Archived: Linden House

Linden House is registered to provide accommodation and care to six people who have a learning disability and autistic spectrum condition. At the time of this inspection there were three men living in the home. The provider planned to close the home and informed us that the three people would be moving on to new places by the end of July 2017.

There was no registered manager at Linden House at the time of this inspection. 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 previous registered manager had left in January 2017 and there was an acting manager in place since then, who has applied for registration with the Care Quality Commission.

This was a time of uncertainty for people at Linden House due to the planned closure. People were moving to new places and two people had clear transition plans to help them move from one home to another. The third person did not have a written transition plan in place but had been assessed as needing a short transition period which would start in two weeks.

Regular health and safety checks took place and the senior staff carried out monthly audits of medicines, care files and the building to ensure the environment was safe and safe care provided. Due to the planned closure of the home there had been no deep cleaning or decoration so the environment was safe but not in as good condition as at the previous inspection. The garden was in a poor condition and had not been kept safe for people to use over the summer. The manager addressed this as soon as we raised this concern.

People were supported by an experienced staff team who knew them well. Their relatives said they were happy with the care provided.

Staff supported people to keep safe and helped them with their medicines, personal care and leisure activities. Staff supported people to go to health appointments and had supported one person during a hospital stay in the last year.

The manager and staff were supported by a provider manager from Haringey Learning Disability Partnership who supervised the manager, provided advice and support to staff and checked that the home was providing a good service.

The London Borough of Haringey owns and operates Linden House. The service provides accommodation and personal care for up to six people with learning disabilities and autistic spectrum disorders. At the time of inspection there were four people living at the service.

There was a registered manager at the service; however they were not able to be present at the time of inspection as they were on planned leave from the service. 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. Because the registered manager was unavailable during the inspection visit we talked with the team leader and the head of Haringey Learning Disability Partnership throughout our visit. Following the visit we spoke with the acting manager in the registered manager’s absence.

We found that although people had person -centred plans that identified individual activities there were not enough staff currently to take people out into the community on a regular basis.

Relatives of people using the service told us they felt their family members were safe at Linden House and that they were “Really happy with the care provided.” We found the provider had systems in place to manage safeguarding matters and medicines, which helped ensure people's safety. Care plans helped address safety risks identified for individuals. The staff team could demonstrate they were knowledgeable about the people living in the service and knew what steps to take to keep people safe.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). We found the management had a good understanding of MCA and DoLS legislation. DoLS were applied for appropriately and applications were kept under review.

Relatives said staff were caring and knew their family member well. Staff we met approached people in a friendly manner and used appropriate communication techniques to encourage people to interact with them. We saw staff were respectful knocking at bedroom doors before they entered and understood the need to give people time to have their own space.

Each person had a person-centred plan that was kept under review. Care planning responded to the diverse needs of the people using the service.

The service encouraged people to undertake activities they enjoyed. There was evidence of good leadership. This included regular auditing of processes such as care records and medicines to ensure the correct procedures were being adhered to. Staff received regular supervision, appraisal and team meetings in support of providing appropriate care to people.

The service is due to close, for which there was evidence of consultation with people using the service and their relatives. The service was working closely with advocacy services, health, and social care professionals to ensure people had a smooth transition from the service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 18 Staffing

You can see what action we told the provider to take at the back of the full version of the report.

One relative told us "I am happy with the support provided" and, in response to a question about the quality of the home's management, "They get in touch with anything." Another said, "I am happy with what's going on."

We found that people who used this service experienced support that met their needs and protected their rights. Peoples' needs were being met in an individual way and risks were identified and documented.

People were supported to have adequate nutrition and hydration and food and drink was provided in a person-centred manner. Staff were sensitive to peoples' cultural needs and choices.

The provider operated effective systems to assess the risk of and to prevent, detect and control the spread of health care associated infections. The service was clean and well maintained.

People who used this service were not at risk of harm from unsafe or unsuitable equipment. All the equipment we saw was in good working order.

Suitable recruitment procedures were in place. Staff spoke with and about people who used this service with respect.

Records were accurate and fit for purpose, were held securely and remained confidential.