Linden Grange

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last inspection we rated this key question good. At this inspection the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The provider assessed people’s needs where possible before they moved to the home to ensure their needs could be met. Initial assessments detailed people’s life history, summary of needs and details of health conditions to support staff in providing effective care. Records showed families and people were involved in these plans. The provider had introductory meetings to help ease people’s transition into the service. One staff member said, “People can visit and decorate their room before they move in. People may have the option to take part in a mealtime before making decision.”

A relative told us they had the opportunity to view the home before their relative moved in and decorated their relative’s room to their preference. They said, “They let me bring all of their important things which mattered to them.” The relative said by enabling them to do this, “It made it feel like [Person’s] home, I bought their ornaments, so this replicated their old living room.” Some relatives said they were involved in reviewing their family member’s care plans. Relatives we spoke with said they were updated with any changes in people’s needs. One relative said, “We look at [person’s name] likes and dislikes, and what matters to them.”

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

People told us they got enough food and drink when they wanted. Comments included: “The food at lunch time is excellent and well presented. The chef is of a good standard”, “The food is nice we have choices” and “If we are hungry, they would always get you something.” One relative said, “They would just ask for food and it would appear.” Another person’s family member joined their relative for lunch every day. This comforted the person and encouraged them to have enough to eat and drink.

We saw staff offering people choices during mealtimes. For example, people freely choose where they wished to sit and eat staff respected people’s choices.

Where people were at risk of choking, staff had appropriately referred them to health professionals to ensure risks were identified and managed to keep the person safe. Details of people’s dietary needs such as a diabetic friendly diet were recorded and followed.

Nationally recognised clinical tools were used to assess and monitor people’s needs to help ensure their needs were met. For example, a nutritional screening tool used to identify people at risk of malnutrition.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

A relative said, “There’s a good relationship between this place and the GP practice.” The relative said this meant their family member had access to the professional health care they needed.

We saw staff teams work together for example during lunch and when activities were being undertaken. One staff member said of the other staff, “They help me with anything.” Staff said there was effective communication and coordination with external partners and management staff. One staff member explained how the registered manager met with each individual team.

External professionals shared they received detailed information from the staff team when required. One healthcare professional told us, “The staff communicate well, expressing any [people’s] needs and concerns in a timely manner.”

The provider had made timely referrals to other health and social care professionals. The outcome of appointments had been recorded and acted upon as required. There were weekly visits from the local GP where they carried out regular checks with people. People told us they were supported to see a doctor as soon as possible if they requested one.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control.

People were encouraged to take part in exercise classes to support their health and wellbeing. We saw staff and people taking part together. People told us, “We have keep fit, singers in, and lots of other activities going on.”

Staff supported people to live healthier lives, and where possible, reduce their future needs for care and support. People were supported to access healthcare professionals to help maintain their physical needs and their wellbeing. This included visits from opticians to support eye care and chiropody for foot care.

People told us they were able to access health professionals when needed. One person said, “The GP will come if needed. I see the chiropodist and the hairdresser.” A relative said “The GP is called if needed, [Person] had a water infection, and the GP came out the same day. They see the chiropodist; hairdresser and the opticians are due.”

External professionals told us staff knew people well. Comments included: “All the staff know their residents really well, which is vital when understanding if the needs have changed for the resident and what their normal presentation is.I am then able to decide on the appropriate care/ treatment required for this resident”,“I always have confidence that any care advice is followed up on” and “Staff have a very good understanding of individuals health and wellbeing needs. This appears to be true for staff at all levels.”

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

People had monitoring charts in place where this was an identified need. For example, one person needed to be repositioned regularly to prevent them from developing sore areas on their skin. Records showed repositioning was being completed by staff at the required times to manage people’s skin integrity.

One external professional told us staff followed their instructions and completed monitoring checks where required for people. One professional said, “Staff follow the advice I give to them, for example encouraging legs to be elevated due to swelling or bedrest in an afternoon. I will at times ask them to complete blood pressure readings and these are always ready for me to review on my next ward round.”

For people who required pressure relieving equipment to prevent damage to their skin, we found the equipment was available and had been maintained to meet people’s individual requirements. This is important for preventing and treating wound care or for people who have limited mobility. Where people required their blood levels monitoring, we saw this was done before administering medication.

The provider respected people’s their rights when delivering care and treatment, however the documentation in relation to capacity assessments and best interest decisions needed to be developed further.

People’s capacity to make their own decisions had been considered and mental capacity assessments had been completed. However, mental capacity assessments contained limited information about how people had been supported to understand the decision to be made. This was important because capacity assessment did not demonstrate how people had been fully involved in the decision.

Where decisions had been made which were in the person’s best interests, this had involved people who knew the person well such as a family member.

People told us they were involved in making day to day decisions about their care. Comments included: “I can and do make my own decisions” and “I do my own personal care; they help me to go into the bathroom and are there if I need them.”

Staff demonstrated a good understanding of respecting people’s wishes and decisions this included when a person lacked mental capacity.