Linden Grange

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last inspection we rated this key question good. At this inspection the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 69 (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 had a proactive and positive culture of safety, based on openness and honesty.

People and their relatives told us safety incidents such as people falling or other accidents were reviewed. A relative told us “I am always instantly told if anything happens.” Another relative said, “Staff will call me if they need to regarding [Person’s] care or if they are concerned.”

Staff listened to concerns about safety and investigated and reported safety events. One staff member told us “[Registered manager] will share details of anything we need to change. She does share lessons learned.”

Records showed when accidents and incident were reported by staff, action had been taken to reduce the risk of them reoccurring. This included monitoring incidents for trends and patterns. Processes were in place to communicate any learning across staff teams. This helped to identify and embed good practice.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People had hospital packs which were sent with people to hospital. These contained important information so if a person required external medical treatment, a summary of their needs including communication, health mobility and medical records could be shared. Staff told us where people returned from hospital further checks were completed. For example, if there had been any changes to their needs, or prescribed medication, these were updated onto their electronic care planning system. This is important so staff can provide safe, consistent and appropriate support to people. However, we found one person who may benefit from having a hospital passport did not have one in place. A hospital passport is a document which helps professionals provide the right support and make reasonable adjustments for people. Hospital passports help to ensure care is person centred and assists people to avoid feeling distressed or confused during appointments and hospital stays. We shared this information with the registered manager who assured us one would be put in place.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People told they felt safe living at Linden Grange. Comments included: “I feel safe as all is being done to look after me” and “I feel safe as the people around me are nice and they work hard.” Relatives told us their loved ones were treated well. One relative told us, “I got so lucky with finding this home, every care home deserves to be like this one, this is the benchmark.”

Staff had completed safeguarding training and demonstrated they understood their responsibilities in safeguarding people.

A healthcare professional who regularly worked at the home told us staff were committed to ensuring people remained safe. One professional said, “I would be comfortable with the home looking after my loved ones.”

Where people had restrictions associated with their care, this was recorded in their care plans and applications had been made to the authorising authority for a Deprivation of Liberty Safeguards (DoLS). The provider had made appropriate referrals where people were potentially being deprived of their liberties.

The provider had processes in place to communicate any safeguarding concerns to other organisations and knew their responsibilities to help to keep people safe.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People had been assessed for risks associated with their care such as diabetes, continence care and skin integrity. Where a person had an identified area of risk, control measures had been put in place to reduce these risks. For example, those people with diabetes needed to have their blood sugar levels monitored. Records showed the expected blood sugar ranges for people and signs and symptoms to look out for that would indicate any concerns.

We found that not all care records informed staff how to keep people safe where people had behaviours that were communicated through their emotions and distress. Positive support behaviour plans (PBS) were in place to guide staff to positively distract people if and when they were anxious, but these did not always detail people’s individualised distraction techniques. Where people had become distressed staff had not always recorded how they supported the person. Records were not analysed to help understand potential triggers for people’s individual needs. Despite this, staff we spoke with told us the distraction techniques they would use to support people and felt confident to do so. During our inspection we saw people become distressed and staff did meet people’s emotional needs. The registered manager assured us care records would be reviewed and said they had recognised this was an area of improvement. Further positive behaviour support training had already been booked for staff for the 13 16 and 20 October 2025.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

We found some free-standing wardrobes were not secured to the wall. This presented a risk to people's heath as unsecured wardrobes could fall onto people and cause them harm. We raised this with the registered manager who had the wardrobes secured at the end of the first day of inspection. Some people had oil filled radiators, the risk assessments needed some further information such as the control measures to manage risks arising. The registered manager assured us this would be updated.

People had the choice to bring items from their home. Portable appliance testing (PAT) items had been completed.

Environmental checks were completed regularly. These included gas and electricity checks which helped to ensure people remained safe.

People had personal evacuation plans in place to support staff and the emergency services in the event of a fire or emergency situation. These reflected people’s support needs in the event of a fire. Staff had been trained in how to respond in the event of a fire and knew how to support people.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

People felt there were enough staff to support them. Comments included: “There is enough staff to look after us” and “The staff seem well trained and know what they are doing when they look after me.” Some relatives felt there were not enough staff to meet people’s needs, but we saw people did not have to wait long if they wanted support from staff. Relatives told us staff had the skills and experience to provide good care to people. One relative said, “They have high standards.”

Staff spoken to felt there was enough staff to meet the needs of the people in the home. One staff member said, “[Senior care staff] always help out on the floor to help us out. There is enough staff.” We observed staff met people’s needs in a timely way.

The provider ensured staff had access to additional training where this was required to meet the needs of people who used the service. They worked with health professionals such as district nurses and dietetic services to provide further training to staff in relation to health conditions such as diabetes and dietary advice.

The provider completed the necessary recruitment checks to ensure staff were recruited safely. The provider held regular staff team meetings. Staff had the opportunity to discuss and understand changes in the service and good practice. There was some staff overdue supervisions and appraisals. However, staff we had spoken to raised no concerns around this and shared there was an open door policy and they could approach the manager whenever needed. The registered manager told us, “I am planning to have these done by December 2025. I do some informal chats and supervisions and recognise I need to record these.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The home was clean. One person said, “Everywhere is clean and tidy.” Another person said, “They clean every day; my room is always clean. Sometimes I have to tell them that it doesn’t need it, but they clean anyway.” One relative told us “[Person’s] room is spotless.”

Staff wore personal protective equipment (PPE) when required to prevent the spread of infections. Staff had a good understanding of Infection Prevention and Control (IPC) and gave examples showing how they varied the way items were stored and disposed of to reduce the likelihood of the spread of infections. Staff undertook annual training on IPC so they could develop and refresh the skills and knowledge required to manage risks associated with the spread of infections. Staff confirmed they had access to the consumables required to clean the home and manage any infectious outbreaks. For example, foggers. (Fogging is a process of disinfecting the environment or equipment using a machine which generates tiny droplets of a chemical which travels through the air and lands on surfaces).

Improvements were needed to ensure people’s medicines were always managed safely. Some people received their medicines via a transdermal patch to provide pain relief which was applied on their body. There was not always clear guidance for staff on where to apply this. This was important to ensure the patch was rotated and did not cause any negative reaction on the person’s skin. There was a system in place to show the site application and removal of the previous patch. However, these were not always completed which meant staff may not apply the new patches safely, in line with the manufacturer’s instructions. The registered manager assured us they would review their systems for managing the application of transdermal patches.

One person was supported with eyedrops. Staff had recorded the date of opening as required they were all stored in the fridge as appropriate. However, the date on 2 of the 3 bottles opened exceeded the timescales stated on the bottles. Two of the used bottles had not been discarded in line with the manufacturers instructions. Keeping all 3 bottles in the fridge meant staff could administer the wrong eyedrops in error which increased the risk of the person developing an eye infection. The registered manager assured us the medication would be safely discarded.

When supporting people with the application of external medicines, such as creams and ointments, topical medicine administration records (TMARS) and body mars were not used. This is important so staff know where to apply the medicine on the body and they are applied to the frequency as prescribed.

Medicines prescribed ‘when required’ (PRN) protocols were in place but they did not always include clear guidance for staff on how to support people with these medicines. This meant staff may not have a consistent approach to the administration of this type of medicine to fully support a person’s needs.

However, when we checked the MAR charts there was no gaps to suggest people missed their medications and people we spoke to raised no concerns around their medicines. One person said, “They never forget to give me my medication.”

A health and social care professional told us staff consistently and promptly communicated any changes in the medicines prescribed. A health and social care professional said, “Medication is consistently ordered ahead of time to prevent any shortages for residents.”

Processes were in place to ensure timely ordering of medicines. There was a medication policy in place.