We inspected this service on 17 and 22 May 2017. The inspection was unannounced.

The service is one of three homes provided by the Linden Care Homes Limited and provides accommodation and personal care for up to 34 older people over three floors. Thirty-four people were living at the home on the day of our inspection.

The registered manager had been in post for two and a half years. 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 previous inspection in August 2016, we identified improvements were required in keeping people safe, in delivering effective care and treatment, in promoting people’s privacy and dignity, in responsiveness and in the management of the service. We gave the home an overall rating of requires improvement. The provider created an action plan, setting out the actions they planned to take to improve the quality of the service. At this inspection, we checked whether the actions they had taken were effective.

Since our previous inspection the provider had made improvements to the advice and guidance available to staff to enable them to support people with specific health conditions effectively.

The provider had improved the training and support available for staff to ensure there were enough suitably skilled and experienced staff on duty, with the confidence to meet people’s care and support needs safely and effectively.

People were safe from the risks of harm, because the registered manager checked staff’s suitability to deliver care and support during the recruitment process. Staff understood their responsibilities to protect people from harm and were encouraged and supported to raise concerns under the provider’s safeguarding and whistleblowing policies.

The registered manager had made improvements to the advice and guidance available to staff to ensure people’s medicines were managed and administered safely and in line with best practice and in accordance with the Mental Capacity Act 2006.

The registered manager understood their responsibility to comply with the requirements of the Deprivation of Liberty Safeguards (DoLS). They had applied to the Supervisory Body for the authority to restrict people’s rights, choices or liberty in their best interests. Staff’s understanding of their obligations under the Act had improved through the changes the registered manager had made to people’s care plan records.

People were offered meals that were suitable for their individual dietary needs and met their preferences. The provider had made sure staff were given advice and guidance about how to support people to maintain a healthy and balanced diet.

Staff monitored people who were at risk of poor health and obtained advice and support from healthcare professionals to maintain and improve their health.

People were cared for by kind and thoughtful staff who knew their individual preferences for care and their likes and dislikes. The registered manager had taken action to enable staff to protect people’s privacy and promote their dignity in shared bedrooms

People and relatives were involved in planning their care and care plans were regularly reviewed and updated when people’s needs changed. People were satisfied with the care and support they received and told us they had not made any complaints.

People made their own decisions about their day-to-day care and how they spent their time. There were planned and spontaneous individual and group activities for people to take part in if they wished to do so.

The registered manager’s quality audit checks included reviews of people’s care plans and checking that the premises and equipment were suitable, safe and only used for their designated purposes.

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The inspection took place on 18 August 2016 and it was unannounced.

Linden Lodge is one of three homes provided by the Linden Care Homes Limited and provides accommodation and personal care for up to 34 older people; over three floors. At the time of the inspection 32 people lived at the home. Linden Lodge was last inspected by us in May 2013 and we found the regulations were met.

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. Since our last inspection, there has been a change of manager, with the new manager registering with us in December 2014.

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, however guidance was not always available for staff to ensure people received their medicines in a safe way.

Some risks were assessed but actions were not always put into place to reduce the risk of harm or 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 worked within the principles of the Mental Capacity Act 2005 when supporting people with personal care but did not always act in accordance with the requirements of the Act when supporting people with their medicines. 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.

Staff had received some training but did not always feel this gave them the skills and knowledge they needed to effectively meet people’s needs.

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. There were planned group activities for people to take part in if they wished to do so.

Staff promoted people’s dignity where they were able to, but the registered manager and provider had not given consideration to promoting people’s privacy and dignity in shared bedrooms.

Systems were in place to assess the quality of the service provided but audits were not always effective. Risks of cross infection had not been identified by checks undertaken and care plan reviews had not identified where improvement was needed. Feedback was sought from relatives, however people living at the home were not always given the opportunity to give their feedback on the service they received.

We found a breach in the regulation relating to the governance of the home. You can see what action we told the provider to take at the back of the full version of the report.

During our visit to Linden Lodge Residential Home we met with most of the people who used the service. We wanted to see what life was like for people who were living at the home. We spent time talking to seven people who used the service, three visiting relatives, five members of staff and the registered manager. We looked at some of the records kept to support staff in providing the correct care to people who use the service.

People living at the home and their relatives all told us they were happy living at Linden Lodge and they got plenty of choices about their daily living. They all felt there were enough staff to help them and that the staff were “helpful and kind.” One person told us, “It’s a nice place to be. All the staff are nice and I’ve got friends here.” Another person said, “I’m very happy here.” A relative said, “I have complete confidence in the staff because they’re so kind and attentive.”

Staff we spoke with felt confident the care provided to people living at the home was good. They told us they felt well-supported by the manager and deputy manager.

The people and visitors we spoke with did not express any concern about the care they had received. We saw the service had a reliable system for receiving and resolving complaints.

We visited Linden Lodge Residential Home on 16 April 2012 and we met with each person using the service and spoke to four people in more detail about their care. We met and spoke with five relatives and with four members of staff.

People using the service told us they liked living at the care home and felt well cared for. One person told us, “Staff are good here, everything is nice.” Other people told us their beds were “really comfortable.” and how much they liked the staff. Some people were not able to talk to us about their care because of their dementia, 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. One person told us, ”The food is excellent.” We observed lunchtime was relaxed with people using the service and staff sitting down together to eat their lunch. People’s dietary needs were detailed in their care plan and the cook told us what these were when we asked.

We observed people being supported with their medication and we noted this was done sensitively and discreetly when other people were present. Staff explained what the medicine was and gave people the time they needed to take their medication.

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. When they had a concern they told us they were able to talk to the manager and staff about this and were confident it would be “sorted out.” Relatives told us they were particularly pleased with the “Family Room” facility where they could meet in private with their family member and make a drink or small snack if they wished.