The inspection took place on 31 January and 7 February 2017 and was unannounced. The service was last inspected in December 2015 and was found to be in breach of five regulations.Following the last inspection, requirement notices for regulations 9, 11,12 and 13 and a warning notice for regulation 17, good governance had been issued to the provider. Several aspects of the warning notice had not been sufficiently addressed by the provider and significant concerns remained at this inspection.
Linson Court is registered to provide residential and nursing care for up to 40 people in single rooms with en-suite facilities. The bedrooms are situated on two levels with a lift and stairs for people to access the first floor.
The home had been without a registered manager and a manager had been in post since August 2016. They were in the process of registering with the Care Quality Commission to become the registered manager. 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.
Linson Court was welcoming and provided a homely environment. Staff had an understanding of how to keep people safe and knew the safeguarding procedures to follow in the event of a concern or allegation of abuse.
Individual risks to people were not always assessed and there was little analysis of accidents or incidents. There was poor oversight of clinical risks to those people who required nursing care and we found weaknesses in medicines management.
Staffing levels were managed appropriately to meet people's needs, although induction for new staff lacked recorded detail and recruitment was not consistently robust. There were gaps in staff training, knowledge and supervision and there was little evidence staff competencies were checked, particularly around skills required for providing nursing care.
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. Staff had received training on the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards and staff understood this. Where people had care plans completed thoroughly there were recorded details of mental capacity and some best interest discussions. However, not all people’s information was recorded appropriately and some people did not have a care plan in place or any assessment of mental capacity.
Food provision was of good quality and people enjoyed the meals overall. There was a designated chef who understood the importance of diet and nutrition and was involved in the serving of the meals, so knew people's preferences. However, there was poor monitoring of people's dietary and fluid intake. Records of weight monitoring were not maintained regularly; the records that were available showed several people had lost weight, yet there was no oversight of this or evidence of action taken.
Staff had good relationships with people and they knew each person well. There was plenty of friendly banter and a happy atmosphere in the home. Staff respected people's privacy and dignity in care practice although some confidential information was on view in communal areas.
Where people were approaching the end of their life, staff were attentive and compassionate, however, relevant care planning was not always given due consideration.
Staff offered person centred care in the way they interacted with people and supported their needs. Activities were meaningful and staff made frequent checks on people who stayed in their rooms. Care records were variable in quality; some had more detail than others, although some lacked essential information.
Complaints were not always responded to appropriately; where people complained verbally this was not recorded and there was no evidence matters had been satisfactorily addressed.
The management of the home was unsettled and staff lacked clear direction in their work, although staff said they had better support than before the manager was in post. There was no clinical leadership or oversight of nursing care in the home.
This inspection highlighted continued breaches in four out of five regulations identified at the previous inspection and three further breaches.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
You can see what action we told the provider to take at the back of this report.