We carried out a review of the data available to us about Lincombe Manor 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 Lincombe Manor, you can give feedback on this service.
We found the following examples of good practice:
Personal protective equipment (PPE), such as gloves and masks were readily available at the entrance to the home. There was also a stand alone handwashing station with liquid soap, paper towels and hand sanitiser. Temperature checks were carried out on staff and visitors on arrival to the care home. There was clear infection control signage displayed and visitors were able to scan a QR onto a COVID-19 application on their mobile phone for track and trace purposes.
Lincombe Manor had a booking system for visitors, with staggered times and lateral flow testing in place. There was a designated visiting pod in the care home. Other forms of contact with residents was via video calls, telephone calls and garden visits.
All clinically extremely vulnerable people were identified, and care plans had been put into place. Risk assessments had been carried out on staff who may be considered to be high risk, such as those who were pregnant. All staff wore face masks when caring for people living in the home and when required, wore gloves and aprons for personal care.
People were only admitted to the home when they have had a negative COID-19 test and they were then isolated for 14 days within their own room and regularly tested in accordance with current guidance.
Peoples' temperature and oxygen saturations were monitored daily and when needed people displaying signs of COVID-19 were isolated in their bedrooms and a test carried out. The care home had a plan for cohorting staff and people should an outbreak occur.
PPE was readily available throughout the care home and staff had received training on putting on and taking off PPE. The impact of staff wearing PPE and peoples’ reactions had been considered and highlighted in an individual’s care plan if adjustments needed to be made. Online training on infection control had been undertaken by all staff, including managing COVID-19
All staff and people were tested in line with current guidance and the results were recorded. If a member of staff displayed symptoms, then they were tested immediately and sent home to isolate while awaiting test results. There were further testing processes in place for staff working at other locations. Staff did not use public transport whenever possible and the provider paid for taxis. Staff breaks were staggered to support social distancing.
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Routine and enhanced cleaning was in place, for example the visiting pod was cleaned after each use and ‘touch points’, such as door handles and light switches cleaned on a regular basis daily. Lincombe Manor was visibly clean and hygienic at the time of this inspection. Clutter has been removed to allow for effective cleaning. Cleaning schedules were completed which included the cleaning of high touch point areas and appropriate chemicals were in place. A COVID-19 resource file was developed and shared with staff and kept up to date with the latest guidance
Furniture in communal areas was arranged to promote social distancing and screens were in use on the dining tables to enable people to continue to socialise at mealtimes. Outdoor areas had tables and chairs arranged to promote social distancing.
The management team have remained up to date with relevant guidance changes and the care home’s infection control policy reflected this. All staff were informed of changes when needed and they adhered to infection control guidance. Suitable systems were in place to manage any outbreaks of COVID-19.
Lincombe Manor is a care home with nursing, and is registered for a maximum of 48 people. The registered home comprises two buildings - a multi floored and purpose-built nursing home for 40 people, and a separate 8 bed unit, known as Hewitt Lodge used for intermediate care. Intermediate care is a service supporting people return to independence following a short period of illness or hospital stay. Staff work alongside therapy staff from the Care Trust, such as physiotherapists or occupational therapists to return people to their own homes.
At the time of the inspection the service had two vacancies, but these had already been filled.
The care home is set within a complex including a period manor house converted into retirement flats and purpose-built bungalows for older people. People living in the nursing home can access services on site such as a restaurant and exercise classes. The complex is set in the Lincombes area of Torquay and has panoramic sea views from communal areas and some bedrooms.
People’s experience of using this service:
People and their relatives spoke highly of the service they received from Lincombe Manor, both in the main service and from intermediate care.
The service was exceptionally caring. People’s needs and wishes were met by staff who knew them well. We saw and were told of examples of staff going ‘above and beyond’ to help and support people they cared for. Thoughtful touches were in place, such as dog biscuits for visiting animals, and people being able to offer visitors snacks, hot drinks or a glass of wine, which was available in the lounges. This meant people could offer visitors hospitality without having to ask staff.
The service had strong person-centred values and placed people’s wellbeing at the heart of their work. People received personalised support which met their needs and preferences. People told us the service listened to their wishes and suggestions to improve their care and support. The home had a tranquil and calm atmosphere.
People received their medicines as prescribed. Risks around people’s care or health were assessed and managed. People were encouraged to maintain or regain independence, in particular in the intermediate care service. Systems were in place to safeguard people from abuse, and the service responded to any concerns or complaints about people’s wellbeing.
There was a thorough recruitment process in place that checked potential staff were safe to work with people who may be vulnerable. Enough staff were in place to meet people’s needs, and staff received the training and support they needed to carry out their role.
There was strong leadership at the service. Changes were taking place within the governance and management structure at the time of the inspection. This included the provision of a new management company. Although this had been delayed this had not adversely impacted on people living at the service. The manager was newly in post but had applied for registration and was previously an experienced registered manager elsewhere.
There were effective quality assurance systems in place to assess, monitor and improve the quality and safety of the service provided. Systems ensured learning from incidents and accidents.
More information is in the full report
Rating at last inspection: This service was last inspected in September 2016, when it was rated as good in all areas and as an overall rating.
Why we inspected: This inspection was scheduled for follow up based on the last report rating.
Follow up: We will continue to monitor the intelligence we receive about the service. If any concerning information is received, we may inspect sooner.
Lincombe Manor is a care home with nursing, providing care and accommodation for up to 48 people. The home is divided into a main care home (Lincombe Manor Care Centre) providing general nursing care and a smaller 8 bedded unit, Hewitt Lodge, which provides intermediate care commissioned by the local authority. This is aimed at providing an intensive rehabilitation service or intensive support to people to avoid hospital admissions where possible. People living in the main home may live at the home long term or come for short periods of convalescent care and support. At the time of the inspection there were 27 people living in the main home building and seven people in Hewitt Lodge.
The home had a registered manager 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.
People received safe care because their needs were regularly assessed and risks mitigated and managed wherever possible. Risk assessments were in place for individual people and risks in relation to their health and well-being; for safe working practices and for the environment. Learning took place to reduce the risk of re-occurrences of incidents and accidents. For example, following an analysis of falls the service had re-arranged the furniture in one person’s room which had led to a decrease in them falling. Where people had been assessed as being at risk of poor nutrition, actions taken had received additional support from community professionals and the home. As a result the people’ whose care we tracked had put on weight. People told us they ate well and enjoyed their meals.
People received good quality safe care because staff received sufficient training and support to carry out their role. Enough staff were on duty to meet people’s needs, including registered nurses both day and night. People were protected because a full recruitment process had been followed. Staff understood how to keep people safe from abuse, and how to report any concerns about people’s well-being. Policies and procedures helped staff understand what to do if they had any concerns, and indicators of abuse or abusive practices. The manager told us they had an open door and that people could come to them at any time with concerns. Systems were in place for the safe management of complaints and concerns.
People were protected from the risks associated with medicines, because safe systems were in place for their storage, administration and recording. At Hewitt Lodge systems were in place to ensure that medicines bought to the unit with the person were in line with the most up to date prescriptions.
The home provided a comfortable and attractive environment for people. Many rooms had sea views, but all were clean, warm and well appointed. Hewitt lodge provided facilities in a small homely environment to help people maintain their independence. The environment was very clean and well maintained. Infection control practices were well understood. Regular checks, such as for fire safety were carried out to make sure the home was safe.
People’s rights under the Mental Capacity Act 2005 were being respected. Staff understood about people’s right to refuse care and about decisions made in their best interests.
People were supported by staff who were professional in their approach, but still demonstrated affection, care and respect for the people living at the home. People’s care was delivered in private and their confidentiality was respected.
Care plans identified people’s goals for their care as well as areas of support needed. Care planning was individualised and people’s wishes regarding their care were taken into account. People had good medical and community healthcare support.
People living at the home guided the provision of activities and made decisions about what they wanted to do. The home was busy and active for some people, others chose to spend their time more quietly. For people who were very frail the home’s staff ensured they had one to one time with staff to reduce the risks of social isolation, or to provide sensory stimulation and comfort.
Systems were well developed to ensure the quality and safety of services at the home. The registered manager had put in place effective systems for the management of the service and to ensure people had a positive experience at Lincombe Manor and Hewitt Lodge. People were consulted about their views on how the service could be improved. People were encouraged to give feedback and any concerns or suggestions were addressed.
The manager took advantage of learning resources to improve the home.
Records were well maintained.
This inspection took place on 11 and 13 August 2015 and was unannounced.
Lincombe Manor is a care home with nursing, registered to provide care for up to 48 people. People living at the service were older people or people with long term health conditions needing nursing care. Some people were living at the home for end of life care or for short term respite care/NHS funded intermediate care with a view to returning to their own home. The home does not provide care for people with dementia as a primary diagnosis.
The home did not have a registered manager in post. A manager had recently been appointed to the home and had made application to the Care Quality Commission to be registered but this process had not yet been completed. The manager was very experienced, and had been previously registered to manage similar services. 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.
Staff recruitment practices had not always been safe. Since the appointment of the new manager the home had followed a robust recruitment procedure, but this had not always been the case.
People told us they felt safe at Lincombe Manor, and staff understood how to raise any concerns over abuse or abusive practices they saw. Medicines were being managed safely. However we identified some concerns that care plans did not always demonstrate staff acted in accordance with the Mental Capacity Act 2005, in relation to assessing people’s capacity to consent to care.
There were enough staff on duty at the home to meet people’s needs, both day and night. However we identified concerns staff had not always completed the training they needed for their role and had not received effective supervision and appraisal. Staff were clear about who they could go to for support, and new systems had been introduced to help ensure they were clear about delegated duties each day.
People told us they liked the food and had a good choice available to them. However we identified some concerns that showed where people had been assessed as being at risk of poor nutrition or hydration it was not always clear whether appropriate and consistent actions were being taken to manage this. For example, food and fluid balance charts were not always being completed clearly. The manager took actions to address this at the time of the inspection.
There was a policy in place for dealing with any concerns or complaints and this was made available to people and their families. People said they would speak with the manager or their family if they had any concerns. The manager had made herself accessible to relatives either in person or out of office hours through email to help address any concerns or ideas for improvement of the service. A forum had been set up to share information with relatives and people who lived at the home about changes and improvements being made as well as offer people opportunities to make comments about the service. People and staff told us there had been improvements since the new manager had been in post. One member of staff told us there had been a “truly spectacular” turnaround at the home and that it was a much happier place to work.
The home provided activities for people seven days a week, and staff took time to ensure everyone who wanted to engage with them could do so. This included people who were effectively nursed in bed due to their ill health or approaching the end of their life.
The home is in an attractive position with panoramic sea views from open terraces, lounges and some bedrooms. It is accessed via a steep hill, but transport is available to help people with going out. The home was clean and free from any unpleasant odours. Staff we spoke with understood about infection control practices and we saw staff using gloves and aprons to protect people from potential cross infection.
We also looked to answer five key questions; is the service safe, effective, caring, responsive and well-led?
There were 25 people living at the home at the time of the inspection. As a part of the inspection we spoke with eight people who lived at the home. We also reviewed records relating to the management of the home, including five people's care plans and sampled people's daily notes, fluid charts, and other records. We also spoke with seven members of staff over both day and night shifts, and four visiting relatives.
Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.
If you want to see the evidence that supports our summary please read the full report.
Is the service safe?
We found that there were sufficient staff on duty with the right skills to support people safely and ensure their needs were met both at night and throughout the day. Staff we spoke with knew people's needs well, including how to support them to move and transfer safely.
Staff who worked at the home had been appointed following a robust recruitment process. People we spoke with told us they felt the staff had the right skills to support them safely.
We found that risks to people's health and wellbeing were assessed and action taken to minimise risks. For example we saw that one person had been found climbing over a bed rail. The bedrails were discontinued and observations increased as the person was thought to be more at risk from climbing over the rail.
However we identified some concerns over the lack of consistency or accuracy in the monitoring of people's hydration. This meant it was not always possible to identify the amount of fluid a person had taken in over a 24 hour period. This could have put people at risk of poor hydration not being recognised.
Is the service effective?
We found that the care plans had been updated and reviewed regularly, and that staff used the home's records throughout the visit for reference or to make new entries. This helped ensure that people could be cared for effectively.
We saw that where concerns had been identified action was taken by the home to support the person and ensure their needs were met. For example we saw where one person had lost weight a referral had been made to the dietician service.
A person who lived at the home told us 'They are all very nice staff who work here. I am pleased with what they do for me. They all seem to know what they are doing so I leave it to them. No complaints'.
Is the service caring?
We saw many examples during our inspection of kindness from staff towards the people they were caring for. We saw staff supported one person and waited patiently for them to walk down a corridor. The person spoke cheerily with people at the nurses station as they passed. We also heard staff talking to people in their rooms and encouraging them to eat.
A member of staff we spoke with told us that that had seen many instances where staff had gone above and beyond what they were required to do in their job role. We heard evidence of this in our discussions with people who lived at the home. For example one person who lived at the home told us they enjoyed Rugby. This person and their relative said that a member of staff had bought them in a programme from a match they had attended. They told us they had really appreciated this thoughtfulness. Other staff had been involved in helping them set up their SMART TV to enable them to watch sport.
Another person told us 'The girls and nurses are excellent ' really good care here ' couldn't be better anywhere'.
Is the service responsive?
We saw that the home responded well to changes in people's needs. Care plans were regularly reviewed to take account of changes and we saw during a staff handover that staff were briefed as to any changes that had occurred. For example one person was due to be returned to their own home in a few days. The staff at Lincombe Manor were helping them return to managing their own medication. This meant the person could regain their confidence while in a monitored environment.
Another person had been identified as having a sore area of skin. Staff confirmed they would check and monitor this and apply cream to the area to prevent any skin breakdown. This showed us that the home could respond quickly to changes in people's need.
We saw that the home responded well to requests for food choices and flexibility over mealtimes. We heard examples of people's choices and wishes being respected. One person told us 'I love a jacket potato with cheese and tomato. They will do me one whenever I want'. Another person and their relative told us they had told the chef that the person enjoyed sardines on toast. They told us these were prepared for them when they wished. We also heard one person had requested thinner cut chips and these had been provided for them specifically as that was how they enjoyed them.
We found that the home's staff responded well to areas of potential non-compliance identified during this inspection. For example we found that one person's file contained a partially completed 'best interests' decision form in relation to them receiving medication without them being aware of this. We saw that appropriate steps had been taken to ensure the person was protected, by involving their GP and family members in making the decision to administer the medication as the person no longer had the capacity to make that decision. During our inspection staff worked on ensuring the correct process had been recorded on the form.
Is the service well led?
At the time of the inspection the manager who was working at the home had not yet submitted an application for registration. However they told us they had started this process with an application made for a disclosure and barring service check. This meant that at the time of the inspection there was not a Registered Manager in post.
We found that the staff on duty were clear about their role and positive about working at Lincombe Manor. We found changes were being made to improve the home. For example the manager was working towards supporting care staff to increase their skills and work towards team leader positions.
On the day of our inspection 25 people were living at the home. We spoke with four people, three members of support staff, three care staff and one nurse.
One person said "They are always so helpful, they can't do enough for us" Another said "it's like a five star hotel". One person told us that they particularly liked the quiet lounge with outdoor terrace as they felt close to the sea.
Staff had a good understanding of safeguarding and what to do if they were concerned about anything. The manager was friendly and welcoming and this was evident when he greeted people, staff and a visitor who wanted to see if the home would be suitable for a family member. It was evident that staff felt able to approach him. We saw him greet and welcome a new member of ancillary staff who was working their first shift that morning.
The senior nurse on duty talked us through the procedure used for the administration of medicine. All necessary documentation was completed, medicines were stored and labelled correctly, there were no out of date drugs in the medicine cabinets and the returns procedure including documentation was accurate and current.
On the day of our inspection 15 people were living at the home. We (the CQC) spoke with three people, two relatives, the manager, two nurses and one care worker.
One person said 'It's a nice personal service. I wouldn't have been here so long if it wasn't so lovely.' Another person said 'They (the staff) know what I like to do. I really enjoy it.' One relative said they were 'very pleased' and it's 'very good here'. They added that the staff were 'very attentive and caring'.
Staff understood the action to be taken in the event of an allegation of abuse being made. Medicines were administered safely. Suitable arrangements were in place for supporting staff.
Systems were being continually developed to monitor the quality of the service and manage risk. One nurse described the service as 'always going forward'. When asked about making improvements they said they were 'doing it all the time' since the home opened.