This inspection took place on 22 May 2018. The inspection was unannounced.

Linden Lodge Nursing Home is a care home registered to provide nursing care and accommodation for a maximum of 75 people. 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. The home is situated in rural North Warwickshire and the accommodation is on three floors. The ground floor provides residential accommodation for people living with dementia. The first floor provides accommodation for people requiring nursing care. There are four bedrooms on the second floor, predominately for people who receive residential care.

We last inspected Linden Lodge Nursing Home in February 2017 when we rated the service as 'Requires Improvement' in the key question of safe and well-led. We found risk was not always mitigated, medicines were not always managed safely and quality monitoring checks were not consistently effective. This meant the overall rating of the service was 'Requires Improvement'. At this inspection we found improvements had been made and the service is now rated as 'Good' overall.

The service has a registered manager. This is a requirement of the provider's registration. 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 home was well-led by an experienced management team who were enthusiastic about the service and committed to providing good standards. Staff received appropriate training and support, understood their roles and responsibilities and had confidence in the management team. The provider and registered manager used their own quality assurance checks, together with feedback from people, staff, relatives and visitors to the home, to identify where improvements in service provision were required.

There were sufficient nursing and care staff to provide the support and stimulation people required to promote their wellbeing and to keep them safe. People felt safe with staff who understood their responsibilities to protect people from avoidable harm, neglect and discrimination. Any risks to people’s health and wellbeing were identified in their care plans and plans put in place to minimise those risks. People were protected from environmental risks within the home.

People received good healthcare and were referred to external healthcare professionals when a need was identified to maintain their health. Staff who gave people their prescribed medicines demonstrated a good knowledge and understanding of how to do this safely and following best practice. The provider had a strong commitment to supporting people and their relatives before and after death, and the service was accredited under the Gold Standards Framework (GSF).

People's ability to make decisions was assessed in line with the Mental Capacity Act 2005. Staff offered people choice and respected the decisions they made. Where restrictions on people had been identified, Deprivation of Liberty Safeguards authorisations were in place to lawfully deprive people of their liberty for their own safety.

Staff showed compassion, encouragement and empathy towards people and ensured people’s views and opinions were heard. Staff were interested in what people had to say and liked to find a common interest to generate discussions. People were offered opportunities to engage in, and experience, different and stimulating activities both inside and outside the home. Activities offered opportunities for social engagement and supported people’s mental, physical and emotional wellbeing.

People were encouraged and supported to eat and drink enough and

We inspected Linden Lodge Nursing Home on 22 February 2017. The inspection visit was unannounced.

Linden Lodge is divided into two separate units over three floors and provides accommodation, personal and nursing care for up to 75 people. Some people at the home were younger adults, other people were elderly. There were 69 people living at the home when we inspected the service.

A requirement of the service’s registration 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 and the associated Regulations about how the service is run. There was an experienced registered manager in post at the time of our inspection visit. We refer to the registered manager as the manager in the body of this report.

Care records were not always up to date to ensure risks to people who used the service were identified and action taken to keep people safe. Medicines procedures and protocols did not always describe clearly how people should receive topical medicines.

Quality monitoring procedures did not always identify where the provider needed to make improvements, for example, in the area of topical medicines management, care records and manual handling techniques. Where issues had been identified the manager took action to address them to continuously improve the service.

We received mixed feedback about whether there were always enough staff at Linden Lodge. On the nursing unit we received feedback that staffing numbers were not always sufficient to ensure people were cared for safely and effectively, especially at night. The manager had changed some staffing levels on the unit, and was introducing quality assurance and monitoring measures to review the number of staff allocated to each unit at the home, to check staffing was adequate at all times.

Staff received training in safeguarding adults and understood the correct procedure to follow if they had any concerns. They were confident if they raised concerns with their manager these would be investigated appropriately.

All necessary checks had been completed before new staff started work at the home to make sure, as far as possible, they were safe to work with the people who lived there. People were supported by a staff team that knew them well. Staff received training and had their practice observed to ensure they had the necessary skills to support people.

People were supported to access healthcare from a range of professionals inside and outside the home and received support with their nutritional needs. This assisted them to maintain their health.

The provider, manager and staff understood their responsibilities under the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure people were looked after in a way that did not inappropriately restrict their freedom. The manager had made applications to the local authority where people’s freedom was restricted, in accordance with DoLS and the MCA requirements. Decisions were made in people’s ‘best interests’ where they could not make decisions for themselves.

Staff knew people well and could describe people’s care and support needs. Staff treated people with respect and dignity and supported people to maintain their privacy and independence.

People were supported to take part in social activities and pursue their interests and hobbies. People made choices about who visited them at the home, which helped people maintain personal relationships with people that were important to them.

People knew how to make a complaint if they needed to. Complaints received were investigated and analysed so that the provider could learn from them. People who used the service and their relatives were given the opportunity to share their views about how th

The inspection of Linden Lodge Nursing Home took place on 27 May 2015 and was unannounced.

The home has two units. The Acacia unit provides nursing and end of life care to people. The Orchard Unit provides residential care to older people and people living with dementia. The home can accommodate a maximum of 75 people. On the day of our visit, 70 people were living in the home.

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 2008 and associated Regulations about how the service is run.

Staff had the skills, experience and knowledge to work well with people who lived at Linden Lodge. There was sufficient staff on both floors to meet people’s care needs safely and effectively.

People received their medicines as prescribed. Medicines were ordered, stored and disposed of safely.

The premises and equipment provided, supported people to live safely.

Staff listened and responded well to people’s needs, requests, likes and dislikes. Staff were caring and enjoyed the company of people they cared for. Both organised and daily activities reflected people’s interests.

People were provided with sufficient to eat and drink and people’s individual nutrition needs were well supported. People enjoyed the food provided. Where changes in people’s health were identified, they were referred promptly to other healthcare professionals.

People received good end of life care from a compassionate and knowledgeable staff team. The home was accredited with the Gold Standards Framework for palliative care.

Staff respected and acted upon people’s decisions. Where people did not have capacity to make informed decisions, ‘best interest’ decisions were taken on the person’s behalf. This meant the service was adhering to the Mental Capacity Act 2005.

The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and had followed the advice of the local authority DoLS team.

The management team were supportive to staff and worked with them to provide good standards of nursing and dementia care. There were effective management systems to monitor and improve the quality of service provided.

We spoke with seventeen people, three visitors, seven members of staff, as well as the manager and registered provider. We also looked at some of the records kept to support staff in providing the correct care to people who use the service.

People told us that staff respected their privacy and dignity and they confirmed they were involved in the way their care was provided. A visiting family member told us, “I observe the staff treating all the residents with dignity and respect.”

People and their visiting family members told us they were happy with the care and support provided. One person said, “Staff really are caring, patient and treat me as a person.” A visiting family member commented, “Our entire family are more than happy with the care mum receives here.”

We looked at care records for four people and found that these contained guidance for staff on how to meet their needs. We saw that people's needs were reviewed regularly.

Staff told us they received excellent support from the management team. A staff member told us, “We get a lot of support on a personal level as well as a professional level.”

Our observations throughout the inspection demonstrated that staff engaged in a positive way with people. We saw when people needed assistance staff were on hand to help them.

There were systems in place to monitor and assess the quality of the service, which included gathering the views of people living in the home and their relatives.

When we visited Linden Lodge nursing home we met with most of the people using the service and spoke to five people in more detail about their care. We met and spoke with four relatives, four members of staff and the registered manager. People using the service told us staff were kind and they felt well cared for. One person told us, "I like it here. I have my own bedroom and it is kept very clean." Another person told us, "I have settled into the home very well, I am looked after and I can have my friends visit me." Some people were not able to talk to us about their care because of their complex needs, however when we asked them if they were comfortable they smiled and nodded.

We asked people about the food being served to them and they told us they enjoyed their meals and there was always a choice. They told us, "The food is very good" and "There is always plenty to eat."

We saw people's bedrooms were clean, warm and well furnished. People had brought some personal items with them into the care home and this made their rooms "homely".

We asked relatives about the care provided to their family and they each told us that the care delivered to people was good. They told us, "Staff work hard. We liked what we saw when we came to look round this home" and "Staff ask what you think and listen to you." Relatives told us they could talk with the manager and were confident any concern they might have would be looked in to.