Lincoln House Care Home

Lincoln House Care Home is a residential care home which provides nursing and personal care for older people some who may be living with dementia. The service can support up to 60 people. At the time of the inspection 40 people were being supported.

The service is split into a nursing unit and a residential unit in one purpose-built building.

People’s experience of using this service and what we found

Care plans detailed how to support people in their daily lives; ensuring risks were assessed to keep people safe.

Improvements to people’s living environment have been undertaken since our last inspection. These improvements include removing trip hazards from the courtyard area and improving signage where flooring levels change.

People’s medicines were stored securely for the safety of the people supported. Medicines were well audited to ensure people received their medicines as prescribed.

People spoke positively about the support they received and the staff team who cared for them.

Families felt their loved ones were safe and gave feedback about the positive improvements made at this service, since our last inspection.

People were involved in planning and reviewing their support needs. Care plans were shaped around people's preferences.

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.

Governance at the service had improved. Robust audits were now in place to monitor care records, medicines and people’s wellbeing.

At this inspection we identified damaged surfaces in communal areas which were an infection control risk to people. The provider confirmed that works would be completed to rectify these areas and new handrails sourced.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 06 September 2021) and there were multiple breaches of registrations identified. These related to not notifying relevant bodies of serious incidents, inexperienced and insufficient numbers of staff, a lack of assessments detailing peoples needs and preferences, peoples consent not being sought, risks not being assessed or mitigated, failing to protect people from abuse and a failure to ensure premises were secure and maintained.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations, their overall rating had improved.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Exiting special measures

This service has been in Special Measures since 06 September 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Lincoln House care Home is a residential care home providing personal and nursing care to 53 people including seven who were receiving respite care at the time of the inspection. The service can support up to 60 people.

The service is split into a nursing unit and a residential unit in one purpose-built building.

People’s experience of using this service and what we found

Risks, including those relating to the environment, were not well managed. Some risks had not been sufficiently assessed and mitigated and placed people at risk of harm. Some safeguarding incidents had not been appropriately reported and investigated to see if lessons could be learned to avoid a repeat occurrence. Medicines were mostly well managed, but some risks associated with particular medicines had not been fully assessed. Infection prevention and control measures were good.

There were not always enough staff to meet people’s needs on the residential unit. There was a reliance on agency staff who did not always have the skills needed to provide quality support. Permanent staff, although trained, did not always demonstrate an understanding of people’s needs and health conditions. The environment was not always safe or suitable to meet people’s needs. Environmental risks had not been clearly identified and mitigated in the provider’s auditing processes. Monitoring of people’s food and fluid requirements on the residential unit was poor and placed people at risk of not having enough to drink.

Records relating to some people’s capacity to consent to their care and treatment showed they were not supported to have maximum choice and control of their lives; the policies and systems in the service did not support this practice.

Staff were caring and kind and people who used the service praised their dedication and patience. Staff were busy and sometimes struggled to spend time with people. There had been limited engagement with people about their views on the service. New surveys had been devised to seek feedback from people about key aspects of the service.

Pre-admission assessments were not fully completed for all people who used the service. This risked people’s needs not being met safely. People had the opportunity to review their care needs with staff but sometimes their preferences, although recorded, were not respected. A new care planning system was about to be introduced which had been designed to improve all aspects of care planning and recording. People’s end of life care was well managed and people’s wishes clearly documented. Complaints were well managed.

Oversight of the service at all management levels, including regional oversight, was poor. Systems to assess, monitor and mitigate risks to people’s health, safety and welfare were not fit for purpose and placed people at risk of harm. The provider has acknowledged this and introduced new systems and made changes to staff deployment to begin to address the serious failings we found.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 7 June 2019.) The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part by notification of a specific incident, following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of risks relating to people who leave the service when it is unsafe for them to do so. This inspection examined those risks as part of a comprehensive inspection process.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, 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.

Following the incident which prompted this inspection, the provider took immediate action to begin improving the security of the service by fitting alarms to external doors and carrying out a full review of the security of the environment. They also began to address our concerns relating to safety as soon as we raised them by removing items which could be choking, ingestion or scalding risks and by closing off the courtyard until remedial works were completed. These actions have mitigated these risks.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lincoln House Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to assessing people’s needs, consent, safeguarding, risk management, safety of premises, staffing, governance and failure to make appropriate notifications to CQC at this inspection. Please see the action we have told the provider to take at the end of this 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 the provider sends us their service development plan outlining 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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Lincoln House is a nursing and residential home that provides accommodation and personal care for up to 60 people. At the time of the inspection, a total of 53 people were living in the home.

People’s experience of using this service:

Some risks to people’s safety had not been assessed and therefore managed appropriately placing them at risk of avoidable harm. The registered manager took immediate action in response to these findings to keep people safe.

There were not enough staff working on some shifts within the home. This resulted in people having to wait for assistance and care staff not being able to spend much time with them.

There had been a lack of impetus to increase staffing levels when it had been identified this was needed.

Some of the provider’s current systems to monitor the quality of care people received, had not been effective at identifying issues and driving improvement.

Medicines were not always being managed safely at the home.

Improvements to the environment are recommended to help people with memory difficulties orientate themselves around it.

People told us staff were kind and caring and treated them with dignity and respect.

People had several different activities they could participate in that were available seven days a week, to stimulate them and enhance their wellbeing.

Good links with the community had been made for the benefit of people living in the home.

Staff supported people to maintain their health and were quick to report concerns to outside healthcare professionals when required.

The staff had been recognised externally for the kind and compassionate care they provided at the end of people’s lives.

The home was clean, and staff understood how to protect people from the risk of the spread of infection.

People were involved in making decisions about their care and were given choice.

When things went wrong such as accidents or complaints, these were fully investigated, and lessons learnt. People were involved in this process if they wanted to be.

Systems were in place to protect people from the risk of abuse.

Consent had been obtained from people before care was given and in line with relevant legislation.

Rating at last inspection:

Good (Published October 2016)

Why we inspected:

This was a planned inspection based on the period since the last report was published by CQC.

Follow up:

We will continue to monitor intelligence we receive about the service 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

This unannounced inspection took place on 27 September 2016.

At the last comprehensive inspection on 11 and 12 November 2015 the overall rating for the home was requires improvement. Improvements were needed to make the home safer, effective, responsive, caring and well led. We asked the provider to take action to make improvements to the assessment and monitoring of the service. During this inspection we found improvements had been made.

There was a registered manager in post at the time of this 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 told us that they felt safe living in the home and they were cared for by staff in a respectful and dignified manner. Their rights to privacy and expressing their views and opinions were respected and supported. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe.

Staff had received training, which was regularly updated in order to enable staff to provide care in a way which ensured that people's individual and changing needs were met. Staff knew how to manage any identified risks and provided the care needed as described in each person's care record.

People’s health, care and nutritional needs were effectively met. People were provided with a varied, balanced diet and staff were aware of people’s dietary needs. Staff referred people appropriately to healthcare professionals. People received their prescribed medicines and medicines were stored in a safe way.

There was a warm and welcoming atmosphere in the home and staff worked closely with people and their families to ensure each person was supported to maintain their individual interests and to have a meaningful and enjoyable life. In addition staff provided a varied programme of activities for people who wished to participate in them.

The registered manager ran the home in an open and inclusive way and encouraged people, their relatives and staff to speak out if they had any concerns. The registered manager and deputy manager listened and took action to resolve any issues or concerns identified. More formal systems were also in place for handling and resolving formal complaints.

The provider and registered manager worked together as a team in order to regularly assess and monitor the quality of all the services provided. This approach ensured that any shortfalls in quality would be quickly identified and actions take to improve and develop the services people received.

Lincoln House Care Home is a service that provides accommodation and care for up to 60 older people, some of whom may be living with dementia. The service is split into three areas, a nursing wing, a residential wing and it also has three intermediate NHS beds. On the day of the inspection there were a total of 51 people living at the home.

There was a registered manager employed at the home. 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 and associated Regulations about how the service is run.

People who lived at Lincoln House Care Home felt safe and were happy living there. Relatives were also happy with the standard of care that was being provided and most people we spoke with recommended it as a place to live.

People were cared for by kind, caring and compassionate staff who listened to people and made them feel valued. However, there were not always enough staff to support people which resulted in some having to wait for long periods for assistance. This on occasion, compromised their dignity. Not all people’s medicines were being managed safely.

Most people’s preferences on how they wanted to be cared for were being met and people had a choice about the care they received and how it was delivered. People were asked for their consent by the staff before they started a task. However, the staff had a limited knowledge about how to provide care to people who lacked capacity to make their own decisions in line with the principles of the Mental Capacity Act.

The equipment that people used had been well maintained and risks to the safety of the premises were managed well. People had access to a choice of food and drink however, some people’s risk of not eating or drinking were not being managed effectively to make sure that they received sufficient food and drink to meet their needs.

People were provided with a number of different activities to complement their hobbies and interests and any complaints made were investigated. The staff felt supported in their roles and were able to raise any concerns to the management team without fear of recriminations.

A number of improvements had been made recently to the home. The registered manager had plans in place to continue to make improvements to the quality of care that people received. However, some systems that were currently in place to monitor the quality of service given were ineffective which meant that people had or were at risk of experiencing poor care.

There are some breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and you can see what action we have told the provider to take at the back of our report.

We have made recommendations regarding following the principles of the Mental Capacity Act 2005 when making ‘best interest’ decisions on behalf of people.

Medicines were prescribed and given to people appropriately. We reviewed the medication administration records for 10 people using this service. We saw that medication was appropriately documented and each dose signed for by a member of staff who had received training on administering medication.

There were effective recruitment and selection process in place. During our review of staff files we saw that an application form was completed by prospective employees followed by a face to face interview prior to their selection for employment. We also found that references were sought from previous employers and prospective staff members were asked to provide details of their relevant qualifications, skills and experience.

During our inspection in December 2012 we found that the people living in the residential unit of this home were at risk of receiving care which did not meet their needs as accurate records about them were not being maintained. We checked to see that improvements had been made. We found that they had.

Whilst we were speaking with two of the people they required assistance. They used the call bell system to request help for a member of staff. We waited in each case and observed that people were not left waiting, the staff responded promptly.

Our observations of the home demonstrated to us that it was clean, mostly free from any unpleasant odours and that infection control practices were in place. For example, we observed staff wearing disposable gloves and aprons.

We reviewed details of a recent complaint made by a relative of one of the people living in the home. We saw that the relative had been responded to in a timely manner and that they had confirmed to the home, by e-mail, that they were fully satisfied with the actions taken.

However, we are not confident that people living on the residential unit were protected from risks to their health and wellbeing because accurate records about their care needs were not in place