Archived: The Lindens

The Lindens is a residential care home that was providing personal care to 12 older people at the time of the inspection. The service can support up to 15 people. The Lindens accommodates people across two separate floors, each of which has separate adapted facilities and a stair lift. Some of the people living in the home had a diagnosis of early stage dementia. The home is situated close to the centre of Haslingden.

People's experience of using this service and what we found:

People were supported to be safe and said that they felt safe. Staff received robust safeguarding training and had a good understanding of the principals involved in taking action when abuse was suspected. There was an open and transparent culture in relation to accidents and incidents. Medicines were managed safely. The provider had a recruitment process but there were issues in some of the files we looked at. We have made a recommendation about this that can be seen in the 'Safe' section of this report.

People's needs were met through robust assessments and support planning. The service worked with healthcare and social professionals to achieve positive outcomes for people. Staff and carers had good knowledge and skills and this ensured people's needs were well met. We saw good examples of when people had been supported to maintain a healthy and balanced diet.

People told us carers and staff were compassionate and kind and during the inspection, we observed this to be the case. Management and staff knew people well. 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 received care and support that was person-centred. We saw good examples of how the care and support people received enriched their lives through meaningful activities. The service had a robust complaints policy. There was an end of life policy in place that could be used if appropriate.

The values and culture embedded in the service ensured people were at the heart of the care and support they received. The registered manager and provider planned and promoted holistic, person-centred, high-quality care resulting in good outcomes for people. People knew how to feedback their experiences and this was considered and acted upon by the registered manager and provider. Staff told us they received good support from management.

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

Rating at last inspection:

At the last inspection, the service was rated good (published 14 December 2016).

Why we inspected:

We carried out this inspection based on the previous rating of the service.

Follow up:

We will continue to review information we receive about the service until we return to visit as part of our re-inspection programme. If any concerning information is received we may inspect sooner.

The Lindens is registered to provide residential care for up to 15 older people. There are 13 bedrooms on two floors which can be accessed via a stair lift. The home is situated close to the centre of Haslingden and provides good access to shops and public transport.

At the time of the inspection there was a registered manager who had been in post since October 2008. 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 registered manager was supported in his role by the home’s assistant manager.

The service was last inspected on 2 April 2014. We found it was meeting the regulations applicable at that time.

During this inspection, we found the service was meeting the current regulations.

People told us they considered themselves safe whilst living at The Lindens. They also indicated that the care they received was delivered in a professional and caring way and that staff had the correct skills to undertake their role effectively.

People were provided with personalised care and support based on their individual needs and requirements and the provider ensured the service maintained satisfactory staffing levels to support the operation of the service in this area. Comments from people supported that there were enough staff to safely meet their needs and people told us they never felt rushed with their routine. The provider offered a variety of training to its staff which ensured the staff team were skilled and experienced in safely and effectively supporting all people using the service.

Care files contained person centred assessments and care plans to support the development of the care planning process and support the delivery of care. Effective systems were implemented to maintain independence, by providing a detailed plan covering essential information care staff needed to follow. This ensured clear information about people’s needs wishes, feelings and health conditions and were kept under regular review.

The provider ensured practices were in place to maintain to uphold a suitable and safe environment for all people using the service and their visitors. Recognised training was offered to staff to ensure they were able to recognise the signs of abuse and confidently respond to any safeguarding concerns by notifying the relevant authorities when needed.

The provider ensured a robust recruitment system was implemented. Appropriate steps were taken to verify new employee’s character and fitness to work. Following successful appointment to the role the provider ensured a thorough induction plan was carried out which ensured staff were equipped with the correct skills and knowledge to effectively support people in an informed, confident and self-assured manner.

Staff interacted in a positive way with people. Their demeanour was that of a caring, respectful and understanding nature. The promotion of people’s dignity and rights were supported which ensured people maintained control over their lives. People were given information about their care and the service to help them make informed decisions. Their opinions were routinely sought and acted upon by means of questionnaires enabling them to influence the service they received. Comments were received from people during the inspection which supported these observations.

Safeguards were in place to take immediate action against staff in the event of any misconduct or failure to follow company policies and procedures.

Fire audits were completed and relevant checks were carried out to fire equipment and lighting. People using the service had personal evacuation risk assessments in place and the provider had an additional contingency plan which provided direction on who to contact and how to act in the event of an emergency or failure in utility services or equipment.

Appropriate processes were in place for the safe administration of medicines in line with best practice guidance from the National Institute for Health and Care Excellence. Staff had received training in medicines management and all medicines were stored securely and safely. However we did note that on three occasions medicines stocks we checked did not match with the amount documented on the medicines administration records, (MARS). Following the inspection the registered manager contacted us to inform us he had investigated the issue and that the medicines had now been accounted for. The investigation concluded that there had been a numerical error made on all three occasions when carrying stock over from the previous month.

People’s dietary requirements and preferences had been sought and we saw choice was given at every mealtime. Referrals had been made to health professionals when appropriate and instructions were followed in cases where people had known dietary requirements.

Staff displayed an awareness of the Mental Capacity Act 2005 and had completed appropriate training. Referrals had been submitted to the local authority by the registered manager when appropriate.

All people spoken with including relatives and staff were complimentary about the management structure. People described the registered and assistant manager as helpful and professional. Staff informed us they felt well supported and that they could approach either manager with any concerns.

This is a summary of what we found:

Is the service safe?

Before people were admitted to the home arrangements were in place to make sure they would be safe in the environment and there was enough skilled and qualified staff to meet their needs.

We found people had been given a contract of residence outlining the terms and conditions of residency therefore protecting their legal rights.

The provider and manager had been trained and understood their obligation to apply the principles of the Mental capacity Act and Deprivation of Liberty Safeguards (DOLS). This is a legal framework designed to protect the best interests of people who are unable to make their own decisions No person living at the home had been assessed as needing this safeguard in place.

People told us they were treated with respect and dignity by the staff. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Staff had been made aware of who may be at risk of falling, developing pressure ulcers or may not eat enough and they had a plan of care to deal with this.

People's care and treatment was planned and delivered in a way to protect them from any unlawful discrimination within the home and wider community. They had opportunities to continue to practice their faith, vote in elections and access community health and social facilities.

Staff were trained in emergency procedures such as fire and first aid. Other emergency situations were planned for and people had a personalised evacuation plan.

Staff dealing with food had been trained in safe food hygiene and the home was awarded a five star hygiene rating from environmental health.

We found the provider has taken steps to provide care in an environment that was adequately maintained. Health and safety checks were carried out at regular intervals and all essential services such as fire, gas electric and water were certified as being safe. Security arrangements at the home were good.

Care had been taken to make sure people were kept safe by only employing people who had proven good character records.

Systems were in place to make sure the provider and manager continually checked the service was safe. This reduced the risks to people and helped the service to continually improve.

Is the service caring?

People told us they were happy with the care they received and the staff team, They said, 'I feel I'm important and I matter. Staff treat me very well. The other night (anonymised carer) came to tell me she was going off duty and gave me a big hug. I felt wanted and cared for. Isn't that what all this is about?' and 'I couldn't wish for better care. I get all the help I need.'

We observed staff were considerate, respectful of people's wishes, and delivered care and support in a way that maintained people's dignity and promoted their independence.

Staff worked to care plans that were person centred, well written and sufficiently detailed on how best to meet individual needs. Daily records maintained showed staff responded to people's needs as required day and night. Staff had received training to meet the needs of people living in the home.

Surveys carried out showed people considered the service they received was very good. They wrote, 'I feel safe and well looked after at all times. Staff are very kind and thoughtful.' And 'I have always felt cared for and the home exceeds everything I need.'

Is the service responsive?

People were given plenty of opportunities to say what they wanted and offer 'thoughts on future care needs'. This meant plans could be made to support people achieve their aims. People's assessment of needs and care plans were reviewed regularly and professional help and support was sought from health and social care professionals when needed.

People had expressed their desire to get out more and in addition to the daily activities provided, people were given a two hour personal activity time and could choose what they wanted to do. One person had commented, they 'enjoyed going on outings and that they were nice surprises'.

People using the service and their relatives had completed a satisfaction survey. Residents meetings were held and people could say what they wanted and they felt listened to. A system was in place for receiving comments, compliments and complaints. People told us that they would know how to make a complaint, should they need to do so.

Is the service effective?

People told us they discussed their care. They had their own preferred routines, likes and dislikes staff knew about. One person told us 'If I'm sleeping they will leave me till later. They do check on me to make sure I'm all right.' Another person said 'I get my meals brought to me and I like the food. If I'm not well they will get my doctor.'

People's health and well-being was monitored and appropriate advice and support had been sought in response to changes in their condition. The service had good links with other health care professionals to make sure people received prompt, co-ordinated and effective care.

People told us they were consulted with and listened to. One person told us they were involved in discussions and decisions about the activities they would prefer. They said, "We decide what we want to do and they sort it out".

Is the service well led?

People told us the management of the service was very good. They said 'She's (manager) always around chatting to us. We are like a big family here. We talk about different things. I can say what I want without hesitation and if I was unhappy about the service I would say. Whatever we want we get and I think we are treated very well. 'I'm happy enough. I think everyone works hard for us' and 'no complaints. I'm very happy. I would say if I wasn't'.

The service had a registered manager responsible for the day to day management of the home. Staff were clear about their responsibilities and duty of care and were able to raise their views and concerns. Meetings were held for staff and residents and these showed people were kept up to date with all aspects of the running of the home including best practice issues, quality monitoring and of planned improvements.

There were systems in place to regularly assess and monitor how the home was managed and to monitor the quality of the service. We saw evidence the service knew when to consult with health and social care professionals when required. This meant any decision about people's care and support was made by the appropriate staff at the appropriate level.

We found there were processes in place to record people's consent to care and treatment, although these were not always fully completed. On the day of our visit we observed staff ask people before they provided any care or support.

We reviewed the care files for five people who used the service. We found care plans had not been updated to reflect the changing needs of people. We found some care files did not include risk assessments or risk management plans. This meant there was a risk of people receiving unsafe or inappropriate care.

We found people were cared for in a homely and clean environment. Appropriate arrangements were in place to reduce the risk and spread of infection.

We found there were sufficient staff employed to meet the needs of people who used the service. People we spoke with told us there were enough staff to meet their needs.

We found there were insufficient systems in place to enable the provider to assess and monitor the quality and safety of the service.

We found arrangements were in place to manage the process for identifying, receiving and handling complaints for people living in The Lindens.

We reviewed the care files held for three people using the service and found that their care was planned and delivered in accordance with their needs. People had individual care plans which identified their wishes and preferences in relation to the care they required.

We found that people were provided with appropriate nutrition and had a choice in relation to the food available to them at mealtimes. We also observed staff ensuring that people had access to drinks and snacks throughout the day.

We found the premises were safe and secure and had been maintained to a good standard. All the people we spoke with told us they felt comfortable within the home.

We spoke with four members of staff who told us they felt well supported and confident in carrying out their responsibilities. We saw evidence that staff were appropriately qualified to carry out their role.

We found there were effective systems in place for the completion and storage of records relating to the care of people using the service and the maintenance of the premises.