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Archived: Linden House Care Home Good

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Reports


Inspection carried out on 29 January 2018

During a routine inspection

We carried out an inspection at Linden House on 29 and 30 January 2018. The first day of the inspection was unannounced

Linden House is a single storey 'care home' for up to 41 older people and adults with physical disabilities. People in care homes receive accommodation and nursing or 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. Since the last inspection a new unit for up to 22 people living with dementia had been opened. There were 49 people accommodated in the home at the time of this inspection.

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

The service was managed by 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 registered manager was supported in the day to day running of the home by a general manager and a deputy manager.

Improvements needed to be made to the way medicines were handled in the service. In particular, the recording of when prescribed topical creams were administered needed to be improved.

People told us they felt safe in Linden House and received good quality care. Staff had been safely recruited and there were enough staff on duty to meet people’s needs in a timely manner. People told us staff were kind, caring and respectful of their dignity and privacy.

We observed staff at the home communicating with people in a kind and caring way. People looked relaxed and comfortable and moved around the home freely.

Staff received the induction, training and supervision necessary to enable them to provide safe and effective care.

Care records accurately reflected people’s needs. Staff were knowledgeable about the support people needed as well as people’s preferences in relation to their daily routines.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Systems were in place to help ensure people’s health and nutritional needs were met. People told us the quality of food was generally good.

The environment had been extended and refurbished to a high standard since the last inspection. A range of technology was used within the home to help ensure people received care that was responsive to their needs.

People were encouraged to provide feedback on the care they received. We reviewed the responses from the most recent survey carried out by the provider and noted a high level of satisfaction had been expressed about all areas of the service.

We found that audits and checks of the service were completed regularly and were effective in ensuring that required levels of quality and safety were maintained at the home.

Further information is in the detailed findings below.

Inspection carried out on 22 September 2015

During a routine inspection

This was an unannounced inspection which took place on 22 September 2015. The service was last inspected in October 2014 when we found it to be in breach of two of the regulations we reviewed. This was because the provider had not taken proper steps to ensure care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. In addition the provider did not have an effective system to regularly assess and monitor the quality of service that people received.

Following the inspection in October 2014 the provider sent us an action plan telling us what they intended to do make the improvements needed. This inspection took place to check that the required improvements had been made. During this inspection we found all the regulations we reviewed were met.

Linden House Care Home provides accommodation for up to 40 people who need support with personal care. There is a dedicated unit for up to 12 people with dementia care needs. There were 36 people living in the home at the time of our inspection. Building work was taking place at time of the inspection to extend the service to accommodate a total of 63 people including an additional 12 bedrooms on the unit for people living with a dementia.

The service had 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.

People we spoke with told us they felt safe in Linden House. Relatives we spoke with had no concerns about the safety of their family members in the service. Staff had completed training in safeguarding adults. All the staff we spoke with told us of the correct action to take should they witness or suspect abuse.

People made differing statements about staffing levels in the service. Five of the people we spoke with told us there were not always enough staff, while five other people stated they considered staffing levels were appropriate to meet people’s needs. Staff we spoke with told us they had enough time to spend with people.

We have made a recommendation that the provider reviews the deployment of staff at busy periods to help ensure people always receive care in a timely manner.

We saw a robust system of recruitment was in place in the service. This helped to protect people from the risk of unsuitable staff. We saw that staff received the induction, training and supervision necessary to enable them to do their jobs effectively and care for people safely.

People gave positive feedback about the caring nature of staff. During the inspection we observed staff interactions with people who used the service were warm and friendly. Our discussions with staff showed they knew people well and demonstrated a commitment to providing person-centred care.

Medicines were safely managed and people told us they received their medicines as prescribed. Staff responsible for administering medicines had received training for this role. A system was in place to assess the competence of staff to safely administer medicines but assessments were not being completed on an annual basis in line with current guidance.

People’s care records contained good information to guide staff on the care and support required. People told us they received the care they required. The care records we reviewed showed that risks to people’s health and well-being had been identified and plans were in place to help reduce or eliminate the risk.

Policies and procedures were in place to prevent and control the spread of infection. Systems were also in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and gas supply. Records showed that the equipment and services within the home were serviced and maintained in accordance with the manufacturers’ instructions; this helps to ensure the safety and well-being of everybody living, working and visiting the home. We saw checks were made to the premises with regards to fire safety to ensure that people were kept safe.

People told us they were able to make choices about the way they wanted their care to be provided. We found the provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

Systems were in place to help ensure people’s health and nutritional needs were met. People made mostly positive comments about the quality of the food provided in Linden House.

A programme of activities was in place to help promote the well-being of people who used the service. Staff told us and records confirmed they would always try and support people on an individual basis to undertake activities of their choice.

Staff told us they enjoyed working in the service and the managers were supportive and approachable.

To help ensure that people received safe and effective care, systems were in place to monitor the quality of the service provided. Regular checks were undertaken on all aspects of the running of the home and there were opportunities for people to comment on the facilities of the service and the quality of the care provided. The provider also had systems in place for receiving, handling and responding appropriately to complaints.

We saw that work to extend and refurbish the environment was taking place. All the people we spoke with were positive about this development and considered it would enhance the service provided in Linden House.

Inspection carried out on 7 and 8 October 2014

During a routine inspection

This was an unannounced inspection which took place on 7 and 8 October 2014. The service was last inspected in April 2013 when we found it to be meeting all the regulations we reviewed.

Linden House Care Home provides accommodation for up to 40 people who need support with personal care. There is a dedicated unit for up to 12 people with dementia care needs. There were 38 people living in the home at the time of our inspection.

The service had 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 and associated Regulations about how the service is run.

All the people we spoke with told us they felt safe living in Linden House and that the care they received met their needs. They told us there were always sufficient staff on duty to meet their needs. Comments included, “I definitely feel safe here because we are looked after”, “Staff know me and I have choices about what I do” and “Staff are kind and caring”.

Staff told us they had received training in how to protect people who used the service. However, we observed one incident during the inspection which was not recognised by one staff member as abusive and therefore necessary action to protect the person concerned was not taken. This meant there was a risk staff did not understand their responsibilities to report abuse in order to safeguard the health and welfare of people who used the service.

Risk management policies and procedures were in place. However, the completion, reviewing and updating of risk assessments needed improving so that information accurately reflected the needs of people and how they were to be kept safe.

Plans were in place to extend and refurbish Linden House. While we found some improvements could be made to the environment in order to support people with dementia to be as independent as possible and to provide more privacy, the registered manager told us these had already been included in the planned refurbishment of the premises.

There were systems in place to provide staff with support, induction, supervision and training. Staff told us they enjoyed working at Linden House and considered they received the training and support they needed to effectively carry out their role.

Staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. Where restrictions were in place for people we found these had been legally authorised.

People’s health needs were assessed and staff ensured appropriate services were in place to meet these needs, including dieticians and palliative care services. Where necessary, staff provided support and monitoring to ensure people’s nutritional needs were met. All the people we spoke with made positive comments about the quality of food in Linden House.

We observed positive interactions between staff and people who used the service, particularly those people in the residential unit. People told us staff treated them with dignity and respect and were always kind and caring.

Although people who used the service told us they could not recall being involved in reviewing their care plan, they felt the care they received was appropriate to meet their needs.

There were a number of quality assurance processes in place at the home. However, improvements needed to be made tothe way complaints were recorded and responded to. The system for reviewing, updating and auditing care plans also needed to be improved in order to protect people from the risks of unsafe and inappropriate care.

We have identified breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2010. You can see what action we have told the provider to take in the full version of this report.

Inspection carried out on 15 April 2013

During a routine inspection

We spoke with seven people who used the service as well as four visitors. Most people we spoke with were happy with the care they or their relative received. One person told us, �I enjoy being here. I am very satisfied with the service I get�. Another person commented, �I was in a bad way when I came here. Staff have built me up and I feel more secure here�.

We reviewed the care files of seven people who used the service and found evidence that there were procedures in place to ensure their consent was gained in relation to the care provided for them.

We saw that care plans clearly identified the needs of the person and included information on how they wished their care to be delivered.

People we spoke with told us they received appropriate support with their medication. We found evidence that there were effective systems in place for the safe administration of medicines.

We saw evidence that there were effective recruitment procedures in place to ensure that people who used the service were protected from inappropriate staff.

We found there were sufficient numbers of staff on duty to meet the needs of people in Linden House.

We found that suitable arrangements were in place for identifying, receiving and handling complaints for people in Linden House.

Inspection carried out on 12 July 2012

During a routine inspection

People told us they were satisfied with the service provided. They told us they were agreeable to the treatment and support they were receiving at the home. One person commented, �Yes, they always ask me what I want them to do when they are helping me�.

People told us they had no concerns about their care and support. They said they were encouraged to be as independent as possible; Two people told us, �We can get up when we want to. We�re not rushed� and �They do their best to help me�.

People using the service told us they were able to voice any concerns about the service to a member of staff and they felt confident appropriate action would be taken. Two people told us, �I have no complaints� and �If I had a complaint I would tell the staff�.

Two people we spoke with told us there were enough staff on duty to meet their needs. People made complimentary comments about the staff team. One person told us, �They do their best here�.

Three people who used the service told us that they were asked on an ongoing basis if they were satisfied with the care provided in the home. Two people using the service told us that they were involved in residents' meetings, which were held on a regular basis.