This inspection took place on 7 November 2018 and was unannounced. We previously inspected the service on 4 and 6 September 2017 and we rated the service requires improvement. This was because the service did not always ensure good infection control practices, regular involvement of people and their relatives in the running of the home, and there was no sustained evidence of regular audits taking place.

During this inspection we identified the home had made improvements. The home was clean and in a good state of repair. Appropriate infection control practices were followed. The home had undertaken regular involvement of people and relatives in the running of the home. Regular audits were undertaken.

Linson Court is a ‘care home’. People in care homes receive accommodation and nursing or 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.

Linson Court provides nursing care and support to people, some of whom are living with dementia. The home has a maximum occupancy of 40 people. On the day of our inspection there were 37 people living at the home.

The service had 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.

People told us they felt safe living at Linson Court. The registered manager and staff were aware of relevant procedures to help keep people safe and staff could describe signs that may indicate someone was at risk of abuse or harm. Staff had received safeguarding training.

Staff were recruited safely and systems were in place to reduce the risk of employing staff who may not be suitable to work with vulnerable people. Sufficient numbers of staff were deployed to keep people safe and the home manager had gained approval for and implemented additional staffing resources.

Care plans contained individualised risk assessments and adequate information to ensure people’s care and support was safe, however these had not been updated regularly. People had up to date personal emergency evacuation plans and fire risks were well-managed.

Premises were safely maintained and appropriate checks to ensure this were completed. A recent refurbishment of the lift had taken place to ensure this was safe.

Medicines administration records (MAR) were in place to monitor and manage the administration of medicines. This system was used safely and recorded consistently.

New staff received an induction to the home which included mandatory training and shadowing more experienced colleagues. Staff received ongoing training and a programme of regular supervisions and appraisals had been planned, however not all staff had received a regular supervision in the months prior to the inspection.

Mental capacity assessments were decision specific and people were deprived of their liberty lawfully. Staff were aware of how to promote independence.

People were offered a good choice of meals. Their nutritional risks were assessed and weight loss monitored and appropriate action taken when necessary.

People had good and timely access to external healthcare professionals.

People told us staff were caring and kind. Staff were knowledgeable about people and encouraged people to make choices about their daily lives and retain a level of independence. Staff were aware of the need to maintain people’s privacy, dignity and confidentiality.

People’s care plans were person-centred and detailed. Regular reviews of people’s care had not taken place however the manager had implemented a programme of reviewing each and every care and support record. This had not been fully completed at the time of our inspection.

There was acces

The inspection of Linson Court took place on 4 and 6 September 2017 and was unannounced. The home had previously been inspected on 31 January and 7 February 2017 and was found to be inadequate at that time, with multiple breaches of regulations in relation to person centred care, consent, meeting nutrition and hydration needs, complaints, staffing, safe care and treatment and good governance. During this inspection, we checked and found improvements had been made in all these areas.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Linson Court is registered to provide residential and nursing care for up to 40 people in single rooms with en-suite facilities. The bedrooms are situated on two levels with a lift and stairs for people to access the first floor. Each floor has a communal lounge and dining area. There were 30 people living at the home at the time of our inspection.

There was 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 2008 and associated Regulations about how the service is run.

People told us they felt safe living at Linson Court. The registered manager and staff were aware of relevant procedures to help keep people safe and staff could describe signs that may indicate someone was at risk of abuse or harm. Staff had received safeguarding training.

Staff were recruited safely, with appropriate pre-employment checks taking place. Sufficient numbers of staff were deployed to keep people safe, however, most staff felt improved quality of care could be provided if additional staff were deployed.

Risks had been assessed, such as those relating to choking, falling and moving and handling. Measures had been introduced to reduce risk and we saw moving and handling plans were in place which provided staff with information in order to safely assist people to move.

Regular safety checks took place and fire, gas and electrical systems had been tested. Plans and evacuation equipment were in place to safely evacuate people in the case of emergencies. Staff had been trained to use evacuation equipment effectively.

Since the last inspection, the deputy manager had been responsible for introducing new, improved systems for the management of medicines. Improved systems were in place for managing, storing and administering medicines. Staff responsible for the management and administration of medicines had received training and their competency had been assessed. However, we found not all protocols for ‘as required’ medicines were accessible on the first day of our inspection. This had been rectified by the second day.

Although the home appeared clean and staff were observed using personal protective equipment, which reduced risks associated with infection prevention and control, a recent audit had identified actions required in order to improve infection control.

Staff had received training in relation to the Mental Capacity Act 2005 and demonstrated a good understanding of the requirements of the Act. Decision specific mental capacity assessments had been completed for people who lacked capacity to make specific decisions, as required by the Mental Capacity Act 2005.

Our observations were that, for the majority of people, they were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, we saw one instance

The inspection took place on 31 January and 7 February 2017 and was unannounced. The service was last inspected in December 2015 and was found to be in breach of five regulations.

Following the last inspection, requirement notices for regulations 9, 11,12 and 13 and a warning notice for regulation 17, good governance had been issued to the provider. Several aspects of the warning notice had not been sufficiently addressed by the provider and significant concerns remained at this inspection.

Linson Court is registered to provide residential and nursing care for up to 40 people in single rooms with en-suite facilities. The bedrooms are situated on two levels with a lift and stairs for people to access the first floor.

The home had been without a registered manager and a manager had been in post since August 2016. They were in the process of registering with the Care Quality Commission to become the 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.

Linson Court was welcoming and provided a homely environment. Staff had an understanding of how to keep people safe and knew the safeguarding procedures to follow in the event of a concern or allegation of abuse.

Individual risks to people were not always assessed and there was little analysis of accidents or incidents. There was poor oversight of clinical risks to those people who required nursing care and we found weaknesses in medicines management.

Staffing levels were managed appropriately to meet people's needs, although induction for new staff lacked recorded detail and recruitment was not consistently robust. There were gaps in staff training, knowledge and supervision and there was little evidence staff competencies were checked, particularly around skills required for providing nursing care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff had received training on the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards and staff understood this. Where people had care plans completed thoroughly there were recorded details of mental capacity and some best interest discussions. However, not all people’s information was recorded appropriately and some people did not have a care plan in place or any assessment of mental capacity.

Food provision was of good quality and people enjoyed the meals overall. There was a designated chef who understood the importance of diet and nutrition and was involved in the serving of the meals, so knew people's preferences. However, there was poor monitoring of people's dietary and fluid intake. Records of weight monitoring were not maintained regularly; the records that were available showed several people had lost weight, yet there was no oversight of this or evidence of action taken.

Staff had good relationships with people and they knew each person well. There was plenty of friendly banter and a happy atmosphere in the home. Staff respected people's privacy and dignity in care practice although some confidential information was on view in communal areas.

Where people were approaching the end of their life, staff were attentive and compassionate, however, relevant care planning was not always given due consideration.

Staff offered person centred care in the way they interacted with people and supported their needs. Activities were meaningful and staff made frequent checks on people who stayed in their rooms. Care records were variable in quality; some had more detail than others, although some lacked essential information.

Complaints were not always respo

The inspection took place on 21 and 23 December and was unannounced. The service was last inspected in March 2013 and was found to be compliant in all areas we looked at.

Linson Court is registered to provide nursing and personal care for up to 40 people in single rooms with en-suite facilities. The bedrooms are situated on two levels with a lift and stairs for people to access the first floor. There are not specific units for people living with dementia.

There are gardens to the front and rear of the property. There is ample parking space.

There had been a registered manager at the home until the end of August 2015 after which the home had been without a registered manager. The person who had been the registered manager had sent in an application to be removed from the register. The new manager was in the process of applying to become the new 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.

People were protected from the risk of abuse because staff had received training in safeguarding vulnerable people. Staff were able to identify different type of abuse and understood their responsibilities in reporting any concerns they may have about the way people who used the service were treated.

Systems were not consistently in place for the safe management of medicines. The service did not record the temperature of the drugs fridge on a consistent basis.

Some of the risk assessments in place did not give staff guidance on how to protect people. For example some people had been assessed as being at risk of choking and there was no information to guide staff to support people who were choking. However staff we spoke with told us they would know what to do if they saw someone was choking. Risk assessments and action plans were not always robust. Some risk assessment action plans such as those for the prevention of pressure ulcers did not contain sufficient guidance for staff to follow, for example how often people should be re-positioned. However, we found in practice, staff were re-positioning people to prevent the development of pressure ulcers.

Staff had a clear understanding of the importance of preserving people’s dignity. Visitors we spoke with felt staff respected people’s dignity. People who used the service had mixed feelings about the care they received. Three of the people we spoke with enjoyed living at the home and one person told us they did not like living at the home because they felt the staff did not support them in a caring way. However during our observations during the inspection we saw interaction between staff and people who used the service was warm and respectful.

There were areas of the home where people could meet with their visitors. People who used the service told us they could have visitors at any time. The manager told us there were no restrictions on the times people could come and visit their friends and relatives. People and their relatives were encouraged to express their opinions through surveys and residents meetings.

Staff had training in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) and they understood the need to ask for consent prior to carrying out personal care. The service was not meeting their requirements under DoLS because they had not identified that a person had restrictions on them which could have amounted to them being deprived of their liberty. None of the people who had memory difficulties had their capacity to make decisions such as having bed rails in place, assessed.

In the care records we looked at consent to the provision of personal care had not been signed by people who used the service.

Care records were not always being completed and there were gaps in information such as personal histories, how often people should be weighed or re-positioned.

People’s dignity was not always respected. There were sections within the care record for people to record their end of life wishes. In the care records we looked at we saw only one end of life plan had been completed. Some people had a Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) form in place and in one case we saw this had been signed by a neighbour without consulting the person. There was no record this person had a Lasting Power of Attorney (LPA) in place A LPA is a way of giving some one people trust the legal authority to make decisions on their behalf when people lack capacity to make decisions for themselves.

We identified five breaches of Regulations of the Health and Social Care Act 2008 (regulated activities) Regulations 2014. You can see the actions we have asked the provider to take at the end of the full version of this report.