This inspection took place on 23 March 2017 and was unannounced.

Linden House is registered to provide accommodation with personal care for up to 16 older people. There were 15 people living in the service on the day of our inspection. The service provides care and support for older people, with a range of medical and age related conditions, including mobility issues and dementia.

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 service was last inspected on 16 and 17 November 2015, when they were rated as Requires Improvement. We asked the provider to send us an action plan to show how they intended to improve the service, and they did this. At this inspection, we found improvements had been made, and the service now met all requirements of the relevant regulations.

People’s medicines were managed safely. There were procedures in place to ensure medicines were safely stored, administered and disposed of.

The provider had a system of ensuring new staff participated in an induction which included a period of shadowing an experienced staff member. New staff completed The Care Certificate as part of their induction.

The provider ensured staff received training relevant to their roles and responsibilities. Staff felt supported by other staff members. There were enough staff available to support and respond to people’s needs in a timely manner. The provider had recruitment procedures in place and employed new staff once appropriate checks had been completed.

People’s care plans and records were updated and provided staff with the information needed to meet people’s needs. People and their relatives were happy with the care and support provided and everyone felt their individual needs were being met.

Staff and the provider were able to explain to us how they maintained people’s safety and protected their rights. Training was provided in relation to The Mental Capacity Act (2005), Deprivation of Liberty Safeguards (DoLS) and safeguarding. Appropriate referrals for authorisation to the DoLS team had taken place.

Staff supported people to maintain good health and have access to the appropriate health professional. People’s nutritional needs were met; special dietary needs were catered for.

Staff knew people well and were aware of the importance of treating them with dignity and respect. Staff were kind, caring and compassionate; people’s self-esteem and dignity was promoted and staff supported and encouraged them to remain as independent as possible.

People’s care plans contained information to assist staff to meet their needs. People’s individual care plans were reviewed to ensure they received the care and service they required. People felt listened to and said their individual needs were understood and met by staff. People were given information on what to do if they had any concerns or complaints.

The provider had processes in place for monitoring the quality of the service people received. There were clear arrangements for the day-to-day running of the service. The provider understood their role and responsibility for providing people with a safe and effective service.

This inspection took place on 16 and 17 November 2015. On the first day our inspection was unannounced, on the second day the provider knew we were coming.

Linden House provides care and accommodation for up to 16 older people. On each day of our inspection there were 15 people using the service.

The home had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager is also the provider.

People who used the service and family members told us they were satisfied with the standard of care at Linden House.

Staff treated people with dignity and respect and helped them to maintain their independence by encouraging them to remain active where possible.

Care records showed that people’s needs were assessed before they moved into Linden House.

Staff training was up to date and staff received regular supervisions and appraisals which helped them to provide effective care to people who used the service.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service.

We found three instances where the provider was not meeting the requirements of the law.

The provider did not consistently follow their own policy to ensure staff were safely recruited.

The provider was not fulfilling their responsibilities with regard to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

The provider’s quality assurance system was not always effective in identifying shortfalls within the service nor in identifying what action, if any, had been taken in response.

You can see what action we told the provider to take at the back of the full version of the report.

Linden House is a care home for up to 16 older people some people may have dementia. There were 15 people using the service with one person in hospital. We spoke with six people, two staff and two relatives. The registered manager is also the provider of the service and is in daily charge of the service and because of this is able to make decisions when needed. During our inspection we wanted to understand people’s experience of the service they were using. We did this by spending time sitting and talking with people, observing the way staff responded to them, reading care records about their care and speaking with staff about people’s needs.

Our inspection on 20 December 2013 found people’s medicines were not stored or administered safely to people at the home. During this inspection we found the medication management of medicines had been improved.

Is it Safe?

On entering the premises we noticed that it was not clear to visitors as to the entrance to the property. The provider may wish to make this clearer for visitors. We looked at the suitability of the environment to ensure people lived in a home where the décor and environmental standards were appropriate. We found the home was clean, safe and well maintained. We spoke with six people who all told us they felt safe in the home. One person told us “Everyone tries to help you” and another person said “Staff are around when you need them and this makes me feel safe”.

Another person told us there were enough staff on duty when they needed them and said “If I ever have to wait for assistance I find staff are always pleasant and helpful”. This meant people were supported by staff who could meet their needs.

We looked at how people were supported with their medication and found people were appropriately supported and medications were administered and stored in a safe way.

The Mental Capacity Act 2005 (MCA) is a law providing a system of assessment and decision making to protect people who do not have capacity to give consent themselves. We were told by the manager there was no one who needed a Deprivation of Liberty Safeguard. This is where a person is restricted of their freedom and considerations are made in the person’s best interest.

Is it Effective?

Relatives who spoke with us told us people were well cared for and they were contacted by staff about people’s changing needs. One relative told us “I find the staff to be considerate and respectful to my parent. My parent’s physical and emotional needs are met by a supportive staff team who can provide care to meet their needs. My parent could not be happier. I remember when we first visited the home we felt it was the right place for my parent. It was small and homely and my parent has a lovely room. We couldn’t be happier everything is good about the home”.

Is it Caring?

One person described the staff as being caring and added “I am quite happy with the way that I’m looked after”. Another person said “I have no complaints and I am well cared for”. Throughout the day we observed staff interacting in a positive way with the people using the service. Staff were attentive and responsive ensuring that people’s needs were met.

Is it Responsive?

One person told us “When I am not well staff will contact the doctor or nurse to see me. I have my eyes checked each year or when I need this. We met a physio therapist who was making an assessment to help a person at the home with their posture. This meant that when people needed the help of other professionals they were contacted as appropriate.

Is it well led?

One person told us “I can do many things for myself and I see staff supporting other people when they need them”.

One family member explained “When I visit I find that activities have or are taking place. I have seen a number of different activities at the home they include drawing, painting, doing quizzes together and pot planting. My relative takes part and really enjoys doing so”.

We saw different methods were employed to monitor the effectiveness of the service. This meant people who lived at the home and staff who supported them were provided with an environment that allowed them to live and work safely.

This inspection was unannounced which meant the provider and the staff did not know we were coming. Linden House supports older people who may have a dementia related condition. There were 14 people in residence when we undertook our inspection. We spoke with six people living in the home, one visitor, two staff on duty, a visiting doctor and the registered manager.

Overall people told us they were happy with the care they received and staff were responsive to their needs. One person told us, “I am happy I don't have any worries.”

People using the service had care records which recorded how they wanted to be supported. The information we read in the care records matched the care, support and treatment we saw being delivered to people.

People told us they could make choices about their food and drink. We saw people were provided with a choice of food and refreshments. Snacks and drinks were available throughout the day.

We checked to ensure medication was stored and administered in a safe way. We found medication management needed improvement.

We looked at the suitability of the environment to ensure people lived in a home where the décor and environmental standards were appropriate. We found the home was clean, safe and well maintained.