The Lindons is registered to provide personal care, without nursing care, for up to 25 adults. People living at the service are older and have physical and dementia care needs. During the inspection there were 20 people living at the service.
The inspection took place on 7, 19 and 20 January 2016 and the first day was unannounced. The service was last inspected on 25 November 2014 when it met the requirements relevant at that time.
There were two managers registered in respect of the service. 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. We were told that one of the registered managers no longer worked at the service. The registered manager who was working at the service told us they would contact the other registered manager to remind them of the need to apply to deregister as manager.
Prior to the inspection we received concerns about the way infection control procedures at the home were affecting the health and welfare of people living at the home. There had been a fire in the laundry over the Christmas period and this had resulted in a change to the way laundry was managed at the home. There were also concerns that there was a lack of hot water in some bedrooms. Due to these concerns a scheduled comprehensive inspection was brought forward.
We discussed the situation with the registered manager, care staff and people living at the home. People told us they knew about the fire, but that it had not affected them in any way. Laundry was being taken to a local laundrette. Extra sheets and towels had been purchased to ensure there was a good supply. Staff told us there had never been a time when they had run out of either. Staff told us some items of personal clothing had been destroyed during the fire, but that these had now been replaced.
We had also received concerns that not all bedrooms had access to hot water. On the first day of our inspection we tested the water in all bedrooms and found that 15 of the 25 had either no hot water or the water was tepid. The registered manager told us they knew there was a problem and the heating engineer visited during our inspection. Staff told us that while some rooms had no hot water they had taken water from the bathroom to people’s rooms so that they could wash. They said people had still been able to have a shower or bath. Following the inspection the registered manager informed us the boiler had been replaced.
People did not benefit from individual activity plans to ensure they had meaningful activities to promote their wellbeing. Information about the person’s life, the work they had done, and their interests was limited so could not be used to develop individual ways of stimulating and occupying people. The was no regular programme of activities, but staff told us they did spend some time with people when not carrying out personal care tasks. The registered manager had already identified the lack of social activities and a staff member had been identified who was to increase the level of social interaction. They had begun to identify activities people might like. The reminiscence magazine ‘The Daily Sparkle’ was available for people to look at. A small ‘snug’ area had been redecorated and contained a small library. Plans were in place to use this area to hold film nights.
People’s needs were met by kind and caring staff. People and their visitors told us staff were very good and caring and all the interactions we saw between people and staff were positive. One relative told us they thought staff provided “A good level of care”, and their relative “Always seems well cared for”.
Staff were responsive to people’s individual needs and gave them support at the time they needed it. One person told us “Alright they are [staff] they help you when you need it”. Staff were able to tell us about people’s preferences. For example, staff told us about one person who liked a fixed routine. The person’s care plan clearly detailed this, and the person confirmed staff always followed their preferred routine. One person told us “They [staff] are always asking, are you alright to get up or go to bed?”
People were protected from the risk of abuse because staff understood the signs of abuse and how to report concerns. People we spoke with told us they felt safe living at the home. One person told us “Safe? Yes, I’m alright, I’m fine”. Not everyone we spoke with was able to tell us if they felt safe, so we watched how they interacted with staff. People smiled and took hold of staff’s hands when talking to them, showing us they felt safe in their company.
People’s needs were met in a safe and timely way as there were enough staff available. During the inspection staff were busy, but met people’s needs in a timely manner and call bells were answered promptly.
The systems in place for the management of medicines were safe and protected people who used the service. Records confirmed people had received their medicines as they had been prescribed by their doctor. Topical creams and charts detailing where and when they should be applied were kept in locked cupboards in people’s bedrooms.
Risks to people were identified and staff had information on how to manage risks to ensure people were protected. Moving and transferring, falls and pressure area risk assessments were in place. However, on the first day of inspection not everyone’s risk assessments were up to date. The registered manager told us this was because a new care planning system was about to be introduced and everyone was being completely reassessed. On the other days of inspection we saw this was happening. Pressure relieving equipment was used when needed. Staff knew how often people’s position needed changing and charts indicated people were being repositioned as required.
People were supported to maintain a healthy balanced diet and receive the healthcare they needed.
Staff ensured people’s privacy and dignity was respected and all personal care was provided in private. For example, staff addressed people with their preferred name and spoke with respect. People responded to this by smiling and engaging with staff in a friendly way. We heard staff respectfully reassuring one person they were assisting to move.
Relatives told us they were involved in developing and planning their relation’s care. One relative said staff always asked for their input when reviewing care. Another relative said they had helped to develop their relative’s care plan and staff always let them know if there were any changes to their care. Visitors said they could visit at any time and were always made welcome.
People’s human rights were upheld because staff displayed a good understanding of the principles of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards (DoLS). When a person had been assessed as not having the capacity to make a decision other people were involved to determine what decision would be in the person’s best interest. This procedure had been followed where one person had needed dental treatment.
Staff had received a variety of training such as medicine administration, first aid and moving and transferring to help meet people’s needs. They had also received more specific training relating to people’s needs. This included caring for people living with dementia. We saw a series of training events were due to be held in the forthcoming weeks in order to update staff on such topics as medicine administration, safeguarding people and first aid.
Relatives, staff and a healthcare professional spoke highly of the registered manager who was keen to drive improvements in the home. Improvements introduced included changes to care plans and the environment.
People benefited from systems to assess and monitor the quality of care. The systems enabled issues to be identified and acted on. Suggestions for improvement were encouraged from staff and visitors. For example, staff had suggested name badges would ensure people and visitors knew who they were speaking with. The name badges arrived during our inspection.
We have made a recommendation about increasing social interaction and activities for people living with dementia.