The Lindens Care Home

Updated 14 December 2022

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 Health and Social Care Act 2008.

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 team on day one of the inspection consisted of two inspectors. One inspector visited the service on day two, one inspector and an Expert by Experience visited the service on day three. An Expert by Experience made telephone calls to relatives after the inspection.

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

The Lindens 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. The Lindens Care Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

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

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with five relatives and seven people who used the service about their experience of the care provided. We spoke with two care workers, one team leader, two senior care supervisors, administration staff, deputy manager, the registered manager, the provider and one of the maintenance staff. We spoke with one visiting professional. We observed lunch and used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We walked around the service and reviewed the environment. We reviewed a range of records relating to people's care which included, multiple medicine records and eight care plans. We reviewed three staff recruitment files and a further three staff files to review supervision and training records. A variety of records relating to the management of the service, including fire, health and safety, accident/incident reporting, safeguarding, audits, policies and procedures were reviewed, and others were requested.

Following the visit to the service we sought feedback from relatives, staff, community professionals and continued to seek clarification from the registered manager. We received written feedback from three staff and six relatives.

Updated 14 December 2022

About the service

The Lindens is a residential care home providing accommodation and personal care to up to 60 people. The service provides support to older people. At the time of our inspection there were 52 people using the service.

The Lindens accommodates people across three units, which includes the main house and two wings. People have their own ensuite facilities. The home have three double bedrooms available to couples or family members who wish to share. The service have a large dining room, separate smaller dining area and a variety of sitting areas throughout the home.

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

People and their relatives were happy with the care provided. They felt they received safe care from a consistent staff team. Relatives commented “My mum is very happy at 'The Lindens'. I have confidence in mum’s care. The care staff are very attentive and provide mum with all her physical and emotional needs,” and “The care for mum, in my opinion, is excellent. The facilities and surroundings of 'The Lindens' are lovely and kept very clean and well maintained. I have noticed that staff attitude towards residents is always positive and kind, despite the challenges of this type of job. There is a warm feeling to the home every time I visit.”

Improvements were made to safeguarding processes to safeguard people. However, safeguarding incidents had not been reported to the Local Authority safeguarding team in line with the Multi- Agency safeguarding policy. Alongside this we had not been notified of incidents involving injury to people.

People’s care plans and associated records were in the process of moving over to electronic records. Whilst improvements were made to many records relating to the running of the service, people’s records were not suitably maintained and reflective of their needs.

Systems were in place to manage accidents, incidents and prevent reoccurrence. Safe medicine practices were promoted. Risks to people were identified and actions taken to mitigate risks, including infection control risks. Staff had a good knowledge of the people they supported which further reduced risks to them.

Safe recruitment practices were established, and staff were better supported, inducted and trained to support people. Sufficient staff was provided with management support provided as required, including on call support to staff.

People were supported to have maximum choice and control of their lives and staff supported did them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The registered manager had brought about positive changes to the service. They had improved communication within the team and with relatives. Relatives were welcomed and encouraged to be involved in their family members care. The registered manager had commenced auditing of practices and was aware what improvements were needed to further improve the delivery of person-centred care.

Staff, people and relatives were complimentary of the registered manager who was described as “Approachable, kind, caring and acted as a positive role model to staff.” A relative commented “Changes in the home since the last inspection have all seemed positive and a noticeable improvement. There is now a regime that; respects and welcomes contact with relatives and establishes good working practices in administration and staff organisation, while still giving an aura of friendly care.”

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 inadequate (published 2 April 2022) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made although the provider remained in breach of two regulations.

This service has been in Special Measures since April 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced focused inspection of this service on 25 January, 2 and 3 February 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve person centred care, need for consent, safe care and treatment, safeguarding service users from abuse or improper treatment, good governance, notification of other incidents and ensuring fit and proper persons were employed.

We undertook this focused inspection to check they 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 and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Lindens Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to failures to make the required notifications to us and record management at this inspection. We have made a recommendation to further improve safeguarding reporting.

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.