Linksway

Updated 8 August 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 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 was carried out by 1 inspector; a specialist advisor, whose specialism was nursing care; and an Expert by Experience. 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

Linksway 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. Linksway is a care home with 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 the inspection

We reviewed information we had received about the service since the last inspection. 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 information gathered as part of monitoring activity that took place on 16 March 2023, to help plan the inspection and inform our judgements.

During the inspection

We spoke with 7 people who used the service and 3 relatives about their experience of the care provided. We spoke with 5 members of staff including the registered manager, nursing staff, care staff, maintenance staff and the cook.

We reviewed a range of records. This included 11 people's care records and 16 medicine administration records. We looked at 4 staff files in relation to recruitment and staff supervision. We also reviewed a variety of records relating to the management of the service, including policies and procedures.

Following the inspection, we received feedback from 4 external health and social care professionals who work with the service.

Updated 8 August 2023

About the service

Linksway is a care home registered to provide accommodation and nursing or personal care for up to 24 people. The home provides accommodation over two floors. There were 15 people using the service at the time of the inspection.

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

Medicines were not always managed safely, or in line with the providers medication policy. This related to the completion of medicines administration records (MAR), the administration of external/topical medicines and the disposal of medicines. In addition, improvements were needed to the providers medication policy to ensure its relevance to the service being provided.

Improvements were needed to the management of risk. Documentation and recording did not consistently reflect the care being provided, and staff did not always have the knowledge and skills to support people to change position in line with their individual needs.

People were at risk because care plans did not provide the detailed information staff needed to meet their needs in line with their preferences. For example, there was no care plan to advise staff how best to support a person experiencing frequent periods of distress. There was no specific information in care plans about people’s communication needs and care plans were not available in different formats, for example large print.

The majority of these issues had not been identified by the providers governance systems which meant they were not fully effective. Action previously taken to address concerns about staff practice had not always led to improvements, for example related to the recording of care provision.

The registered manager promoted a culture of openness and honesty. They were open and transparent during the inspection and took immediate action in response to concerns raised. This included seeking advice from external health professionals, addressing concerns with the staff team and improving policies, processes and monitoring systems.

Overall, people and relatives spoke highly of the quality and safety of the service. Comments included, “Staff take marvellous care of me. I am very happy here” and, “Oh, yes he’s very safe, it’s all fine, I can’t fault them”. People’s outcomes demonstrated risks were well managed overall, with improvements in physical health conditions.

Staff told us they felt valued and happy working at the service. They felt well supported and were passionate about their role. There had been a successful overseas recruitment programme. The Provider Information Return (PIR) stated, “This has provided our staff with an opportunity to learn about different backgrounds, religions, and experiences of our new staff members.” Some staff did not have English as a first language, so received individual support to ensure their induction and training was meaningful and accessible to them.

A newly recruited enabler was in post. They were in the process of developing a person-centred activities programme, incorporating group activities and individual time with people.

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.

Regular health and safety checks were undertaken at the service. Some improvement was required to the infection prevention processes, and this was made immediately. A programme of refurbishment was in progress. A robust risk assessment ensured measures were in place to minimise potential risks to people, visitors and staff. People were protected from the risk of abuse through the provision of policies, procedures and staff training, and an effective recruitment process.

Staff had a clear understanding of the process for managing and reporting accidents and incidents and were using it effectively. Information was reviewed and analysed by the registered manager and provider, and action taken where required, to prevent re-occurrence.

Staff made prompt referrals to relevant healthcare services when changes to health or well-being had been identified. The service worked closely with health and social care professionals to ensure people's health needs were met. We spoke to visiting health professionals during the inspection who spoke positively about the responsiveness and effectiveness of the service.

The service worked closely with health and social care professionals to support people at the end of their lives. This ensured people's needs and preferences were understood and met, and they and their families were supported.

People, relatives and staff were invited to express their views of the service through quality assurance surveys. The information from the quality assurance processes was used to drive improvements at the service. Complaints were managed in line with the providers complaints policy.

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 good (published 20 March 2019)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive 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 Linksway on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to the safe management of medicines, the monitoring and mitigation of risks, recording and governance. 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.