We carried out a review of the data available to us about Linden House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Linden House, you can give feedback on this service.
Linden House is a care home providing accommodation and personal care to 27 people aged 65 and over at the time of the inspection. The service can support up to 32 people.
We were assured that this service met good infection prevention and control guidelines.
We found the following examples of good practice
Extensive effort had been made by the home to accommodate visits in a safe way. An outside gazebo area had been converted to enable visits which complied with government guidance. It had become an enclosed space with heating divided into two areas separated by a screen. There were two separate entrances for residents and visitors and the visitor area was designed to be easily sanitised between visits.
Thorough booking in procedures for all visitors had been implemented. This included a health questionnaire, temperature checks and lateral flow tests (LFT) to be completed by all visitors. This was all completed in a designated area at the front of the home prior to any visitor entering the front door. Extensive cleaning rotas evidenced regular sanitising of this area to keep people safe from the risk of spread of infection.
Appropriate zoning had been introduced to the home. This enabled staff to keep people safe and encourage social distancing in communal areas. During a recent outbreak of COVID-19 staff had gone above and beyond to keep people living with dementia safe. This included setting tasks and activities for one resident who would normally visit other residents in their rooms to ensure people isolating remained safe.
Staff were supported with extensive training throughout the pandemic to ensure they were confident with various changes to guidance. This included three training sessions from external trainers and thorough training from internal sources. The registered manager was also keen to promote staff wellbeing support throughout the pandemic. This included regular contact to staff that were isolating due to receiving a positive COVID-19 test and regular staff “catch ups” with the management team.
An extensive list of additional risk assessments had been introduced since the beginning of the pandemic. These included individual health risk assessments for residents and staff. If additional risks were identified then a more in-depth assessment had been completed and changes implemented.
The wellbeing of people living in the home had been prioritised. An example of this was seen with the volume of video calls that had been arranged for relatives to stay in regular contact through periods of lockdown.
The provider had maintained a plentiful supply of Personal Protective Equipment (PPE) throughout the pandemic and was using the government portal to ensure the PPE stock remained at a safe level. There was also an arrangement with other local homes to enable support if ever required.
Thorough cleaning schedules had been implemented in response to the pandemic. This included regular cleaning of high touch areas such as banisters and light switches. Evidence was seen of these high-risk areas being sanitised regularly throughout the day.
The provider was taking part in the regular testing programme and ensured all staff and people living in the home had access to regular testing. This followed guidance and ensured appropriate steps were taken in recording tests in a timely way.
Further information is in the findings below.
Linden House is a residential care home providing personal care to 31 people at the time of
the inspection. The service can support up to 32 people. People’s rooms were situated over two floors and people had easy access to a lift to enable them to move freely between floors. People could move around freely accessing activities of their choosing. The service had three large lounges/sitting rooms and two dining rooms. There was also a well maintained outside space for people to access.
The service has undergone a period of refurbishment and redecoration which has received welcoming praise from people and relatives.
People's experience of using this service:
The service was extremely well-led by a management team who worked closely together to ensure people were at the heart of everything they did. The registered manager routinely went above and beyond to ensure people were well looked after, motivated and provided with innovative methods of care and support.
People told us they were happy living at Linden house. People consistently experienced good care because the service was well-led and organised. The provider's values were shared and practiced by staff who people often referred to as being like family members. One person told us, “They [staff] treat me so well, they do a wonderful job, and this really does feel like home to me.” People had been included in the recent refurbishment works as management had obtained feedback and included people on design ideas. The registered manager told us they were designing the service for the people as this is their home and so involving them in the process was important. Staff felt valued at the service and had recently taken part in a staff appreciation week which also allowed people living at the service to give their thanks and support to staff.
People were supported by staff who promoted their independence as much as possible, and who were creative in their ways of achieving better outcomes for people. People and relatives told us staff were motivated to make a difference and that they made them feel inspired and gave them confidence to make the required changes.
People were provided with a variety of opportunities to participate in activities and events hosted by the service People also had access to a variety of trips out into the community this included trips to do shopping, coffee shops or to visit a local school. The provider had recently staged a staff appreciation week which people were fully involved with and provided positive comments with regards to the care they receive from staff.
People and relatives told us they felt safe because of the quality of care they experienced. The provider took great care when recruiting new staff to ensure they met the values of the service. Staff understood and practised their responsibilities to keep people safe from harm.
People were supported by staff who had the right skills and knowledge to provide care that met people's assessed needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Relatives consistently told us that staff were kind and caring. Staff respected people, treated them with dignity and involved them in decisions about their care. People experienced continuity of care because they were supported by a core team of staff who understood their needs. This meant people experienced care and support that was responsive to their needs. People and relatives reported that they were very satisfied with the quality of care and support they experienced.
Potential risks to people had been assessed and measures put in place to mitigate these. If accidents or incidents occurred, staff took action to reduce the risk of similar incidents happening again. Medicines were managed safely, and staff maintained appropriate standards of hygiene and infection control. Staff supported people to maintain good health and worked effectively with any professionals involved in their care.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was Good (February 2017)
Why we inspected:
This was a planned inspection based on our inspection process.
Follow up:
We will continue to monitor intelligence we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.
Linden House provides personal care and support for up to 32 older people, many of whom may be living with dementia. On the day of our inspection 21 people were living in the home.
There was a registered manager in post. 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.
At our last inspection we found breaches of regulation. At this inspection we found actions had been taken to ensure the regulations had been met and the service had improved.
People’s legal rights were not fully protected as care was not always provided in line with the Mental Capacity Act (2005). Correct procedures weren’t followed when depriving people of their liberty. The provider had taken actions to make improvements following our last inspection, however the improvements had not led to people’s rights being fully protected. We recommended that the provider reviews their MCA assessments and DoLS applications.
People’s medicines were stored and administered safely and staff worked alongside healthcare professionals to ensure that people’s health needs were met. Staff responded quickly to changes in people’s healthcare needs.
Accidents and incidents were recorded and measures were taken to prevent a reoccurrence. Staff routinely carried out risk assessments and created plans to minimise known hazards whilst encouraging people’s independence. Staff understood their responsibilities in safeguarding people and knew what to do if they suspected abuse had occurred.
People told us that they enjoyed the food and we saw evidence of people being provided with choice and also being consulted on food during meetings and reviews.
There were sufficient staff present to meet people’s needs safely. The provider carried out checks on staff to ensure they were appropriate for their roles.
People lived in an inclusive atmosphere in which they had access to a range of meaningful activities and were involved in making decisions about their home. Staff provided care in a way that was personalised and caring.
People’s privacy and dignity was promoted by compassionate staff who knew people well. Staff were trained for their roles and received regular one to one supervision. Care plans reflected people’s preferences, personalities and needs.
Staff felt well supported by the registered manager and had input into how the home was run. Systems were in place to ensure care at the home was of a good quality. People’s feedback was regularly sought and complaints were responded to appropriately.
Linden House provides personal care and support for a maximum of 32 older people, some of whom may be living with dementia. On the day of our inspection 24 people were living in the home.
This was an unannounced inspection that took place on 9 December 2015.
The home had 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 and associated Regulations about how the service is run. The registered manager assisted us with our inspection on the day.
People may not always be receiving safe care and treatment from staff because we observed staff struggling to transfer people from chairs to wheelchairs in an appropriate and safe manner. Staff did not always follow correct and appropriate procedures in dispensing medicines.
Although there were a sufficient number of staff on duty we found deployment of staff could have been better organised to ensure an appropriate number of experienced, permanent staff were on duty during a shift.
Although staff understood their responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards we found the legal requirements in relation to these were not always followed by staff. For example, decisions were made on behalf of people without evidence to show how this had been done.
Staff were not always aware of people’s dietary requirement and we saw people being given inappropriate foods.
People were not always treated with respect and dignity by staff and staff did not take the time to make sure people knew what they were about to do. However, we did see some good examples of kind care from staff.
Care plans were individualised and contained information to guide staff on how someone wished to be cared for. However, this was not always followed by staff and we found some care records lacked detailed information about the person.
We saw evidence of checks carried out by staff to check the quality of care being provided to people. However shortfalls identified from these weren’t always acted on. The registered manager did not always have a good management oversight of the home.
Accidents and incidents in relation to people were recorded and monitored by the registered manager to identify trends. Risk assessments were in place for people for particular issues, such as risk of falls or particular behaviours.
Should there be an emergency in the home, there was guidance in place for staff to follow in order to ensure people’s care was not interrupted and if people needed to be evacuated this would be done in a safe way.
Staff were aware of their role in relation to safeguarding people from abuse and were able to tell us how they would report any concerns they may have. Robust recruitment practices were followed, which meant the provider endeavoured to employ staff who were suitable to work in the home.
Care was provided to people by staff who were trained and received relevant support from their manager. This included regular supervisions and undertaking training specific to their role. Staff were involved in the running of the home as regular staff meetings were held.
People’s health was maintained as staff involved external health care professionals when appropriate.
Visitors were welcome in the home and felt the registered manager was approachable and supportive. People were given information on how to make a complaint and we were told if people had any concerns they would approach the registered manager.
During our inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
We were told that people who used the service were being woken early. It was stated they were up between 5am and 6am. It was also stated there were insufficient staff numbers to meet the needs of the people who used the service. We were also told that radiator thermostats were not working in some rooms which meant some rooms were cold and others too hot.
We visited at 06:00 and found the home to be quiet and peaceful. One person was up and dressed but the carer told us this was because that person thought it was time to be up. Another person was being assisted to get up again we were told it was because they wanted to be up.
The home was clean and tidy and felt warm. We looked around the home and checked many bedrooms and all were warm.
We discussed staffing arrangements with the manager. We were told the home had enough staff to meet the needs of the people.
People who used the service told us staff would ask for their permission before they undertook or helped them with certain tasks. They told us they made choices about their lives. One person told us, 'I choose the clothes I want to wear and the food I want to eat.' Another person told us, 'Staff always asked me if I would like any help. If I need help I say yes, but I like to do things for myself and staff let me.'
People told us they liked the food, they made choices about their meals and they could have a drink or a snack at any time of the day or night.
People told us that the home was always clean and tidy. They told us that they liked their bedrooms and they were pleased with the new refurbishment that had recently been completed. They told us there was plenty of staff on duty and they responded to their call alarms quickly.
People told us they knew how to make a complaint, but they had never had the need to.
We found the service was compliant with the five outcomes we looked at.
Most of the people who used the service told us that they made choices every day. Some of their comments included, 'I choose my own clothes,' and 'I can choose what activities I want to do and the meals I like to eat.'
Most of the people we spoke to could not remember if they had a care plan. One person told us, 'My relative knows all about that and he would have signed it.'
All of the people whom we spoke to told us that they felt very safe living at the service.
People who used the service told us that their bedrooms were nice. One person told us, 'My bedroom is cleaned every day.'