About the service: The Links Care Centre is a residential care home that was providing personal and nursing care to 68 people, including people with complex mental health needs, at the time of the inspection.

People’s experience of using this service:

People told us they felt safe and enjoyed living at the Links Care Centre. The service had submitted appropriate safeguarding notifications and staff had received safeguarding training. Some staff knowledge in this area needed improving although staff told us they would not hesitate to report concerns to their line manager. Assessments were in place to mitigate risks to people although some of these needed reviewing and consolidating to reflect current practice. Accident and incidents were analysed to check for themes and reduce the risk of reoccurrence.

Staff were recruited safely and a number of new staff were being recruited. However, there was still a reliance on agency staff. Staff expressed concerns about staffing levels at certain times of the day. We have made a recommendation around planning of staff deployment to ensure safe and consistent staff levels for people. Staff training was up to date or in the process of being completed. Most staff told us training was good and had equipped them for their role.

People told us they received prescribed medicines on time and we saw medicines were generally well managed. People’s health care and nutritional needs were met. Where concerns were raised about people, appropriate referrals were made.

The service was compliant with the legal requirements of the Mental Capacity Act. People’s consent was sought for care and treatment and advocates were in place where required. However, people were not involved with care plan reviews and more evidence was needed to show who was involved with best interest decisions.

There had been improvements with documentation since our last inspection, although some care plans required further work to ensure they reflected people’s current needs. Care plans now also needed to reflect person-centred care and supporting people’s independence.

People told us staff were kind and caring. Complaints were treated seriously and appropriately investigated. Regular staff knew people well. However, some staff interaction with people was predominantly task focussed. There was a lack of meaningful, person-centred activities in place.

The management team were keen to continue to drive improvements to the service and improvement action plans were in place. A new manager and clinical lead had been recruited since our last inspection. Most staff said this had made a positive impact on the service. Improvements had been made to checks around the service quality and there was increased provider oversight. The manager acknowledged changes had been difficult for some staff and staff morale was variable.

At this inspection, we found the service met the characteristics of Requires Improvement in all domains. We identified one breach of regulation relating to good governance. More information is contained in the full report.

Rating at last inspection: The service was rated Inadequate at the last inspection which was published in October 2018. We identified nine breaches of regulation which related to person centred care, dignity and respect, need for consent, premises and equipment, staffing, safeguarding people from abuse and improper treatment, meeting nutritional and hydration needs, safe care and treatment and good governance. The service was placed into Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe.

Why we inspected: This inspection was planned based on concerns found at the previous inspection and the service rating. During this inspection the service demonstrated improvements have been made and are ongoing. The service is no longer rated as inadequate overall

The inspection took place on 19, 24 and 31 July 2018. Each day was unannounced.

The service provider registered with CQC on 8 February 2018. This was our first inspection of this location under the new care provider.

The Links Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. This service accommodates up to 85 people across five separate units each of which have separate adapted facilities. At the time of this inspection there were 80 people living at the home. The service specialises in providing nursing and personal care to adults living with mental health conditions.

The service 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.

Risks were not always assessed and monitored to ensure people were kept safe. Our review of records, discussions with staff and tour of the environment demonstrated appropriate action had not always been taken to reduce risk. This included key risks such as falls, pressure sores, choking, behaviour that challenged and smoking.

Accidents and incidents were not always robustly analysed. Where lessons could be learned to improve the service and make the care people received safer; these were not always identified and addressed. Accidents and incidents were not being consistently investigated and followed up.

Robust systems were not in place to ensure people were protected from the risk of abuse. Procedures regarding the use of restraint needed improving to ensure staff only used restraint when it was absolutely necessary, proportionate and lawful.

The environment was not kept clean and was not safely maintained. Risks around fire safety had not been appropriately identified, assessed and mitigated. The provider had not considered people’s individual needs when decorating and designing the environment.

Appropriate action was not always being taken to ensure equipment was safe and appropriate for peoples’ needs.

Sufficient staff were not always deployed to meet people's needs. Staff were task orientated and did not always provide people with the support they needed. Agency staff often worked at the home but were not always receiving the information they needed to deliver effective care.

Medicines management was not always safe and effective, which meant we could not be assured people always received their medicines as prescribed.

Staff told us and records showed that the training staff received needed to be improved.

Staff did not always support people in the least restrictive way possible; the policies and systems in the service do not support this practice.

People told us the food and drink they received was poor quality and did not always reflect their preferences. Risks relating to nutrition and hydration were poorly managed.

Some aspects of care delivery where not person centred. For example, meals and snacks were provided at set times which did not meet people’s needs.

People told us they felt safe living at the service and they provided positive feedback about the staff who supported them.

We saw some staff had developed strong relationships with people. However, staff did not always recognise and intervene where people needed support. We also found some staff lacked awareness and consideration about the things that mattered to people.

People did not always have their privacy and dignity maintained and respected.

Staff involved and consulted a range of health and social care professionals to ensure people’s healthcare needs were met. However, the advice given by t