This inspection took place on 16 October 2018 and was unannounced.

Linda Grove is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Linda Grove accommodates up to four people with a learning disability in one adapted building. At the time of our inspection, four people were living at Linda Grove. The care service had been developed and designed in line with the values that underpin the Registering the Right Support, CQC policy and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in place. 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 the last inspection, the service was rated Good. At this inspection we found the service remained Good.

People were safeguarded from avoidable harm. Staff knew about the risks of abuse and avoidable harm and there were suitable processes in place should they need to report concerns. The provider had procedures in place to identify, assess, manage and reduce risks to people's health and wellbeing which were tailored to their individual needs.

There were sufficient staff on duty to keep people safe and meet their needs. Safe recruitment procedures were in place.

Safe medicines management was followed and people received their medicines as prescribed. Staff protected people from the risk of infection and followed procedures to prevent and control the spread of infections.

Staff were supported by regular supervision and an annual appraisal and staff had appropriate training to ensure they had the knowledge and skills to carry out their roles effectively.

Staff supported people to eat and drink sufficient amounts to meet their needs. Staff liaised with other health and social care professionals and ensured people received effective, coordinated care in regard to any health needs.

People’s rights were protected in line with the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People lived in an environment that met their needs.

Staff treated people with kindness, respect and compassion. They were aware of people’s communication methods and how they expressed themselves. Staff respected people’s individual differences and supported them with any religious or cultural needs. People’s privacy and dignity was respected and their independence was promoted.

People received personalised care that meet their needs. Assessments were undertaken to identify people’s support needs and these were regularly reviewed. Detailed care records were developed informing staff of the level of support people required and how they wanted it to be delivered. People were encouraged and supported to engage in meaningful activities according to their individual preferences.

A complaints process ensured any concerns raised were listened to and investigated. Feedback was sought about the service and this was used to drive improvement.

Staff felt supported by most members of the management team but feedback about the registered manager was mixed.

A programme of audits and checks were in place to monitor the quality of the service and improvements were made where required.

Further information is in the detailed findings below.

This inspection took place on 10 March 2016 and was unannounced.

Linda Grove is a residential care home that provides accommodation and personal care for up to four people with a learning disabilities. The accommodation is all on the ground floor. At the time of our inspection four people lived at the service.

Linda Grove 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 2008 and associated Regulations about how the service is run.

The provider had comprehensive care plans in place for all of the people who used the service. We could see that were people's health care needs had changed staff had written how the staff should support them in light of this change. However care plans for two of the people who used the service had not been reviewed since early 2014. Therefore staff may not be supporting or caring for a person appropriately and promoting their independence.

Staff had an understanding of safeguarding and whistleblowing and were confident that any concerns they had would be listened to by the registered manager. One staff member told us, "I would report it to the registered manager and if needed I would contact the local authority safeguarding number." Staff we spoke with were able to give examples of abuse. Such as physical, financial, emotional and how behaviours may change if someone had been or was subject to abuse.

Staff had an understanding of the Mental Capacity Act 2005 (MCA 2005). Staff sought people’s consent and supported people to make decisions that were in their best interests. People told us they were able to make choices about their support. People told us staff treated them with kindness and understanding and we observed positive, caring interactions between people and the staff. Staff supported people to maintain their independence. The registered manager had a good insight into the principles of the MCA 2005 and explained the processes used by the service in meeting their responsibilities.

Recruitment practices were robust and safe. This meant that only people who were suitable to the role were employed. Staff received an induction in the home on commencement of employment. Staff had completed a range of in house training, such as safeguarding, first aid and MCA 2005. Staff had received regular supervision and appraisals to discuss personal development.

The provider had systems in place for recording safeguarding, accidents, incidents and complaints. People knew how to make a complaint. One relative told us, "I know how to complain but I have never needed to."

Policies and procedures were in place to ensure medicines were managed in a safe way. Records were up to date with no gaps or inaccuracies found. A staff signing

sheet was available so records could be audited. Staff were trained in safe handling of medicines and received regular medicine competency checks.

The provider had effective management systems in place to assess and monitor the quality of the service provided to people.

We have made a recommendation that the service reviews and updates all the care plans for the people that use the service.

During our inspection we spoke to three care staff, the new registered manager and the outgoing registered manager. The outgoing registered manager was leaving the day after the inspection and the new registered manager had already taken on responsibility for the day to day running of the home. They are referred to as the manager throughout this report. We met all four of the people who lived at the home and spent time in the communal areas with two of them. We also observed staff supporting people throughout the inspection.

We looked at three people’s care plans and other records relating to the running of the home.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

This is a summary of what we found

Is the service safe?

People were treated kindly and with dignity and respect by staff. Staff were clear they would report concerns to the manager and these would be acted on. There was a system in place for recording of incidents and accidents.

CQC monitors the operation of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) which apply to care homes. The staff and managers we spoke with had a good understanding of MCA and DoLS and their responsibilities in this.

Is the service effective?

The service was effective because people and their representatives were involved in their care planning. Their individual needs and preferences were recorded in their care plans, for example, religious and cultural needs and preferences. We saw people were supported to express their individuality

Is the service caring?

Staff spoke about people in a caring and respectful manner. They knew people well and treated them as individuals. From our observations we saw staff had a good understanding of people’s needs and the support they required. We saw staff were kind in their approaches when supporting people.

Is the service responsive?

People's health and care needs were assessed and care plans were developed to enable staff to support people in the way they chose and needed. Where there were risks associated with people's care and treatment, these had been assessed and actions to reduce these risks had been identified.

Is the service well led?

We saw there were systems in place to monitor and assess the quality of the service, including regular audits by a regional manager. The management were open about the improvements they intended to make and their plans to continue to improve the service. Staff we spoke with said they thought the service was well led.

During our inspection we spoke with two care staff, the registered manager (referred to as the manager throughout this report).

We met all four of the people living in the home; due to their disability and communication needs we were not able to ascertain their views verbally. However, we spent time observing their care and support. We saw that they looked happy and relaxed. We observed staff interacting with them in a friendly manner and treating them respectfully. People who were able to, moved freely around the home and those that needed support were given it.

We saw that care plans were kept under regular review and had been updated to reflect the risks to people during the recent hot weather.

There were processes in place to ensure that medicines were stored and administered safely. Only trained and competent staff attended to this.

Staff told us they enjoyed their jobs and they thought the home was well run. They spoke highly of the manager who they said was “Brilliant” and "Supportive". Staff knew the people they supported well and showed a good understanding of their needs and preferences.

We found that improvements had been made to ensure that people were supported to engage in meaningful activities in and out of the home. On the day of our inspection we saw people being supported in a respectful manner that upheld their dignity and encouraged their independence. The atmosphere was calm and relaxed and people looked happy and well cared for. We saw they were consulted and treated with respect.

We saw that the home was clean and homely and there were processes in place to minimised any risks to people's health. There were robust recruitment procedures in place to protect people. Staff were happy and confident and acknowledged the improvements had made a positive impact on people's lives.

We did not, on this occasion, seek the views of people who use the service.

We did not, on this occasion, seek the views of people who use the service.