedure in place.