Linkfield Court (Bournemouth) Limited

We found the following examples of good practice.

At the time of our visit no one living in the home had contracted Covid-19 (since April 2020). All the people living in the home had received their first vaccine for Covid-19.

The home was clean and free from clutter. The home had cleaning schedules in place for day to day cleaning. Personal protective equipment (PPE) was available in the home’s main entrance in the vestibule. All residents’ bedrooms and bathrooms were equipped with PPE, there was also PPE in the home’s quiet lounge. Handwashing guidance was displayed throughout the home.

The home provided safe and effective ways for people to visit their relatives during the Covid-19 pandemic. Visiting arrangements were in accordance with Public Health England (PHE) guidance. Families and carers were contacted by the home’s staff about the home’s visiting and social distancing arrangements. The home provided window visits for families and carers. People living in the home and their relatives could see each other through a window whilst speaking to each other. Internally the home had built a plastic screened visitors’ hub in the quiet lounge. Families and carers could book visits to see their relatives in the quiet lounge hub.

Families and carers could book video calls with their relatives by appointment. Families and carers could telephone their relatives at any time without the need for booking.

The home had a contingency plan in the event of an outbreak of Covid-19 in the home. As a contingency plan, the home could isolate the ground from the first floor in the home. Specific staff would be designated to work on each floor to avoid staff moving around floors of the home.

The service participated in the whole home testing programme, this meant people living in the home were tested for Covid-19 every 28 days. The home’s staff were tested for Covid-19 every seven days, this was supplemented by twice weekly lateral flow testing, these are rapid tests used to detect Covid-19.

The home had systems in place to ensure staff isolated for the required period should they test positive for Covid-19. Staff breaks whilst at work were taken in the home’s garden and staggered for social distancing purposes.

To enable staff in providing care safely, staff had received additional infection prevention and control (IPC) and Covid-19 training to ensure they understood what actions to take in the event of people living in the home or themselves becoming symptomatic.

IPC audits were completed regularly and included extra measures the home had put in place due to Covid-19.

Linkfield Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Linkfield Court is registered to accommodate up to 29 people. At the time of our inspection 25 older people were living in the home, the majority of whom were living with dementia.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and on going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There were two registered managers at the home at the time of the inspection. 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.

People were treated with kindness, respect and compassion, and their privacy and dignity was upheld.

People were protected from neglect and abuse. Risks were assessed and people were supported to stay safe with the least possible restriction on their freedom. Pre-employment checks were followed to ensure candidates were suitable to work in a care setting.

People’s physical, mental health and social needs were assessed holistically, and care and support was planned and delivered in a personalised way to meet those needs.

People, and where appropriate their families, were involved in decisions about their care and support. Staff had access to appropriate training. The registered managers had invested in specialist dementia care training for all of the staff. They also had training in equality, diversity and human rights to help them challenge and avoid discrimination.

People's rights were protected because the staff acted in accordance with the Mental Capacity Act 2005. People and their relatives were encouraged to be involved in decisions about care.

Relatives and friends could visit when they wished without notice.

There were links with the local community.

People had access to meaningful activities and were encouraged to follow interests and hobbies. The activities coordinator post was vacant at the time of inspection.

People made choices about what they ate and drank. Mealtimes were relaxed and sociable occasions, with people receiving the support they needed to eat and drink at their own pace. Dietary needs were assessed and referrals made to dieticians or speech and language therapists as appropriate.

People were supported with their health care needs.

There were sufficient appropriately trained staff on duty to support people in a person-centred way. The service used regular agency staff, whom people knew, to fill any gaps in the rota.

Staff were supported through training, supervision and appraisal to perform their roles effectively.

Staff were valued, respected and supported to develop the service, through supervision, team meetings and ad hoc conversations with the management team. The service was open to the concerns of staff, whether through whistleblowing, supervision and staff meetings, or staff surveys.

Accidents, incidents or near misses were recorded and monitored for developing trends.

The premises were clean and well maintained. Individual bedrooms were furnished and decorated according to people’s preferences.

People were protected from the spread of infection.

Medicines were stored securely and managed safely.

The service sought to support people to have a comfortable and dignified death when nearing end of life.

Clear information about how to make a complaint was available for people. Complaints were taken seriously and investigated openly and thoroughly.

The service worked in partnership with health and social care professionals and other organisations, to ensure people’s care needs were met and that staff kept up with good practice.

The provider had quality assurance processes in place, which helped to maintain standards and drive improvement.

At this inspection we found that the service was compliant with all three breaches of regulations because of improvements made. The ‘Is the service Safe?’ question and ‘Is the service Well-led?’ are now rated as ‘Good’.

There were two registered managers at the home at the time of the inspection. 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.

Improvements had been made in the management of risks to people’s health or safety so that care delivery was safer, particularly for those people who had a safe swallow plan in place. There was also better management of risk posed by the physical environment with hazards identified and made as safe as possible. The home had therefore met both the requirements of a Warning Notice and regulation made at the last inspection.

At the last inspection we found that robust recruitment procedures had not always been followed in making sure competent and suitable staff were employed to work at the home. At this inspection we found the provider had complied with a requirement and more robust recruitment practices were now being followed.

Medicines were managed safely with people being administered medicines as prescribed by their doctor.

Staff had been trained in safeguarding adults and were knowledgeable about how to refer any concerns of abuse.

The home employed sufficient staff to meet people’s needs and the registered manager kept the levels under review.

Since the last inspection care planning had migrated to an electronic record keeping system and care plans were up to date and accurate.

Accidents and incidents were monitored and audited to see if there were any trends that could make systems and care delivery safer.

There had been improvement in the management of the home with the registered manager and provider taking action to meet the Warning Notice and requirements made at the last inspection. There were also systems in place to monitor the quality of service provided to people.

There was a positive culture promoted by the management and good morale amongst the staff team.

This was an unannounced comprehensive inspection carried out by two inspectors on 28 February and 1 March January 2017. We last inspected the home in December 2014 when we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

The registered persons had taken action to address the areas for improvement outlined at our previous inspection but at this inspection we identified three breaches of the regulations.

There were two registered managers at the home at the time of the inspection. 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. The provider was in the process of recruiting a new deputy manager who was soon to start working at the home.

Risks to people’s health or safety concerning delivery of their care and the physical environment had been assessed however we identified hazards where action could have been taken to make the environment safer.

Robust recruitment procedures had not always been followed to make sure competent and suitable staff were employed to work at the home.

There had been an improvement in the way medicines were managed; however, we identified one error where a person did not receive all their medicine on one occasion.

The staff team were well-trained and there were systems in place to make sure staff received training when required.

The home was meeting the requirements of the Mental Capacity Act 2005, with appropriate applications made to the local authority for people at risk of being deprived of their liberty.

People’s consent was gained for how they were cared for and supported.

Staff had been trained in safeguarding adults and were knowledgeable about how to refer any concerns of abuse.

The home employed sufficient staff to meet people’s needs and the registered manager kept the levels under review.

Staff were supported through one to one supervision and annual appraisals.

People were provided with a good standard of food and their nutritional needs assessed. We identified improvements were need to make sure that ‘safe swallow’ plans were always followed by the staff.

People were positive about the staff team and the good standards of care provided in the home. People’s privacy and dignity were respected.

Care planning was in the process of changing to electronic records and work was needed to make sure care plans were up to date.

The home provided a programme of activities to keep people meaningfully occupied.

The home had a well-publicised complaints policy and when a complaint was made, these were logged and responded to.

Accidents and incidents were monitored and audited to see if there were any trends that could make systems and care delivery safer.

There were systems in place to monitor the quality of service provided to people but action was required of the management to address the shortfalls identified at this inspection.

There was a positive culture prevailing in the home with staff providing good care to people.

There were 24 people living in the home on the day of our unannounced inspection and we spoke with three of them. The registered manager was available throughout the inspection.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found.

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

Is the service safe?

Care was not always planned to meet people's needs. Where a need was identified a plan was not always in place to meet this need. For example, one person's care records indicated that they occasionally behaved in a manner which others found upsetting. We found that this person's care plan did not contain guidance that staff should take should this happen. The risk assessment that was in place did not adequately set out actions required to ensure the safety and welfare of the person and others living in the home.

People's daily records were not always accurate and did not reflect the care and support provided. We found that where people required their fluid intake to be monitored in order to prevent the risk of dehydration, records were not always completed and they did not accurately reflect the instructions in people's care plans. For example, one person was recorded to only have been offered 100ml of fluid of which they were recorded to have consumed 0ml over a 24 hour period. Other records we looked at were not totalled, which meant it was not clear whether the person had reached their target fluid intake.

People who had skin injuries or bruises were not recorded or monitored appropriately by staff. For example, one person was noted to have a bruise. A body map was completed but was undated and not signed by the member of staff. There was no record that indicated the progress of healing.

People were supported by staff who were able to perform their role. We looked at the staff training matrix and this showed that all staff who worked at Linkfield Court had completed training about safeguarding vulnerable adults. The manager explained that most staff had received refresher training about safeguarding vulnerable adults and a further training session was due to take place the week following our inspection. We spoke with staff who understood what safeguarding was and what they would do if they suspected someone was being abused. All of the staff we spoke with could name types of abuse a person could be subjected to, and said they would report any suspicions to the manager or the local authority.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. One application had been submitted and authorised by the relevant Supervisory Body. We noted that relevant staff understood how an application should be made.

Is the service caring?

People were treated with consideration and respect and their privacy was maintained. We spoke with three people who confirmed this. One person told us, "They are lovely." A visiting relative told us, "I think the staff are excellent.'

Staff communicated with people in a sensitive and considerate manner. For example, we saw a member of staff assisting a person to go into the garden for a walk when they were becoming unsettled. We saw that bedroom and bathroom doors were kept closed when people were being supported with personal care and staff knocked on doors before entering.

Is the service responsive?

The provider was not always responsive to people's needs. We found that the provider recorded accidents and incidents; however there was no analysis completed to check for trends or triggers. For example, one person had fallen multiple times over a period of three months. We saw records that showed that the provider had contacted the falls clinic for further guidance. The falls clinic had recommended that a pressure mat was considered for this person to protect them from harm. On the day of our inspection we found that a pressure mat was not in place, and the person's falls risk assessment had not been reviewed or updated since December 2013. The provider's accident policy stated 'A risk assessment should be made after the incident.' This meant that people were at risk as there was no evidence that learning from incidents / investigations took place and appropriate changes were implemented.

People accessed the services of healthcare professionals as required. Records of visits from healthcare professionals were kept. For example, we found that visits from chiropodists, district nurses, opticians, chiropodists and GPs were documented.

Is the service effective?

People were supported in promoting their independence. We observed that staff promoted people's independence and involvement in their care.

People had access to activities within the home and their care records reflected this. They had regular contact with people who were important to them, such as members of their families.

Is the service well led?

The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

The provider undertook a variety of audits to check the quality of the service. However we found that some of these had not been fully completed or completed in line with the provider's policy. For example, we looked at a staff questionnaires dated December 2013 and a resident's questionnaire dated March 2014 that was sent out to people who use the service and their relatives. We found that the responses had been collated, but had not been analysed and there was no action plan in place to address lower scoring areas.

We looked at the provider's last medication audit that was dated 2 October 2013; the provider's policy stated that "all medicines are checked once a month". We examined the MAR (Medicine Administration Record) for one person; we found that there were several gaps on the MAR for topical creams that should be applied on a daily basis. For example, there were gaps on the 27, 28 and 29th April 2014. This meant that the person may not have received treatment to maintain their skin condition and placed them at risk of skin breakdown. This meant that the provider did not have a suitable system in place to ensure people were not protected against the risks associated with medicines.

We found that people's needs were assessed and that care was planned and delivered to meet their needs. People told us they were satisfied with the care they recieved and a GP who visited regularly, said "the care here has always been good - I have no concerns".

A person said "I think we are very lucky - staff are very kind".We found that people's care was planned to ensure their safety and welfare.

Records showed that people's medicines were safely managed in the home. We found that staff administering medication were assessed as competent to do so and people told us they were satisfied with the management of their medicines.

People we spoke with told us they were generally satisfied with the care they received from the staff. We have asked the provider to make some improvements in their arrangements for ensuring staff are adequately supported to carry out their role.

At this unannounced inspection we spoke with the manager, four members of staff and four people who lived in the home.

All of the people we spoke with told us they were very happy with the care provided. We spoke with three members of staff about training. They stated the provider offered thorough training and gave staff good support in order for them to provide effective personal care and support to people.

We found that people who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.