Linden Lodge Residential Home

Updated 29 September 2022

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

This inspection was completed by three inspectors. Two inspectors undertook an onsite visit to the care home. Another inspector gathered feedback offsite from people's relatives about the service provided.

Service and service type

Linden Lodge Residential Home is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement dependent on their registration with us. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 8 September 2022 and ended on 14 September 2022.

What we did before the inspection

The provider completed a Provider Information Return (PIR) during May 2022. 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 reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. We used all of this information to plan our inspection.

During the inspection

We spent time in the communal area observing the support people received. We gained feedback from three people's relatives. We spoke with 10 staff members including carers, supervisors, team leaders, housekeeping staff, and the activity staff member. We also spoke with the deputy manager and registered manager.

Our inspection also included phone and a video call with the registered manager and provider following the site visit to ask follow-up questions and give feedback. We reviewed a range of records. These included two people's full care records and multiple people's risk management assessments and medication records. We looked at two staff files in relation to recruitment. A variety of records relating to the management of the service, including policies, audits and health and safety and fire safety records were reviewed.

Following our inspection feedback, the registered manager shared evidence with us about immediate actions taken to make improvements.

Updated 29 September 2022

About the service

Linden Lodge Residential Home is a care home providing accommodation and personal care for up to 34 people. At the time of the inspection 29 people were living there including older people who may be frail due to older age or people with dementia. The home is a purpose built three storey building with ensuite bedrooms and care across the three floors. Each floor has a communal lounge and dining areas. There is a communal garden area.

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

At our last inspection we found some concerns related to how the risks to people's health, safety and welfare were managed and this did not meet the regulations. Improvement was needed to the effectiveness of the oversight of the service. Following our last inspection, the provider sent us an action plan telling us what actions they were going to take to improve the service.

At this inspection we found some improvements had been made and some governance systems had been improved, however, the safety of the service and governance were not yet fully effective because they had not identified issues we found during this inspection.

Whilst people and relatives were happy with the care and service they received, we found risks were not always well managed and staff did not always identify or act on risks of potential harm or injury. Risk assessments had not always been completed accurately. We could not always be assured actions to mitigate harm or injury to people had been taken by staff because they had not completed important records.

Some improvements had been made in some areas of the safe handling of medicines, but further improvements were needed. We could not always be assured people received their medicines as prescribed due to discrepancies in stock.

Where incidents had occurred, learning had not always taken place to reduce risks of reoccurrence. Quality checks were in place but these had not always been effective.

Improvements had been made to fire safety and people were protected from the risks of abuse.

The home was clean and tidy and systems and processes were in place to protect people from the risks of infection. Staff observed and followed infection control procedures in line with national guidance for reducing the spread of COVID-19.

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.

There were sufficient staff on shift and staff felt well supported in their roles. There was a positive culture at the home and people living there were involved in their care and able to give feedback.

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 15 November 2019) and there was a breach of regulation 12. 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 the provider remained in breach of the regulations.

Why we inspected

This inspection was carried out to follow up on an action plan we told the provider to take at the last inspection. The provider had contacted us to inform us they had improved and felt their current rating was no longer reflective of the service they provided. We undertook a focused inspection in the areas of Safe and Well Led as these were the areas that had required improvements.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained unchanged at Requires Improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections of this full report.

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

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

Following our inspection feedback, the registered manager and provider shared evidence of some immediate actions they had taken to make improvements.

We will send the provider a formal letter requesting an action plan to understand what they will do to further improve their quality assurance systems. 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.