Linwood

Updated 3 February 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Our inspection was completed by 3 inspectors.

Service and service type

Linwood is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Linwood is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. However, a new manager had started at the service who was applying to be registered. They and the providers regional support team were at the inspection.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 9 people who used the service about their experience of the care provided. We also spoke with 3 relatives and 2 health care professionals. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records including 6 people's care plans, daily care notes, medication records, safeguarding records and incidents. We reviewed a variety of records relating to the management of the service including supervisions, training and recruitment files. We spoke with 9 members of staff including the manager, regional manager and care staff.

Updated 3 February 2023

About the service

Linwood is a residential care home for up to 67 in one adapted building across three floors. Linwood provides care to older people who may have a physical disability or may be living with dementia. On the day of the inspection there were 44 people living at the service.

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

People’s medicines and risks associated with their care were not always managed in a safe way.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Care was not always provided that met people's individual and most current needs. This included the lack of accurate care plans, the lack of activities for people and the environment not set up to meet the needs of people living with dementia. Staff were not always familiar with people’s needs and supervisions were not taking place with staff to assess their performance. Although there were sufficient numbers of staff, they were not always deployed effectively to ensure good delivery of care. We have made a recommendation around this.

We observed examples of people not always being treated with respect and dignity. Although people and their families did feedback there were staff that were kind and caring. People and relatives fed back they were not happy with the quality of the meals although there were steps being taken to address this. People choices around care delivery and meals choices were not always considered. We have made a recommendation around this.

There was not always a record of the investigation into complaints that had been made. We have made a recommendation around this. There were other complaints that had been addressed to the person and relatives’ satisfaction. There was a lack of communication between staff at the service which was impacting on the delivery of care. The provider had not ensured systems and processes were established and operated effectively. Audits were not always identifying areas that required improvement. People fed back they liked the manager who had recently joined and could see they were making positive changes at the service.

Rating at last inspection and update

The last full rating for this service was requires improvement (published 8 October 2019). We undertook a focused inspection more recently however we only looked at Safe and Well Led. Both of these domains were rated good (published 13 July 2021)

Why we inspected

The inspection was prompted in part due to concerns received about the management of medicines, staffing and incidents of accidents and incidents. A decision was made for us to inspect and examine those 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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, 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. After the inspection the provider took action to mitigate risks to people.

Enforcement and Recommendations

We have identified breaches in relation to the safe management of medicines and risks to people’s care, lack of detailed care planning and activities and the requirements of the mental capacity act. We found breaches in relation to people not always being treated with dignity and respect, staff not being supervised in their role and lack of robust governance at this inspection. Please see the action we have told the provider to take at the end of this report.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

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