We carried out a review of the data available to us about Linfield House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Linfield House, you can give feedback on this service.
Linfield House is a care home providing personal and nursing care for up to 54 older people. The service supports people with a variety of health needs including Parkinson’s and Diabetes across five suites, two of which were designed to support people living with Dementia. There were 47 people using the service at the time of inspection.
People’s experience of using this service and what we found
People were supported by staff who knew them well, they were relaxed and engaged with a variety of activities. The atmosphere of the service was calm. A visiting professional told us, “On the Richmond unit, care assistants interact particularly well with residents, I see lots of activities and find care assistants sitting and chatting with residents, they are not just task focussed”.
People were cared for by enough staff who responded to their requests appropriately. One person told us, "The girls are very helpful and I definitely feel safe". They had a sensor mat and call bell and advised when triggered, "The girls come within seconds".
Staff were observed to treat people with respect and kindness. People were seen to be given choices which were respected. For example, staff offered additional helpings at lunch time and different options if people changed their mind about their meal choice.
Staff told us they felt supported by management, they were informed of changes to the management structure and said the changes were positive. One staff member commented, “They listen and act, not all managers are like that and its appreciated by us”.
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.
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 requires improvement (published 3 October 2019). At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.
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.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Linfield House care home is a Nursing home providing personal and nursing care to people with health and age related needs and degenerative conditions including, Parkinson’s and dementia. There were 53 people aged 65 and over at the time of the inspection.
The service is located in Worthing and is modern and purpose built. It accommodates 54 people across five separate units, each of which has separate adapted facilities. One of the units specialises in providing care to people living with dementia.
People’s experience of using this service and what we found
There was not an adequate process for ensuring that records were accurate and complete. Some people's risk assessments lacked important detail to guide staff on how to make people safe. CQC were not always notified of events which the provider is required to notify us of by law.
Staff provided personalised care and people were happy with the care they received and felt safe with the staff that were supporting them. Systems were in place to protect people from the risk of abuse and improper treatment and staff knew how to identify potential harm and report concerns. People received their medicines safely from trained nurses and senior staff.
People were cared for by staff who were well supported and had the right skills and knowledge to meet their needs effectively. Checks were carried out prior to staff starting work to ensure their suitability to work with people. People received support from a consistent staff team who knew them well. There were sufficient numbers of staff to ensure people did not feel rushed and people received their support on time.
People were supported to have maximum control over 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.
Positive and caring relationships had been developed between staff and people. People were treated with kindness and compassion and staff were friendly and respectful. People benefited from having support from staff who had a good understanding of their individual needs.
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 6 January 2017)
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to assessing and managing risk, how the provider checks the quality of the service being provided and the notification of events to CQC. You can see what action we have asked the provider to take at the end of this full report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded
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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The last inspection took place in September 2015. As a result of this inspection, we found the provider in breach of four regulations relating to staffing, dignity and respect, good governance and person-centred care. We asked them to submit an action plan on how they would address these breaches. An action plan was submitted by the provider which identified the steps that would be taken. At this inspection, we found that the provider and registered manager had taken appropriate action and all these regulations had been met. As a result, the overall rating for the service has improved from 'Requires Improvement' to 'Good'.
Linfield House is a purpose-built home that provides nursing and personal care for up to 54 people with a variety of health and care needs, including people living with dementia. At the time of our inspection, 53 people were in residence. The home is divided into five units or suites: Richmond suite caters for people living with dementia and is a secure unit. The other four suites provide nursing or residential care: Whitcomb, Frazer, Selden and Gordon. People living in the Richmond suite have separate facilities comprising a sitting room, dining room and have access to a garden. The other suites are housed on the first and second floors at Linfield House. Each suite has its own small lounge, kitchenette area and bathroom. There is a communal lounge and large dining room on the ground floor and a further dining room on the first floor. All rooms have en-suite facilities, including a shower. There are accessible gardens at the rear of the property which overlooks Victoria Park. The home is situated close to the town centre of Worthing.
A registered manager was in post. 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.
Staffing levels were sufficient to meet people’s care needs safely. Staff were used flexibly and could be deployed to areas of the home where additional staffing was required. Improved staffing levels meant that staff had time to spend with people and call bells could be responded to promptly. Safe recruitment practices were in place and people were protected from the risk of abuse and avoidable harm. Staff had been trained in safeguarding adults at risk and knew what action to take in the event they suspected abuse was taking place. Risks to people had been identified, assessed and managed appropriately, with clear guidance for staff on how to mitigate risks. Generally, medicines were managed safely.
People were looked after and supported by kind and caring staff. They were treated with dignity and respect and had the privacy they needed. People were supported to express their views and to be involved in reviewing their care plans. Relatives confirmed they were involved in reviewing their family members’ care plans and invited to monthly meetings. Staff knew people well, their likes, dislikes and preferences and positive, caring relationships had been developed. Staff were very attentive to people, were complimentary on their appearance and genuinely cared about their welfare.
Records containing confidential information about people were kept securely. A range of systems had been put in place to measure and monitor the quality of care delivered and the service overall. Where improvements were identified, actions were taken to address these. People and their relatives were invited to monthly meetings to give their feedback about the service. A survey was sent out in June 2016 to obtain people’s feedback and suggestions for any improvements. Staff felt supported by the management team and good leadership was evident. People spoke positively about the care at Linfield House and of the staff who worked there.
Staff were trained in a range of areas and new staff followed the Care Certificate, a universally recognised qualification. The majority of staff had regular supervision meetings. Some staff had not received supervision meetings on a regular basis and the registered manager was taking action to address this. Staff attended monthly team meetings. People’s consent was sought in line with the requirements of legislation under the Mental Capacity Act 2005 and staff understood their responsibilities in this area. The majority of people were subject to Deprivation of Liberty Safeguards and applications had been sent to the local authority to seek authorisation. People had sufficient to eat and drink and were encouraged to maintain a balanced diet. People had access to a range of healthcare professionals and support. The environment had been adapted to meet the individual needs of people in residence, especially those living with dementia.
Advice had been sought from healthcare professionals and improvements had been made to the activities on offer. Activities were planned based on people’s individual interests and preferences. Staff were flexible in their approach in engaging people with activities and organised group and 1:1 sessions with people. Memory boxes were in the process of being made up for people living with dementia and provided mental stimulation and ideas for conversation. Care plans provided detailed information about people and their support needs, with advice and guidance to staff on how to deliver personalised care. Handover meetings held between shifts enabled staff to receive updates about people and their most up to date care needs. Complaints were managed in line with the provider’s policy.
The inspection took place on 29 September 2015 and was unannounced.
Linfield House is a purpose-built home that provides nursing and personal care for up to 54 people with a variety of health and care needs, including people living with dementia. The home is divided into five units: Richmond unit caters for people living with dementia and is a secure unit. The other four units provide nursing or residential care: Whitcomb, Frazer, Selden and Gordon. People living in the Richmond unit have separate facilities comprising a sitting room, dining room and have access to a garden. The other units are housed on the 1st and 2nd floors at Linfield House. Each suite of two units has its own small lounge, kitchenette area and bathroom. There is a communal lounge and large dining room on the ground floor and a further dining room on the first floor. All rooms have en-suite facilities, including a shower. There are accessible gardens at the rear of the property which overlooks Victoria Park. The home is situated close to the centre of Worthing.
There was no registered manager in post at the time of our inspection, but the person currently managing the home was in the process of registering with the Commission. 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.
Staffing levels had not been assessed based on people’s care needs. Staff were busy trying to support people safely, but there were not always enough to do so at the time of our inspection. There were insufficient staff to support people at lunchtime and some people had to wait a long time for assistance. Call bells were not always responded to promptly. People felt safe living at Linfield House and staff had been trained to recognise what might constitute potential abuse and what action they should take. Risks to people were identified and assessed appropriately and risk assessments were reviewed monthly. There was information and guidance for staff on how to manage people’s needs safely. The service followed safe recruitment practices. Generally, people’s medicines were managed safely. However, there were two instances on the day of inspection when staff left the medicines trolley unlocked when administering medicines. The home was generally clean and hygienic.
There was a mixed response from relatives regarding whether all staff had the knowledge and skills they needed to care for people effectively. New staff underwent an induction programme and progressed to the Care Certificate, a universally recognised qualification. Staff completed all essential training and received regular supervision and annual appraisals from their supervisors. People’s consent was gained in line with current legislation under the Mental Capacity Act (MCA) 2005 and associated legislation under the Deprivation of Liberty Safeguards (DoLS). Staff had a good understanding of this legislation and put what they had learned into practice. Generally people had sufficient to eat, drink and maintain a balanced diet. However, a shortage of staff at lunchtime meant that some people were not supported adequately. The lunchtime experience in Richmond unit was in contrast to that of people in the main dining room. People in Richmond were supported effectively and encouraged to eat their meals. People were supported to maintain good health and had access to healthcare professionals as needed.
Mostly people were looked after by kind and caring staff. There were occasions, however, when people were not always responded to by some staff when needed and were ignored. Other staff were patient, warm and friendly with people and were receptive to their needs. People and their relatives were not always involved in discussions or decisions about their care, with the exception of their end of life care. Mainly, people were treated with dignity and respect.
Care plans provided staff with detailed, comprehensive information about people and how they wished to be cared for. Care plans were reviewed monthly. Some relatives felt that people’s care was managed well, whilst others felt this had taken time to achieve. Relatives could visit at any time and were made to feel welcome. There were some organised activities for people at Linfield House, however, these were not always meaningful for all the participants. Some outings were available to people, but generally there was little opportunity for people to go out of Linfield House, unless they were supported by their relatives or friends. Complaints were listened to, acted upon and dealt with to the satisfaction of the complainant.
People felt the home was well run and that the management were approachable. Some staff felt that, whilst the manager was amenable, she was not always available to observe what was happening in all parts of the home. People’s personal information was not always kept confidentially, but left in folders in open offices. Audit systems were in place but did not always identify and assess improvements that were required.
We have identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told this provider to take at the back of this report.
We found that people were treated with dignity and respect. People's individuality and choices were respected by staff on a daily basis. People told us they were involved in their care decisions
People we spoke with were happy with their environment and their care. One person said "I feel safe here, the carers are good". Another said "they do a good job". One relative we spoke with said "I am impressed with the service" whilst another said 'It gives me peace of mind to know they are safe and they do listen to any concerns".
People we spoke with told us the food was good and plentiful. A full time activities co-ordinator was employed and we saw a good range of activities available, particularly for people living with dementia, to help stimulate and engage them.
We spoke with five care workers who told us they liked working at the home and after a period of staff changes were looking forward to meeting new permanent staff. All the staff had been appropriately trained.
People's needs were assessed and they were consulted and involved in the planning of their care plans and service delivery. We saw that there had been some improvement in making care plans more person centred but still required further improvement to provide sufficient information regarding peoples likes and dislikes such as what they like to eat and drink hobbies and what time they like to get up and go to bed.
The manager told us that this is being addressed when the care plans are being reviewed.
All staff had received safeguarding training and policies and procedures were in place and staff were able to explain what abuse is and how they would report it to their line manager.
We saw that people who used the service were not cared for by staff that was supported to deliver care and treatment safely and to an appropriate standard. Staff had not received regular formal supervision or annual appraisals. Training was not always provided or updated to ensure that staff had the skills and knowledge required to provide the appropriate support to the people who used the service.