The inspection took place on 6 and 8 December 2016 and was unannounced.

The last inspection took place in September 2015. As a result of this inspection, we found the provider in breach of four regulations relating to staffing, dignity and respect, good governance and person-centred care. We asked them to submit an action plan on how they would address these breaches. An action plan was submitted by the provider which identified the steps that would be taken. At this inspection, we found that the provider and registered manager had taken appropriate action and all these regulations had been met. As a result, the overall rating for the service has improved from 'Requires Improvement' to 'Good'.

Linfield House is a purpose-built home that provides nursing and personal care for up to 54 people with a variety of health and care needs, including people living with dementia. At the time of our inspection, 53 people were in residence. The home is divided into five units or suites: Richmond suite caters for people living with dementia and is a secure unit. The other four suites provide nursing or residential care: Whitcomb, Frazer, Selden and Gordon. People living in the Richmond suite have separate facilities comprising a sitting room, dining room and have access to a garden. The other suites are housed on the first and second floors at Linfield House. Each suite has its own small lounge, kitchenette area and bathroom. There is a communal lounge and large dining room on the ground floor and a further dining room on the first floor. All rooms have en-suite facilities, including a shower. There are accessible gardens at the rear of the property which overlooks Victoria Park. The home is situated close to the town centre of Worthing.

A registered manager was in post. 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.

Staffing levels were sufficient to meet people’s care needs safely. Staff were used flexibly and could be deployed to areas of the home where additional staffing was required. Improved staffing levels meant that staff had time to spend with people and call bells could be responded to promptly. Safe recruitment practices were in place and people were protected from the risk of abuse and avoidable harm. Staff had been trained in safeguarding adults at risk and knew what action to take in the event they suspected abuse was taking place. Risks to people had been identified, assessed and managed appropriately, with clear guidance for staff on how to mitigate risks. Generally, medicines were managed safely.

People were looked after and supported by kind and caring staff. They were treated with dignity and respect and had the privacy they needed. People were supported to express their views and to be involved in reviewing their care plans. Relatives confirmed they were involved in reviewing their family members’ care plans and invited to monthly meetings. Staff knew people well, their likes, dislikes and preferences and positive, caring relationships had been developed. Staff were very attentive to people, were complimentary on their appearance and genuinely cared about their welfare.

Records containing confidential information about people were kept securely. A range of systems had been put in place to measure and monitor the quality of care delivered and the service overall. Where improvements were identified, actions were taken to address these. People and their relatives were invited to monthly meetings to give their feedback about the service. A survey was sent out in June 2016 to obtain people’s feedback and suggestions for any improvements. Staff felt supported by the management team and good leadership w

The inspection took place on 29 September 2015 and was unannounced.

Linfield House is a purpose-built home that provides nursing and personal care for up to 54 people with a variety of health and care needs, including people living with dementia. The home is divided into five units: Richmond unit caters for people living with dementia and is a secure unit. The other four units provide nursing or residential care: Whitcomb, Frazer, Selden and Gordon. People living in the Richmond unit have separate facilities comprising a sitting room, dining room and have access to a garden. The other units are housed on the 1st and 2nd floors at Linfield House. Each suite of two units has its own small lounge, kitchenette area and bathroom. There is a communal lounge and large dining room on the ground floor and a further dining room on the first floor. All rooms have en-suite facilities, including a shower. There are accessible gardens at the rear of the property which overlooks Victoria Park. The home is situated close to the centre of Worthing.

There was no registered manager in post at the time of our inspection, but the person currently managing the home was in the process of registering with the Commission. 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.

Staffing levels had not been assessed based on people’s care needs. Staff were busy trying to support people safely, but there were not always enough to do so at the time of our inspection. There were insufficient staff to support people at lunchtime and some people had to wait a long time for assistance. Call bells were not always responded to promptly. People felt safe living at Linfield House and staff had been trained to recognise what might constitute potential abuse and what action they should take. Risks to people were identified and assessed appropriately and risk assessments were reviewed monthly. There was information and guidance for staff on how to manage people’s needs safely. The service followed safe recruitment practices. Generally, people’s medicines were managed safely. However, there were two instances on the day of inspection when staff left the medicines trolley unlocked when administering medicines. The home was generally clean and hygienic.

There was a mixed response from relatives regarding whether all staff had the knowledge and skills they needed to care for people effectively. New staff underwent an induction programme and progressed to the Care Certificate, a universally recognised qualification. Staff completed all essential training and received regular supervision and annual appraisals from their supervisors. People’s consent was gained in line with current legislation under the Mental Capacity Act (MCA) 2005 and associated legislation under the Deprivation of Liberty Safeguards (DoLS). Staff had a good understanding of this legislation and put what they had learned into practice. Generally people had sufficient to eat, drink and maintain a balanced diet. However, a shortage of staff at lunchtime meant that some people were not supported adequately. The lunchtime experience in Richmond unit was in contrast to that of people in the main dining room. People in Richmond were supported effectively and encouraged to eat their meals. People were supported to maintain good health and had access to healthcare professionals as needed.

Mostly people were looked after by kind and caring staff. There were occasions, however, when people were not always responded to by some staff when needed and were ignored. Other staff were patient, warm and friendly with people and were receptive to their needs. People and their relatives were not always involved in discussions or decisions about their care, with the exception of their end of life care. Mainly, people were treated with dignity and respect.

Care plans provided staff with detailed, comprehensive information about people and how they wished to be cared for. Care plans were reviewed monthly. Some relatives felt that people’s care was managed well, whilst others felt this had taken time to achieve. Relatives could visit at any time and were made to feel welcome. There were some organised activities for people at Linfield House, however, these were not always meaningful for all the participants. Some outings were available to people, but generally there was little opportunity for people to go out of Linfield House, unless they were supported by their relatives or friends. Complaints were listened to, acted upon and dealt with to the satisfaction of the complainant.

People felt the home was well run and that the management were approachable. Some staff felt that, whilst the manager was amenable, she was not always available to observe what was happening in all parts of the home. People’s personal information was not always kept confidentially, but left in folders in open offices. Audit systems were in place but did not always identify and assess improvements that were required.

We have identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told this provider to take at the back of this report.

We talked with the manager, deputy manager, people who used the service, staff, and relatives and friends who were visiting the home.

We found that people were treated with dignity and respect. People's individuality and choices were respected by staff on a daily basis. People told us they were involved in their care decisions

People we spoke with were happy with their environment and their care. One person said "I feel safe here, the carers are good". Another said "they do a good job". One relative we spoke with said "I am impressed with the service" whilst another said “It gives me peace of mind to know they are safe and they do listen to any concerns".

People we spoke with told us the food was good and plentiful. A full time activities co-ordinator was employed and we saw a good range of activities available, particularly for people living with dementia, to help stimulate and engage them.

We spoke with five care workers who told us they liked working at the home and after a period of staff changes were looking forward to meeting new permanent staff. All the staff had been appropriately trained.

We saw staff interacting with people used the service, listening to them and responding to them in a polite and courteous way, ensuring that they given time to ask questions and respond at their own pace. We also saw that staff supported and gently encouraged people to eat and drink at their own pace. One person who used the service said "The food was variable and we get lots of choices."

People’s needs were assessed and they were consulted and involved in the planning of their care plans and service delivery. We saw that there had been some improvement in making care plans more person centred but still required further improvement to provide sufficient information regarding peoples likes and dislikes such as what they like to eat and drink hobbies and what time they like to get up and go to bed.

The manager told us that this is being addressed when the care plans are being reviewed.

All staff had received safeguarding training and policies and procedures were in place and staff were able to explain what abuse is and how they would report it to their line manager.

We saw that people who used the service were not cared for by staff that was supported to deliver care and treatment safely and to an appropriate standard. Staff had not received regular formal supervision or annual appraisals. Training was not always provided or updated to ensure that staff had the skills and knowledge required to provide the appropriate support to the people who used the service.

Everybody who we spoke with told us that Linfield was a good care home and that they thought it was a nice place to live. They told us that staff were kind and attentive; that the food was excellent and that they were able to participate in a wide range of activities.