CQC report explained · a nursing home
What the CQC found at The Links Care Centre
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found poor compliance with infection prevention guidance and saw staff not follow one person's choking risk plan. They also found that some as-required medicine protocols were missing, although this was addressed on the inspection day.
- Effective?
- Requires improvement
- This question was not inspected during this focused visit. The previous rating was carried forward.
- Caring?
- Requires improvement
- This question was not inspected during this focused visit. The previous rating was carried forward, although inspectors observed warm interactions and people said staff were kind and caring.
- Responsive?
- Requires improvement
- This question was not inspected during this focused visit. The previous rating was carried forward.
- Well-led?
- Requires improvement
- Audits and senior oversight had not identified the infection control and choking risks found by inspectors. The manager was described as visible, approachable and responsive, but the provider remained in breach of good governance requirements.
What inspectors found, January 2021
The Links Care Centre is rated Requires Improvement; inspectors found infection control and risk management were not always safe, although staff were kind and medicines were managed well.
This was an unannounced focused inspection. Inspectors visited on 8 December 2020 and carried out further inspection activity until 18 December 2020. They observed care, spoke with people, relatives, staff and professionals, and reviewed care, medicines and management records.
The home was rated Requires Improvement overall. Safe and Well-led were both rated Requires Improvement. Staff did not always follow infection control guidance, including correct mask use, social distancing and ventilation. Inspectors also saw staff fail to follow one person's choking risk plan.
There were strengths too. People were supported by a consistent and experienced staff team. Medicines were managed safely, and staff worked with health professionals. The registered manager had introduced changes that people, relatives and staff viewed positively, but the home's checks had not found the safety problems inspectors identified.
The rating stayed at Requires Improvement, as it had at the previous inspection published in April 2019. The provider remained in breach of Regulation 12 and Regulation 17.
Kind support with medicines
Inspectors saw people supported with medicines kindly and patiently. Medicines were given when they should be, and staff training and competency checks were in place.
“We observed people were supported with their medicines kindly and patiently.” from the report
Experienced staff team
The home had reduced its use of agency staff. People were supported by a more consistent and experienced team.
“This meant people were supported by a consistent and experienced team.” from the report
Good safeguarding arrangements
Staff understood abuse and how to report concerns. Accidents and incidents were reviewed, with examples of lessons being learned.
“Accidents and incidents were reported and there was a detailed monthly analysis completed to identify any themes and trends.” from the report
Positive management changes
People, relatives and staff spoke positively about changes introduced by the registered manager. Inspectors saw examples of changes improving people's independence and wellbeing.
“Staff, people and relatives spoke highly of the registered manager and described the changes that were underway as positive.” from the report
Links with professionals
The home worked with health and social care professionals to respond to people's health needs and changes.
“There were close links with health professionals and other agencies to ensure people's health needs were met and changes responded to promptly.” from the report
Infection control was not consistent
seriousSome staff wore fabric masks or did not wear fluid-resistant masks correctly. Social distancing and ventilation guidance was also not consistently followed, creating a risk of infection spreading.
“Staff did not always follow the provider's COVID-19 policy or infection prevention and control guidelines set out by the government.” from the report
A choking risk plan was not followed
seriousInspectors saw staff fail to follow one person's eating and drinking plan. The person was left unsupervised with food, creating a risk of choking.
“We observed several instances over the course of the lunch-time service when the person was at risk of choking.” from the report
Checks did not identify key risks
seriousThe home's audits covered several areas, but senior oversight had not identified the infection control and choking concerns found during the inspection.
“However, audits and oversight by senior staff had not identified the concerns relating to infection prevention and control and risk to people identified on the day of the inspection.” from the report
Some care language was institutional
minorInspectors found that a communal task board did not reflect a person-centred approach. They also observed warm and positive interactions between people and staff.
“Some of the language used suggested an institutionalised approach to care.” from the report
- 01What changes have you made to ensure all staff use masks, social distancing and ventilation measures correctly?
- 02How do you check that staff follow each person's choking, eating and drinking risk plan?
- 03What evidence can you show that your audits now identify infection control and care risks promptly?
- 04What action has been completed in response to the Regulation 12 and Regulation 17 breaches?
- 05How are you continuing the changes introduced by the registered manager, and how do you measure whether they improve people's independence and wellbeing?
This was a focused inspection of Safe and Well-led, including infection prevention and control; Effective, Caring and Responsive were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 27 January 2021 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 2019
Rated Requires Improvement; inspectors found improvements and the home had left Special Measures, but care records and person-centred support still needed work.
Inspectors visited without notice on 18 and 19 March 2019. They spoke with people living there, staff and managers, and reviewed care records, staff files and quality checks.
The home had improved since its previous inspection, when it was rated Inadequate and placed in Special Measures. People generally said they felt safe and staff were kind. Medicines, food, health care, safeguarding and complaints handling had also improved.
However, all five areas were still rated Requires Improvement. Inspectors found staffing could be stretched, agency staff were used heavily, and some care plans and risk records were not accurate or up to date. There was also not enough meaningful activity, and some staff interactions were focused mainly on completing tasks.
The home breached Regulation 17 on good governance because records and quality monitoring were not always effective. The provider was asked to send CQC an action plan. The home was no longer in Special Measures, but CQC said further improvements were needed.
People generally felt safe
People told inspectors they felt safe and enjoyed living in the home. Safeguarding referrals were made appropriately and staff had received safeguarding training.
“People told us they felt safe and enjoyed living at the Links Care Centre.” from the report
Improved medicines management
Prescribed medicines were given at the correct time, including medicines that had to be given at specific times. Audits, stock counts and investigations of errors were in place.
“People received their prescribed medicines at the correct time, including time specific medicines.” from the report
Health and food support
People's health needs were supported and referrals were made when needed. Nutritional needs and weights were monitored, and menus could be adapted to people's needs and preferences.
“Where concerns were raised about people's weight or nutritional status, referrals were made to the GP, dietician or speech and language team (SALT).” from the report
Complaints were investigated
The home had a complaints policy in an easy-read format. Inspectors found that complaints were recorded, investigated and acted on.
“We saw complaints had been fully investigated and appropriate action taken.” from the report
Management improvements
A new manager and clinical lead had been appointed since the previous inspection. The home had strengthened audits, daily checks and oversight of care.
“Following the last inspection, a number of improvements had been made.” from the report
Staffing and agency use
needs fixingStaff numbers were sometimes stretched, particularly on units with higher dependency needs. People experienced less consistency because staff, including agency staff, moved between units.
“We saw there remained a large reliance on agency staff in the service.” from the report
Care records were not reliable enough
seriousSome care plans and risk assessments did not reflect people's current needs or what happened in practice. This was the subject of the Regulation 17 breach.
“Care plans were not always accurate, person centred and up to date, or focussed on promoting people's independence.” from the report
Limited meaningful activities
needs fixingThere were too few meaningful activities, and staff contact was often focused on completing care tasks rather than spending quality time with people.
“There was a lack of meaningful activities available to people and interactions from care staff were predominantly task focused.” from the report
Some care instructions lacked detail
needs fixingSome instructions for medicines, nutrition and choking risks were incomplete. Inspectors also found that agency staff did not always know about special diets and thickeners.
“Some people's nutritional care plans needed further information to show how staff were to support people at nutritional risk.” from the report
People were not always involved in planning
minorThere was not enough evidence that people were involved regularly in reviewing their care plans or in documenting best-interest decisions.
“However, in some instances, we saw better documentation was needed about who was involved in the best interest decision.” from the report
- 01What are the current staffing levels on each unit, and how often are agency staff used now?
- 02How do you make sure agency staff know each person's risks, special diet, medicines and communication needs?
- 03How are care plans and risk assessments checked so they match people's current needs and what staff do in practice?
- 04How are residents involved in reviewing their care plans and setting goals about independence?
- 05What meaningful activities are now available, and how are they matched to each person's interests and abilities?
This was an unannounced inspection of all five key questions, covering the premises and care provided, and it followed an earlier Inadequate inspection that had placed the service in Special Measures. This explanation was written from the published report of 17 April 2019 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 The Links Care Centre
3 rated inspections over 2 years: the service has improved, from Inadequate to Requires improvement.
- January 2021Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- April 2019Requires improvementup from InadequateSafe: Requires improvementWell-led: Requires improvement
- October 2018InadequateSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: InadequateWell-led: Inadequate
- February 2018
Registered with the Care Quality Commission on 8 February 2018.
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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