Linda Lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission [CQC] regulates both the premises and the care provided, and both were looked at during this inspection. Linda Lodge accommodates up to 25 older people in one adapted building. Some of whom have mental health needs. At the time of this inspection there were 20 people living at the home.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the 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.

People told us they felt they were safe living at Linda Lodge and they said they were treated with dignity and respect. Risk assessments were in place to minimise the potential risk of harm to people during the delivery of their care while still encouraging people to be independent.

Staff knew how to keep people safe and the staff members demonstrated a good knowledge of how to recognise abuse and how to report any concerns. Staff understood their responsibilities to safeguard people from abuse. Staff were aware of the provider’s whistleblowing procedures and told us they would not hesitate to report any concerns they might have.

There were systems in place for the safe storage, administration and recording of medicines. Each person's medicine was stored securely and trained staff whose competencies were assessed administered people’s medicines safely.

Staff were recruited safely with appropriate checks on their backgrounds completed. All staff had completed an induction programme and on-going training was provided to ensure skills and knowledge were kept up to date.

There were sufficient numbers of staff on duty for each shift at the time of this inspection.

Necessary improvements were underway with the provider’s infection control procedures. We saw areas of the service were clean and well maintained. Cleaning schedules were in place and staff had access to personal protective equipment when required.

People's healthcare needs were met and staff supported them to attend medical appointments.

People lived in a comfortable environment which was clean and free of hazards. They were able to personalise their bedrooms as they wished.

Staff had undertaken training in the Mental Capacity Act 2005 and were aware of their responsibilities in relation to people who might be deprived of their liberty. They ensured people were given choices and the opportunity to make decisions.

Throughout the inspection, we observed staff caring for people in a way that took into account their diversity, values and human rights. People were supported to make decisions about their activities in the home and in the community.

Information about how to make a complaint was available to people and their families, and they felt confident that any complaint would be addressed.

Work was being progressed to ensure people had a choice about what happened to them in the event of their death and that staff had the information they needed to make sure people’s final wishes would be respected.

There was a clear management structure at the service, and people and staff told us that the registered manager and deputy manager were supportive and approachable. There was a transparent and open culture within the service and people and staff were supported to raise concerns and make suggestions about where improvements could be made.

The provider had effective systems in place to monitor the quality of the service and where issues were identified, they were addressed promptly.

This was an unannounced inspection which took place on 1 November 2017. When we last visited the home in September 2015 the service was meeting the regulations we looked at and was rated Good overall and in all five key questions.

Linda Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Linda Lodge accommodates up to 25 older people in one adapted building. Some of whom have mental health needs. At the time of this inspection there were 23 people living at the home with two vacancies.

The service has 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 the associated Regulations about how a service is run.

People told us they felt they were safe living at Linda Lodge and this was also the view of the relatives we spoke with.

People were at risk of not receiving sufficient levels of support that was appropriate to meet their needs. The care plan reviews we inspected did not reflect people’s personal preferences or any progress made with care plan objectives set out in earlier care plans. The deputy manager confirmed with us they would ensure all people’s care plans would be reviewed immediately together with people living in the home or their relatives. This is in line with the provider’s own policies and procedures. The deputy manager also told us that staff will receive additional training with this to ensure they fully understand their responsibilities and carry them out as required. The example above showed the provider was not assessing or mitigating risks to people’s safety effectively. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People and their relatives told us they thought there were enough staff to meet people’s needs. We looked at staff rotas and observed care being provided for people and we found there were sufficient levels of staff available to meet people’s needs. Relatives told us staff kept them well informed about people’s needs and preferences about their care.

People received their medicines as prescribed and staff knew how to manage medicines safely. Those people who were able to, took their medicines themselves with minimal assistance from staff.

Staff were suitably trained and supported to carry out their work effectively. The deputy manager told us that the provider’s training schedule helped to ensure all staff received appropriate training and support for their roles and their work in the home. We saw evidence of this. Staff told us they were well supported with appropriate training and were able to discuss any concerns or issues with the managers whenever they needed to do so.

People had a varied and nutritious diet and choice of meals. Staff supported people to keep healthy and well through regular monitoring of their general health and wellbeing.

During our inspection we saw people were treated with kindness and compassion. Our observations and discussions showed staff to have a good knowledge and understanding of the people they were supporting. Staff told us they enjoyed working with the people they cared for.

On a day to day basis people told us they were able to express their views and make decisions about their care and support. Staff told us people’s likes, dislikes and their preferences were seen by them as an important part of people’s care but this was not recorded in the care plans we inspected and there was no evidence this was a part of the care plan reviews.

Relatives of people were involved in developing their family member’s initial care p

When we visited Linda Lodge there were 25 people living at this home. We spoke with six people, two were new to the service, two relatives, the registered manager and three members of staff. We reviewed four people's care plans and three staff files.

Was the service safe?

People who use the services were treated with respect and dignity by the staff. They told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. There were mechanisms in place to help to safeguard people from the risks of abuse.

Systems were in place to make sure that the manager and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This has reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made.

The manager had ensured there were sufficient numbers of staff on duty, appropriately qualified to meet the support needs of people who used the services. This has helped to ensure that people’s needs were met.

The manager set the staff rotas. They took people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. This has helped to ensure that people’s needs are met.

Was the service effective?

People’s health and care needs were assessed together with them, and they were involved in their care and support planning. People told us that they had been involved in their care and support plans and that the plans reflected their needs. One person said, “I was asked about my care plan some time ago. I am looked after well, it’s like a good hotel. I get everything I need; I wouldn’t want to live anywhere else”. We inspected four people’s care files. They included essential information about the person, needs and risk assessment information, care plans and records of health care appointments.

Was the service caring?

People who use the services were assisted by kind and supportive staff. We saw that staff showed patience and professionalism and gave appropriate encouragement when supporting people. The people we talked to said the staff treated them well and respected their wishes, dignity and privacy. One person said about their relative’s care, “my mother is well looked after here, she’s been here for over a year now, long enough to know its good, actually they are all well looked after”.

We observed that staff knocked on the people’s doors before entering their rooms and asked if it was convenient for them to go in. This reflected the caring environment that we found on the day of the inspection.

Was the service responsive?

Relatives of people who use the services told us that if a person’s needs changed, their care and support would be tailored to those changed needs. We saw that care plans were reviewed regularly and changed appropriately. This was important as this helped staff understand what people wanted or needed or how they were feeling.

All the people who use the services we spoke with knew how to make a complaint. There was an appropriate complaints procedure in place and discussions we had with relatives and staff indicated that they would be supportive of anyone who needed to complain. People can therefore be assured that complaints would be investigated and action taken as necessary.

Is the service well-led?

The managers carried out regular checks to assess and monitor the quality of services provided and took appropriate action to address any issues or concerns raised about service quality.

The views of people who use the services, their representatives and staff were listened to by the managers. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home. This helped to ensure that people received a good quality service.

At our previous inspection of Linda Lodge we identified that action needed to be taken by the service provider to ensure that there were enough staff to meet people’s needs. We also found that staff had not received appropriate professional development in terms of their staff supervision and appraisal of their work. The registered manager wrote to us after that inspection with an action plan that set out how they would address these issues. At this inspection in December 2013 we found that the planned actions with regards to increased staffing had not yet been fully implemented and therefore we could not be sure that people’s needs were being adequately met.

With regards to staff supervision a new policy and procedure had been drawn up and all staff had been made aware of this. We were shown information that set out the new policy and procedure. We also saw information that indicated all staff would start the new supervision in January 2014.

People who we spoke to told us that they enjoyed living at Linda Lodge and that they felt safe and well looked after by staff. They told us that they were involved in their care planning and that they were given opportunities to retain their independence where possible and they were able to choose the activities that they wanted to do. People said that they enjoyed their food. Relatives we spoke to told us that they thought their relatives were being well looked after at Linda Lodge and they thought staff were kind, sensitive and responsive to residents.

During our visit we spoke with five people who use the service, one relative and three staff, plus the manager who also owned the home, and another co-owner.

People who use the service told us they generally liked living at the home. People said the staff were friendly and knew what they liked. However, some people said they would like to have more activities to do.

We found that people were at risk where their needs had not been fully identified and planned for. The deployment of staff at the home meant there was not enough staff to ensure that the regulated activity was being carried out and that the needs of the people who use the service were not being adequately met. The service did also not have any systems for monitoring the quality of the service provided to people.

Overall, we have found that Linda Lodge meets the essential standards but to maintain this we have suggested that some improvements are made. Please see main report for this information.

This was an unannounced inspection which took place on 21 September and 5 October 2015. At our previous visit in July 2014, we judged that the service was meeting all the regulations that we looked at.

Linda Lodge is a service in the Sutton area, providing accommodation, personal care and support for up to 25 older people some of whom have mental health needs. At the time of this inspection there were 24 people living at the home.

The service has 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 the associated Regulations about how a service is run.

People told us they felt they were safe living at Linda Lodge and this was also the view of the relatives we spoke with. Staff knew how to protect people if they suspected they were at risk of abuse or harm. Risks to people’s health, safety and wellbeing had been assessed and the actions taken by staff that were set out in the risk management plans had helped to minimise and manage problems that had been identified. This had helped to keep people safe from harm or injury.

People and their relatives told us they thought there were enough staff to meet people’s needs. We looked at staff rotas and observed care being provided for people and we found there were sufficient levels of staff available to meet people’s needs. Relatives told us staff kept them well informed about people’s needs and preferences about their care.

People received their medicines as prescribed and staff knew how to manage medicines safely. Some people self-medicated with minimal assistance from staff.

At this inspection we found that staff were suitably trained and supported to carry out their work effectively. The registered manager told us that a new training and support plan was introduced recently. We saw evidence of this. Staff told us this was part of the provider’s plan for service improvement and to ensure staff continued to be supported and trained effectively.

People had a varied and nutritious diet and choice of meals. Staff supported people to keep healthy and well through regular monitoring of their general health and wellbeing.

During our inspection we saw people were treated with kindness and compassion. Our observations and discussions showed staff to have a good knowledge and understanding of the people they were supporting. Staff told us they enjoyed working with the people they cared for.

People were able to express their views and make decisions about their care and support. We saw that people’s likes, dislikes and their preferences were considered as an important foundation of care provision and had been recorded clearly in people’s care plans.

Care plans were in place which reflected people’s specific needs and their individual choices. Relatives of people were involved in developing and regularly reviewing their relations’ care plans and we saw people were supported to make decisions about their care and support.

People told us that there was a good range of activities provided for them. Relatives said they were always made welcome when visiting the service.

People using the service and their relatives were encouraged to give feedback to help to improve the service for people. The complaints system in place meant people’s complaints were dealt with effectively and people were satisfied with the outcomes.

Staff told us they were clear about their roles and responsibilities. They understood the ethos of the service which meant people living at Linda Lodge received a good quality service.

Systems were in place to monitor the safety and quality of the service and to get the views of people about the service. Where there were concerns about quality or safety, appropriate action was taken to address the issues identified.