CQC report explained · a residential care home
What the CQC found at Linden House Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected by risk assessments, environmental checks, safeguarding procedures and infection control measures. However, medicines procedures were not always followed, and recruitment checks did not always explore gaps in employment.
- Effective?
- Good
- This area was not inspected during this focused visit. Its rating was carried forward from the previous inspection.
- Caring?
- Good
- This area was not inspected during this focused visit. Its rating was carried forward from the previous inspection.
- Responsive?
- Good
- This area was not inspected during this focused visit. Its rating was carried forward from the previous inspection.
- Well-led?
- Good
- Management and governance had improved, and the earlier breach was no longer in place. However, staff gave mixed views about management support and some audits had not led to action.
What inspectors found, March 2023
Linden House Care Home is rated Good; inspectors found improvements, but medicines records and recruitment checks were not always reliable.
This was an unannounced focused inspection on 14 February 2023. One inspector spoke with people, relatives, staff and a visiting professional. They reviewed care and medicines records, staff files, training, management records and infection control arrangements.
The home was rated Good for Safe and Well-led. Inspectors found safe staffing levels, managed individual risks, suitable infection control arrangements and improvements in thickener guidance. People said they felt safe and usually felt there were enough staff.
There were still problems with medicines procedures. Some administration records were completed before medicines were given, some medicines were given without clear protocols, and the return of unused controlled medicines needed improvement. Recruitment checks did not always explore gaps in employment.
The overall rating rose from Requires improvement to Good after improvements since the previous inspection. This inspection only examined Safe and Well-led. Ratings for the other areas were carried forward from the previous inspection.
People felt safe
People and relatives told inspectors that people felt safe. Staff knew how to report safeguarding concerns and accidents were reviewed for patterns.
“People told us they felt safe in the service.” from the report
Risk management
Individual risks were assessed and reviewed. The home had control measures for identified risks and completed environmental safety checks.
“Risks were effectively assessed and managed.” from the report
Infection control
Inspectors found improvements since the previous inspection. The home had arrangements for preventing and managing infections, including safe use of protective equipment.
“We were assured that the provider was responding effectively to risks and signs of infection.” from the report
Improved leadership systems
The home had improved its governance arrangements since the previous inspection. People and families were asked for their views, and the home used feedback to make changes.
“Enough improvement had been made at this inspection and the provider was no longer in breach of regulation 17.” from the report
Staffing levels
Rotas matched the planned staffing levels and most people said there were enough staff. Staff said staffing had improved, although some wanted more support.
“Staffing levels were safe.” from the report
Medicines procedures
seriousStaff did not always follow medicines procedures or record administration at the correct time. Instructions for as-needed medicines and the return of unused medicines also needed improvement.
“Medicines were not consistently being managed in line with processes and procedures.” from the report
Recruitment checks
needs fixingReferences and criminal record checks were completed, but gaps in employment histories were not always explored. Inspectors recommended that all pre-employment checks follow guidance.
“However, gaps in employment were not being explored.” from the report
Audits did not always lead to action
needs fixingThe home identified issues through audits, but it was not always clear whether these had been fixed. An action about returning unused medicines was still outstanding.
“It was not always clear how effective the audits were at addressing issues.” from the report
Mixed views about management support
minorStaff did not all have the same experience of management support. Some staff said concerns were not always followed through, while others felt listened to.
“Staff provided mixed feedback was given around the culture of the home and management support.” from the report
- 01What changes have been made to ensure medicines are recorded only after they have been given?
- 02How do you check that instructions and administration times for as-needed medicines are recorded correctly?
- 03How are unused and controlled medicines returned promptly, including medicines belonging to people who have died?
- 04How do you now check and record gaps in applicants' employment histories?
- 05How do you make sure actions identified by audits are completed and checked for effectiveness?
This was a focused inspection of Safe and Well-led only; the other key question ratings and the overall rating were carried forward from the previous inspection. This explanation was written from the published report of 17 March 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, April 2022
Rated Requires Improvement; inspectors found good care and support, but staffing, infection control and management systems were not always reliable.
This was an unannounced inspection on 17 March 2022. Inspectors spoke with people, relatives, staff and health professionals. They observed care and checked care records, medicines, staff files, rotas and management records.
The home was clean and people were generally treated kindly and with respect. Inspectors rated Effective, Caring and Responsive as Good. People usually received suitable care, had access to healthcare and were supported with food, personal choices and end of life care.
There were important weaknesses in Safe and Well-led. Staffing levels were a concern, infection control arrangements were not always up to date, relatives were not always told about a COVID-19 outbreak, and thickener powder was not stored safely. The home remained in breach of Regulation 17 about good governance. CQC asked for an action plan and said it would continue monitoring the home.
Safe recruitment
The home had improved its recruitment checks and was no longer in breach of the recruitment regulation.
“Safe systems of staff recruitment were in place. All required checks had been undertaken prior to people commencing employment.” from the report
Kind and respectful care
Most people described staff as caring, and inspectors observed kind interactions. People's privacy, dignity and independence were generally respected.
“People were treated with privacy, dignity and their independence promoted.” from the report
Healthcare support
People were generally supported to access professionals and receive reviews when needed.
“We saw evidence in people's care records that referrals had been made to professionals and reviews had taken place.” from the report
Staffing levels
needs fixingSome people, relatives and staff said there were not enough staff. This could delay care, including getting up and responding to call bells.
“Staffing numbers were not always sufficient. Not all people or relatives could confirm there was always enough staff to support them.” from the report
Infection control and visiting
needs fixingSome PPE areas were not restocked, some staff did not wear masks correctly, and relatives were not always told about the COVID-19 outbreak or visiting arrangements.
“Not all relatives had been informed about the recent outbreak.” from the report
Thickener safety
seriousStaff did not have written guidance about adding thickener to drinks, the amount used was not recorded, and the powder was not stored securely. The manager acted during the inspection.
“Guides for staff to add thickener powder to drinks for people who had swallowing difficulties were not seen.” from the report
Weak management oversight
seriousThe home still had a breach because its systems did not reliably identify and manage risks. Some notifications to CQC were also submitted late.
“Whilst no harm had occurred the findings at this inspection identified systems or processes were not operated effectively to ensure compliance with the requirements.” from the report
Activities and social contact
minorActivities had not been consistent since the pandemic. The home was recruiting an activities co-ordinator to improve the programme.
“People were sometimes supported to avoid social isolation.” from the report
- 01What staffing levels are in place now, including on night duty, and how are they matched to each person's needs?
- 02How will you tell residents and relatives promptly about COVID-19 outbreaks and current visiting arrangements?
- 03What written guidance and staff training are now in place for using and storing thickeners safely?
- 04How do you check that incidents, safeguarding matters and required notifications are reported promptly?
- 05What activities are currently available, and how are residents' interests and social needs being supported?
This unannounced inspection covered all five key questions and included infection prevention and control and COVID-19 vaccination arrangements; the report does not say that any areas were excluded. This explanation was written from the published report of 28 April 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Linden House Care Home
5 rated inspections over 3 years: the service has improved, from Inadequate to Good.
- March 2023Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2022Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- April 2021Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- September 2020Requires improvementup from InadequateSafe: GoodWell-led: Good
- February 2020InadequateSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- January 2019
Registered with the Care Quality Commission on 24 January 2019.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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