Linden House Care Home

Updated 28 January 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by an inspector, a specialist advisor (nurse) and an Expert by Experience on the first day and an inspector on second day. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Linden House Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Linden House Care Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.

Notice of inspection

The first day of the inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service. We sought feedback from the local authority and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used this information to plan our inspection. The provider was not asked to complete a provider information return (PIR) prior to this inspection. A PIR is information providers send to us to give us key information about the service, what the service does well and improvements they plan to make.

During the inspection

We spoke with 2 people who lived at the home and 4 visiting relatives, to gain their feedback about the care provided. We were not able to gain feedback from other people living at the home due to their complex needs. We spoke with the registered manager, the regional manager, 2 nurses, 4 care staff, 1 housekeeping staff and an activities staff member. We also spoke with a visiting healthcare professional. We reviewed a range of records, including 5 people’s care records in detail, and a selection of medicines records.

After the inspection

We telephoned 3 people’s relatives to gain their views about the care provided at the home. We reviewed 2 staff recruitment files, staff supervision and appraisal records and a variety of records related to the management of the service, including audits. We contacted 5 community health care professionals who visited the service regularly for their views about the care provided.

Updated 28 January 2023

About the service

Linden House Care Home is a residential care home which provides personal care and nursing care for up to 30 older people, people with a physical disability and people living with dementia. Accommodation is provided on the ground floor. At the time of the inspection 30 people were living at the home.

This service was previously part of Carders Court Care Home, a residential care home which provided personal and nursing care for up to 150 older people, people with a physical disability and people living with dementia. In September 2022, the provider split Carders Court Care Home into five separate care homes which were registered with the Care Quality Commission (CQC) individually. Linden House Care Home is one of those services. The last inspection of Carders Court Care Home took place in in February 2021.

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

We received some concerns from people, relatives and staff regarding staffing levels at the home. They told us people did not always receive support when they needed it and there were not always enough staff available to monitor people and keep them safe. Some relatives and staff raised concerns about the cleanliness of the home environment. We found unpleasant odours in some areas of the home. We noted that audits of hygiene and infection control were not always completed as often as they should have been and where shortfalls had been identified, action had not always been taken in a timely way to make the necessary improvements. People’s medicines were managed safely and in line with national guidance. The necessary checks were completed when staff were recruited. Staff had completed safeguarding training and knew the action to take if people were at risk of abuse. Safety checks of equipment and the premises were completed regularly.

People did not always receive support which reflected their assessed needs and risks. They did not always receive support when they needed it and their safety was not always monitored effectively. People and relatives felt staff were competent. 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. Two people were unhappy with the meals provided at the home. Staff supported people with their healthcare needs and referred them for specialist support when they needed it. Feedback from community healthcare professionals was mainly positive. The home environment was purpose built to promote people’s independence but needed to be reviewed to ensure it met the needs of people living with dementia, we have made a recommendation about this. There was an improvement plan in place for the home environment.

People were not always supported well, as there were not always enough staff to meet their needs and monitor their safety. People and relatives found staff kind, caring and helpful. Where people were unable to ask for support due to their complex needs, staff anticipated the support they might need. People looked comfortable around staff and we observed staff reassuring people when they were confused or distressed. Care plans included information about people’s background and diversity to guide staff about what was important to them.

Care was not always provided in a way which was responsive to people’s individual needs and risks. People sometimes experienced delays when they needed support and risks to their safety were not always monitored effectively. Concerns and complaints were managed in line with the provider’s complaints policy. Staff supported people with a variety of group and one to one activities and most people and relatives were happy with the activities available. People’s end of life care needs were met.

People did not always receive high quality care, which was personalised and resulted in good outcomes for them. The audits and checks of quality and safety, did not always ensure appropriate standards were being maintained. When audits identified shortfalls, improvements were not always made in a timely way. There were processes in place for people and relatives to share their views about the service. Management and staff worked in partnership with a variety of health and social care community agencies to access any additional support needed.

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

Rating at last inspection

This service was registered with us on 29 September 2022 and this is the first inspection.

Why we inspected

We had planned to complete an inspection of Carders Court Care Home due to the rating at the last inspection and concerns we had received. When the provider changed the registration to split Carders Court Care Home into 5 separate care home services, a decision was made for us to inspect Linden House Care Home, as some of the concerns we had received related to that home.

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.

Enforcement

We have identified breaches in relation to staffing levels, the cleanliness of the home environment, people not always being treated with dignity and respect and the provider’s oversight of the service at this inspection.

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

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.