Linksway

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.

We found the following examples of good practice.

The staff were following up to date infection prevention and control guidance to help people to stay safe. The provider organisation kept staff up to date through newsletters and bulletins. The registered manager and senior staff ensured staff understood why every measure was in place and there were regular updates and reminders.

There was an infection control lead. This enabled the housekeeping team and care staff to work effectively together to ensure infection prevention and control measures were followed. Risk assessments and clear cleaning schedules related to Covid were in place and monitored.

The provider provided training to ensure staff knew how to keep people safe during the COVID-19 pandemic. The provider had also ensured staff had access to training about their emotional response to the pandemic and counselling support. The provider clearly valued staff who had been well supported and received a voucher bonus for their continued good work. Staff took pride in maintaining people's safety as much as possible.

Staff supported people to occupy themselves whilst maintaining their safety. Staff were providing additional one to one activities to people in their rooms and visited them frequently. People who preferred to spend their time in communal areas were supported to this whilst maintaining physical distancing. There were many examples of engaging person centred time and monitoring people's wellbeing.

Staff helped people to stay in touch with family and friends through phone and video calls. Visitors could also book appointments to visit people in a safe way.

The registered manager and provider was communicating with people, staff and family members regularly to make sure everyone had an understanding of precautions being taken, and how to keep people safe.

People’s experience of using this service:

Everyone said the service was well led by the registered managers. The culture was open and promoted person centred values. People, relatives and staff views were sought and taken into account in how the service was run. There were systems in place to monitor the quality of care provided. Audits had not identified some of the issues found at our inspection the management team were responsive and proactive when areas for improvement were highlighted to them.

People remained safe at the service. People said they felt safe and cared for living at Linksway. People were protected because staff knew how to recognise signs of potential abuse and how to report suspected abuse. People’s care needs were assessed before admission to the home and these were reviewed on a regular basis. Risk assessments were undertaken for all people to ensure their individual health needs were identified and met. Where concerns were identified during the inspection the registered managers took immediate action to remedy the concerns.

There were sufficient and suitable staff to keep people safe and meet their needs. Thorough recruitment checks were carried out. New staff received an induction that gave them the skills and confidence to carry out their role and responsibilities effectively.

Linksway supported people who require palliative care. The registered managers and staff were very committed to ensuring people experienced end of life care in an individualised and dignified way.

The provider recognised the importance of social activities. People were encouraged to engage in meaningful activity to aid both their physical and emotional well-being.

Staff told us they were well supported. They commented on the availability of the registered managers for support, advice and guidance at all times. Training covered a wide range of areas and was regularly refreshed. Staff were able to request additional training to meet people’s specific needs. Staff were encouraged to develop their skills and contribute to the running of the service.

People had a varied and nutritious diet. There was a designated enabling staff member to support people to engage in activities they were interested in, on an individual and group basis.

People knew how to make a complaint if necessary. They said if they had a concern or complaint they would feel happy to raise it with the management team.

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.

People were supported to lead a healthy lifestyle and have access to healthcare services. Staff recognised any deterioration in people's health, sought professional advice appropriately and followed it. People received their medicines on time and in a safe way.

Rating at last inspection: Good (report published September 2016).

Why we inspected: This was a planned comprehensive inspection based on the previous rating.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission 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.

Everyone was positive about the registered manager and the management team and felt they were approachable and caring. The registered manager was very visible at the service. The provider and registered manager demonstrated they had a clear vision and values for the service.

There were sufficient and suitable staff to keep people safe and meet their needs. The staff and registered manager undertook additional shifts when necessary and agency staff had been used to ensure adequate staffing levels were maintained.

The registered manager and staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments had been completed and best interest decisions made in line with the MCA.

People were supported by staff who had the required recruitment checks in place. Staff had received a full induction and were knowledgeable about the signs of abuse and how to report concerns. Staff had the skills and knowledge to meet people’s needs.

People were supported to eat and drink enough and maintain a balanced diet.

People said staff treated them with dignity and respect at all times in a caring and compassionate way. People received their prescribed medicines on time and in a safe way.

A designated enabling person was in the process of being employed by the provider to support people so they did not become socially isolated.

Risk assessments were undertaken for people to ensure their health needs were identified. Care plans reflected people’s needs and gave staff clear guidance about how to support them safely. They were personalised and people had been involved in their development. People were involved in making decisions and planning their own care on a day to day basis. They were referred promptly to health care services when required and received on-going healthcare support.

The provider had a quality monitoring system at the service. The provider actively sought the views of people and staff. There was a complaints procedure in place and the registered manager was aware of how to respond to complaints appropriately.

The premises and equipment were managed to keep people safe.

We found that staff were well supported and had completed appropriate training. They knew people as individuals and were aware of each person's needs. They were assisted by care plans which contained clear assessments of needs and the strategies to meet those needs. Care records were reviewed and updated regularly. The service had good relations with health care professionals and acted upon their advice.

We saw people had a choice of suitable and nutritious food and drink available in sufficient quantities. People said the food was good. One person said 'the food is marvellous and I always get a choice.'

Systems were in place to monitor the quality of the service. We found that the provider was responsive when issues were raised and lessons were learnt from incidents.

We found that people were being involved in making decisions about their lives. We saw people were supported well and that the home were working well with other agencies involved with people's care.

We found that people's healthcare needs were being assessed and supported well. We found that the home's staff and management understood people's needs, including communication needs where they were impaired. We found that they understood people's rights and supported them.

The home was clean and comfortable.

People using this service felt safe and were confident that staff had the skills needed to safeguard them and to meet their needs. Staff training, supervision and annual appraisals were linked to ensuring that staff had the skills to meet people's needs.

People said they felt safe living at the home and knew how to raise any concerns or complaints.