Linda Grove

Linda Grove is a residential care home providing accommodation and personal care to people with a learning disability. The service can support four people and at the time of the inspection three people were living in the service although one person was temporarily away.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right support:

• The model of care and setting did not fully maximise people’s choice, control and independence. For example, people lived in an environment where safety issued had been identified and was not homely. The environment did not meet people’s sensory needs. People were supported to personalise their bedrooms and had privacy for themselves and their visitors. The service was located so people could participate in the local community.

Right care:

• Care was not fully person-centred. For example, while staff knew people well and were caring in their approach, people were not always supported in line with preferences which were outlined in their care plans. People were supported by staff who treated them with kindness and respect.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff did not fully ensure people using services lead confident, inclusive and empowered lives. It was not clear how people had been empowered to have as much choice and control over their care as possible. A lack of management presence meant leaders were not always available to monitor the day to day culture. Despite this, staff remained positive and felt well supported. They were motivated to do the best they could for people.

The service was not always safe. Risks associated with people's support needs and health conditions had not been effectively managed. The premises and equipment were not always secure, properly maintained or suitable. The provider had not ensured measures were in place to prevent and control the spread of infection. This increased the risk of harm to people. The manager told us of their plans to make improvements to ensure safety.

There were enough staff to support people safely and staff were recruited safely. Staff had a good understanding of safeguarding people from abuse and were confident the manager would act appropriately if necessary.

The home was not always well-led. Leadership arrangements did not ensure the safety and quality of the service. Governance systems to monitor the quality of care being delivered to people were not effective and did not always drive the necessary improvement. People did not always receive person-centred care.

Staff felt valued and enjoyed working at Linda Grove. They were kind and cared about the people they supported.

The manager demonstrated a willingness to make improvements and during the inspection began reviewing their systems and process to ensure the service consistently provided good, safe, quality care and support. The senior leadership team additionally demonstrated they took our concerns seriously and acted promptly to support the manager to make the necessary improvement. Further progress was still needed to fully embed and sustain these improvements.

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

Rating at last inspection

The last rating for this service was good (published 13 November 2018).

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Linda Grove on our website at www.cqc.org.uk.

Why we inspected

The inspection was prompted in part due to concerns received about the environment, infection control practices and staffing. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, premises, person-centred care and governance.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Linda Grove is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Linda Grove accommodates up to four people with a learning disability in one adapted building. At the time of our inspection, four people were living at Linda Grove. The care service had been developed and designed in line with the values that underpin the Registering the Right Support, CQC policy and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in place. 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.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

People were safeguarded from avoidable harm. Staff knew about the risks of abuse and avoidable harm and there were suitable processes in place should they need to report concerns. The provider had procedures in place to identify, assess, manage and reduce risks to people's health and wellbeing which were tailored to their individual needs.

There were sufficient staff on duty to keep people safe and meet their needs. Safe recruitment procedures were in place.

Safe medicines management was followed and people received their medicines as prescribed. Staff protected people from the risk of infection and followed procedures to prevent and control the spread of infections.

Staff were supported by regular supervision and an annual appraisal and staff had appropriate training to ensure they had the knowledge and skills to carry out their roles effectively.

Staff supported people to eat and drink sufficient amounts to meet their needs. Staff liaised with other health and social care professionals and ensured people received effective, coordinated care in regard to any health needs.

People’s rights were protected in line with the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People lived in an environment that met their needs.

Staff treated people with kindness, respect and compassion. They were aware of people’s communication methods and how they expressed themselves. Staff respected people’s individual differences and supported them with any religious or cultural needs. People’s privacy and dignity was respected and their independence was promoted.

People received personalised care that meet their needs. Assessments were undertaken to identify people’s support needs and these were regularly reviewed. Detailed care records were developed informing staff of the level of support people required and how they wanted it to be delivered. People were encouraged and supported to engage in meaningful activities according to their individual preferences.

A complaints process ensured any concerns raised were listened to and investigated. Feedback was sought about the service and this was used to drive improvement.

Staff felt supported by most members of the management team but feedback about the registered manager was mixed.

A programme of audits and checks were in place to monitor the quality of the service and improvements were made where required.

Further information is in the detailed findings below.

Linda Grove is a residential care home that provides accommodation and personal care for up to four people with a learning disabilities. The accommodation is all on the ground floor. At the time of our inspection four people lived at the service.

Linda Grove had a registered manager. 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.

The provider had comprehensive care plans in place for all of the people who used the service. We could see that were people's health care needs had changed staff had written how the staff should support them in light of this change. However care plans for two of the people who used the service had not been reviewed since early 2014. Therefore staff may not be supporting or caring for a person appropriately and promoting their independence.

Staff had an understanding of safeguarding and whistleblowing and were confident that any concerns they had would be listened to by the registered manager. One staff member told us, "I would report it to the registered manager and if needed I would contact the local authority safeguarding number." Staff we spoke with were able to give examples of abuse. Such as physical, financial, emotional and how behaviours may change if someone had been or was subject to abuse.

Staff had an understanding of the Mental Capacity Act 2005 (MCA 2005). Staff sought people’s consent and supported people to make decisions that were in their best interests. People told us they were able to make choices about their support. People told us staff treated them with kindness and understanding and we observed positive, caring interactions between people and the staff. Staff supported people to maintain their independence. The registered manager had a good insight into the principles of the MCA 2005 and explained the processes used by the service in meeting their responsibilities.

Recruitment practices were robust and safe. This meant that only people who were suitable to the role were employed. Staff received an induction in the home on commencement of employment. Staff had completed a range of in house training, such as safeguarding, first aid and MCA 2005. Staff had received regular supervision and appraisals to discuss personal development.

The provider had systems in place for recording safeguarding, accidents, incidents and complaints. People knew how to make a complaint. One relative told us, "I know how to complain but I have never needed to."

Policies and procedures were in place to ensure medicines were managed in a safe way. Records were up to date with no gaps or inaccuracies found. A staff signing

sheet was available so records could be audited. Staff were trained in safe handling of medicines and received regular medicine competency checks.

The provider had effective management systems in place to assess and monitor the quality of the service provided to people.

We have made a recommendation that the service reviews and updates all the care plans for the people that use the service.

We looked at three people's care plans and other records relating to the running of the home.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

This is a summary of what we found

Is the service safe?

People were treated kindly and with dignity and respect by staff. Staff were clear they would report concerns to the manager and these would be acted on. There was a system in place for recording of incidents and accidents.

CQC monitors the operation of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) which apply to care homes. The staff and managers we spoke with had a good understanding of MCA and DoLS and their responsibilities in this.

Is the service effective?

The service was effective because people and their representatives were involved in their care planning. Their individual needs and preferences were recorded in their care plans, for example, religious and cultural needs and preferences. We saw people were supported to express their individuality

Is the service caring?

Staff spoke about people in a caring and respectful manner. They knew people well and treated them as individuals. From our observations we saw staff had a good understanding of people's needs and the support they required. We saw staff were kind in their approaches when supporting people.

Is the service responsive?

People's health and care needs were assessed and care plans were developed to enable staff to support people in the way they chose and needed. Where there were risks associated with people's care and treatment, these had been assessed and actions to reduce these risks had been identified.

Is the service well led?

We saw there were systems in place to monitor and assess the quality of the service, including regular audits by a regional manager. The management were open about the improvements they intended to make and their plans to continue to improve the service. Staff we spoke with said they thought the service was well led.

We met all four of the people living in the home; due to their disability and communication needs we were not able to ascertain their views verbally. However, we spent time observing their care and support. We saw that they looked happy and relaxed. We observed staff interacting with them in a friendly manner and treating them respectfully. People who were able to, moved freely around the home and those that needed support were given it.

We saw that care plans were kept under regular review and had been updated to reflect the risks to people during the recent hot weather.

There were processes in place to ensure that medicines were stored and administered safely. Only trained and competent staff attended to this.

Staff told us they enjoyed their jobs and they thought the home was well run. They spoke highly of the manager who they said was 'Brilliant' and "Supportive". Staff knew the people they supported well and showed a good understanding of their needs and preferences.

We saw that the home was clean and homely and there were processes in place to minimised any risks to people's health. There were robust recruitment procedures in place to protect people. Staff were happy and confident and acknowledged the improvements had made a positive impact on people's lives.