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Inspection carried out on 30 May 2019

During a routine inspection

About the service:

Linden House Care Home is a residential care home. The service was providing accommodation and personal care for 22 people at the time of inspection. People supported included older people, and people living with dementia. The accommodation was spread over three floors which were accessible via stair lift. There were a range of communal spaces available to people on the ground floor and access to a secured garden space.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk.

People’s experience of using the service:

People received a service that was safe. Systems and processes were in place to protect people from the risk of abuse to mitigate risks associated with their care.

Staff had the right training and skills to provide effective care to people. People’s care led to good outcomes.

Staff respected people’s dignity and privacy and promoted their independence.

People’s care and support met their needs and reflected their preferences. People received individualised care and were supported to lead active lives.

Management processes were in place to monitor and improve the quality of the service. The registered manager was dedicated and pro-active in their role to help drive improvements.

Rating at last inspection:

At the last inspection the service was rated Good (19 October 2016).

Why we inspected:

This was a planned inspection to check that this service remained Good.

Follow up:

We did not identify any concerns at this inspection. We will therefore re-inspect this service within our published timeframe for services rated good. We will continue to monitor the service through the information we receive.

Inspection carried out on 1 September 2016

During a routine inspection

Linden House Care Home is a family run care home registered to provide accommodation for up to 23 people, including people living with a cognitive impairment. At the time of our inspection there were 23 people living in the home.

The inspection was unannounced and was carried out on 01September 2016 and 08 September 2016.

There was a registered manager in place at the home, who was also one of the providers. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

At our previous inspection in May 2015, we found that people were not always protected from risks associated with their care, medicines were not managed safely, hygiene standards were not always maintained and staff did not always follow legislation designed to protect people’s rights. The provider sent us an action plan detailing steps they would take to become compliant with the regulations.

At this inspection we found that action had been taken and improvements made in each of these areas.

People and their families told us they felt the home was well-led and were positive about the registered manager, who was also one of the providers. However, the registered manager had a ‘hands on’ approach to running the home, which prevented him from having effective overview and control of the quality of the service provided.

People and their families told us they felt the home was safe. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the providers’ safeguarding policy and explain the action they would take if they identified any concerns.

The risks relating to people’s health and welfare were assessed and these were recorded along with actions identified to reduce those risks in the least restrictive way. They were personalised and provided sufficient information to allow staff to protect people whilst promoting their independence.

People were supported by staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs. There were enough staff to meet people’s needs and to enable them to engage with people in a relaxed and unhurried manner.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessments. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

Staff followed legislation designed to protect people’s rights and ensure decisions were the least restrictive and made in their best interests.

Staff developed caring and positive relationships with people, were sensitive to their individual choices and treated them with dignity and respect. People were encouraged to maintain relationships that were important to them.

People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people, when necessary, in a patient and friendly manner.

Staff were responsive to people’s communication styles and gave people information and choices in ways that they could understand. They were patient when engaging with people who could not communicate verbally and who used a variety of signs, sounds and body language to express themselves. Staff were able to understand people and respond to what was being said.

People and when appropriate their families were involved in discussions about their care planning, which reflected their assessed needs.

There was an opportunity for families to become involved in developing the service and they were encouraged to provide feedback on the service provided at resi

Inspection carried out on 05 May 2015 and 08 May 2015

During a routine inspection

This was an unannounced inspection and took place on 05 and 08 May 2015.

At our last inspection on 16 December 2013 we found the provider was meeting all the expected standards of care.

Linden House provides accommodation for up to 21 people who require nursing or personal care. Care and support is provided to older people, some of whom are living with dementia. The home is an older style property consisting of two floors. Building work is underway at the back of the property to provide a further lounge area, extend the dining room, toilets, a wet room and four en-suite bedrooms. These beds would be used to accommodate people who were currently sharing rooms. At the time of our inspection there were 21 people living in the home.

The owner was also the 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.

People and their relatives felt safe with the support they received form staff at Linden House. Staff received training in safeguarding adults and could identify abuse and knew how to report this. Recruitment processes were robust and included appropriate checks to ensure staff were suitable to work with older people. People and staff told us there were sufficient numbers of staff on duty.

People did not always receive their medicines safely. Storage of medicines was not safe. ‘As required’ medicines did not have clear guidelines when they should be given or a care plan detailing steps to be taken prior to this medicine being given. Staff were not assessed as to their competency to administer medicines. One medicine’s instructions were not adhered to when it was administered.

Overall the home was clean and people told us their bed linen was changed regularly. There were some areas where cleaning was compromised due to age of equipment and maintenance of the building. There was a risk of infection as connecting doors to the laundry and kitchen were left open. Storage of some cleaning equipment was against control of infection guidelines.

Staff received appropriate levels of training to enable them to deliver care. When staff began working in the service they completed an induction programme and worked alongside experienced staff before they could work unsupervised. Staff told us they did not receive regular supervisions.

The registered manager and staff did not have a full understanding of their responsibility under the Mental Capacity Act. Two applications had been made for DoLS authorisations without mental capacity assessments carried out as part of the process. Mental capacity assessments decisions were not documented.

Assessments of people’s needs were made before they moved into the service. Care plans and risk assessments were written based on people’s identified needs. However, not all care plans contained sufficient guidance to meet people’s specific needs. People told us they were involved in reviews of their care plans but the documentation in their care records did not reflect this.

People and their relatives told us the food was good and they enjoyed the choices of meals available. Where people required a special diet and supplements this was recorded and staff monitored their weight and how much food and drink they had.

Access to healthcare for people within the home and to hospital and dentist appointments was good. Health care professionals told us they were involved in supporting people with their health needs and the provider supported them.

People and their relatives had good relationships with staff and said how caring they thought staff were. They said they were able to speak to the staff or registered manager about any problems they had and know that these would be dealt with. Staff showed respect for people. However, we observed where people were receiving treatment from the chiropodist and having their hair done by the hairdresser, these were happening in rooms which had their doors open. This meant people’s privacy and dignity was not being upheld.

There were few activities happening for some people on the days we inspected. People and their relatives had commented on this through feedback questionnaires and had requested more activities. The provider had responded partly to this but there were still a number of people we saw who were not actively engaged in activities during our visit.

The provider engaged an outside specialist to carry out an audit of the quality of the service. This audit had identified areas for improvement which the provider had not responded to with an action plan. Other monitoring systems for health and safety and maintenance checks were occurring regularly.

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

Inspection carried out on 19 December 2013

During a routine inspection

We spoke with five people who use the service. One person said, "this is my home here and that is just how it feels." Another person told us, "they (the staff) always ask before they do anything for me." We saw staff speaking respectfully with people and finding out what they wanted the staff to do to support them. This showed us people were involved in their care and were treated with dignity and respect.

We observed people during a meal time and saw people were supported to eat their meals where appropriate. One person told us, "this is one of the best dinners I have tasted in ages." Another person said, "this food looks really lovely."

We spoke with seven relatives who were visiting the service on the day of our inspection. One relative said, "they (the staff) always explain everything to my mum and they always knock before entering the room." Another said, "they are on the phone to me as soon as there is even a small problem, so I am aware and involved in any changes that might be needed."

The staff we spoke with had been working in the service for a number of years. They told us they were supported by the provider to attend training and felt they could talk with the provider about any concerns they had. We saw they received regular supervision. A new member of staff told us, "I am enjoying working here and have learned so much in my first week. I am looking forward to working with the service users and getting to know them better."

We looked at six people's care records and saw they were well presented with key information easy to find. The provider audited the records regularly to ensure they were current and fit for purpose. The provider also carried out regular audits of the service to ensure health and safety standards were maintained.

Inspection carried out on 26 February 2013

During a routine inspection

We spoke with four people who use the service, two general practitioners (GP), a community psychiatric nurse, three relatives of people using the service, a social worker, four members of staff and the owner/manager. The people who use the service told us they were happy and found the staff to be helpful. One of the people who use the service told us "it is much better here than the previous home I was in." All people told us they were pleased with the quality and quantity of food. They all said that staff were friendly and helpful.

All of the visiting professionals we spoke with told us they were made to feel welcome when visiting the service and worked well with the staff and the owner/manager. One GP told us "standards of care were good and they could leave instructions for care and know that they would be carried out."

The relatives we spoke with told us they were all happy with the care their relative received. One told us "there had been an improvement in their relative and they were happy and involved in activities." Another told us they were always made to feel welcome by staff and communication was good.

The staff we spoke with had all been working in the service for over four years. They all spoke about how important it was for them to work with the people who used the service and get to know them. We found that people were treated with dignity and respect. The provider was updating the service and changes in decor had a positive impact on people.

Inspection carried out on 6 February 2012

During a routine inspection

People told us that they were happy with the care provided and that they felt safe and well looked after. They were satisfied that the care was tailored to their needs, that it maintained their dignity and privacy and that they were involved in its planning and delivery.

To help us understand the experience of people using the service, we used our Short Observation Framework for Inspection tool (SOFI). This allowed us to spend time watching what was going on in a service and to record how people spend their time, the support they got and whether or not they had positive experiences. Using this, we found that staff had the necessary time and skills to care for people well.

We spoke with six visitors who praised the standard of care given; the needs of their relatives were assessed and delivered satisfactorily without exception.

We also spoke with the District Nursing Team, who felt that the care given was good and that staff at the home would refer people to their services appropriately.

Reports under our old system of regulation (including those from before CQC was created)