We inspected this service on 6 and 7 September 2018 and the inspection was unannounced.

Linden Grange provides accommodation with personal care for up to 35 adults. It is one of three care homes provided by Linden Care Homes Limited. The home has two floors, the ground floor provides accommodation, care and support to up to 23 people and the first floor for up to 12 people. Both floors have communal lounge and dining areas and share enclosed accessible gardens from the ground floor lounge. At the time of this inspection, 30 people lived at the home, some of whom were living with dementia.

A requirement of the services’ registration with us is that they have 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. At the time of this inspection the home had a registered manager in post. The manger in post had become registered with us during August 2018.

We last inspected this service on 31 May 2017 and gave an overall rating of Requires Improvement. There were two breaches of the Health and Social Care Regulations, these related to the safety of the service and how well led the service was.

As a part of this inspection, we looked to see whether the provider had made the required improvements. We found they had, and improvements made by the registered manager and provider ensured people received a safe, effective, caring, responsive and well led service. We gave a rating of Good.

The provider had effective systems to monitor the quality of the service people received and made improvements when needed.

Medicines were stored and handled safely. People had their prescribed medicines available to them. People were supported with their medicines by staff who had been trained to administer medicines safely.

There were sufficient trained staff on shift who had been recruited in a safe way so as to ensure people were not placed at risk of abuse, harm or injury.

Risks management plans described the actions for staff needed to take so that risks of harm or injury to people were mitigated.

Staff on shift met people’s individual needs. People felt well cared for by kind and compassionate staff.

Staff received training and used their skills, knowledge and experience to provide safe, effective and responsive care to people.

Further information is in the detailed findings below.

The inspection took place on 31May 2017 and the visit was unannounced, and carried out by two inspectors.

Linden Grange is one of three homes provided by the Linden Care Homes Limited. The service provides accommodation and personal care for up to 35 older people living with physical frailty due to older age and / or living with dementia. The home has two floors; the ground floor provides care to up to 23 people and the first floor for up to 12 people. Both floors have communal lounge and dining areas and share enclosed gardens accessible to people from the ground floor lounge.

The home is required to have 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 and associated Regulations about how the service is run. At the time of this inspection the home had a registered manager in post, who was on leave at the time of our inspection.

At our previous inspection in July 2016, we identified improvements were required in keeping people safe, in delivering effective care and treatment and in the management of the service. We gave the home an overall rating of requires improvement. At this inspection, we checked whether the provider and registered manager had made the improvements needed. We found sufficient improvements had not been made. We identified a breach in the regulations that related to the management of medicines and in the governance of the service.

The provider’s system for the management of medicines was not always effective or safe. People that lived at the home had their prescribed medicines available to them, however, people that had left after a short stay, had not always had their medicines sent home with them. Checks on medicine records were not always completed and staff did not always have all of the knowledge they needed.

The provider had systems and processes in place to monitor the safety and quality of the service, however, these had not always been effective. The provider and registered manager had not always ensured actions, where risks to people’s safety and wellbeing were identified, were managed effectively to reduce risks of reoccurrence. We found there had been a lack of oversight, from the provider, in relation to the governance of the home.

People who lived at the home felt safe. Risks of harm to people were assessed and actions to minimise those risks were taken by staff. There were sufficient numbers of staff on shift who knew how to safely meet people’s needs. Staff were recruited in a safe way and the provider undertook checks to make sure staff were of good character before they supported people who lived at the home.

Staff received an induction when they started to work at the home and on-going training. People felt staff had the skills and knowledge they needed to care for them. Staff worked within the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. People had choices about what they ate and drank and were referred to healthcare professionals by staff, where there were concerns about any changes in a person’s weight. People were supported to access their GP when they needed.

People were supported by staff who showed a caring and kind approach. Staff showed respect toward people, and encouraged them to make decisions about their day to day care. People felt their privacy and dignity was maintained by staff when they were supported with personal care.

People had individual plans of care which staff told us they read. There were different group activities offered to people and staff also supported people to pursue their individual hobbies and interests and to socialise with others in the home. People had no complaints and said if they did, they would raise them. Meetings with people and their r

The inspection took place on 12 and 13 July 2016. The visit was unannounced on 12 July 2016 and we informed the provider we would return on 13 July 2016.

Linden Grange provides accommodation and personal care for up to 35 older people. The home has two floors; the ground floor provides residential care to up to 23 older people. The first floor has 12 beds, and the provider has a contract with the local Clinical Commissioning Group (CCG) for ten of these beds on a ‘discharge to assess’ plan from a local hospital. These beds are used by older people, discharged from hospital, on a short residential care stay of up to six weeks during which time they will be assessed, by healthcare professionals visiting the home, as to any future care support they may need. At the time of the inspection 33 people lived at the home.

The home is required to have 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 and associated Regulations about how the service is run. At the time of this inspection the home had a registered manager in post.

Linden Grange opened in 2014 and this is their first inspection since their registration with us.

People felt safe living at the home because staff were there to support them when needed. Staff were trained to know what abuse was and how to report any concerns to the registered manager. People were supported to take their prescribed medicines by trained staff. Some risks were assessed but actions were not always put into place to reduce the risk of harm of injury to people. Staff did not have the information available to refer to, if needed, to know how to keep people safe from identified risks.

Staff were trained and had the skills the needed to deliver care and support to people. Staff worked within the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. People had choices offered to them about what they wanted to eat and drink and were supported to maintain their health and, when needed, were referred to health professionals.

People said staff were kind to them and involved them in making decisions about their day to day care and how they spent their time. People said they received care in a way they wanted and everyone had a care plan that gave staff key information about people. There were planned group activities for people to take part in if they wished to do so, access to gardens and a kitchenette people and their relatives could use.

Some systems were in place to assess the quality of the service provided but audits were not always effective. Some people and relatives were asked for their feedback on their experiences of using the service. However, this had not been analysed and actions to improve, where needed, had not been implemented. The provider’s Statement of Purpose did not reflect the range of people living at the home; to include people on a ‘discharge to assess’ plan.