About the service:

Linden Cottage is a residential care home for six younger adults who have learning/ physical and/or sensory adaptive needs. At the time of this inspection four people were living in the service. All the people had special communication needs and used sign-assisted language.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

For more details, please read the full report which is on the CQC website at www.cqc.org.uk

People's experience of using the service:

• People received safe support from support staff who had the knowledge and skills they needed.

• People were safeguarded from the risk of abuse and received person-centred support that promoted their dignity.

• People were supported to safely take medicines and to have enough to eat and drink.

• People and their relatives were consulted about the support provided and their consent had been obtained.

• People were supported to pursue their hobbies and interests and there were robust arrangements to manage complaints.

• Quality checks had been completed, good team work was promoted and regulatory requirements had been met.

• People and their relatives were positive about the service. A relative said, "Linden Cottage is very good and is a home from home for my family member.”

Rating at last inspection:

The service was rated as ‘Good' at the inspection on 28 September 2016. At this inspection in April 2019 the overall rating of the service has been maintained as ‘Good’.

Why we inspected:

This was a planned inspection based on the rating we gave the service at the inspection in September 2016.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit in line with our re-inspection programme. If any concerning information is received we may inspect sooner.

Linden Cottage provides personal care, support and accommodation to up to six people living with a learning disability. This unannounced inspection took place on 28 September 2016. At the time of the inspection six people were using the service.

We last inspected Linden Cottage in November 2014. The service met all the regulations we checked at that time.

The service 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.

People received safe care and support. We saw positive and friendly interactions between staff and people. Staff treated people with respect and upheld their right to privacy and dignity.

Staff knew how to protect people from harm and who to report to if people were at risk. Staff understood the provider’s procedures relating to safeguarding people from harm. Staff managed risks to people's health and safety appropriately and had up to date risk assessments. The provider used a robust recruitment system and recruited staff safely. There were enough staff on duty to meet people's individual needs as required and to take people out as needed.

Staff sought and received people’s consent to care and treatment. Staff supported people in line with the legal requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Staff involved people and their relatives in planning people’s care and support. Care plans were person centred and reflected people’s individual preferences. People received their care as planned. Staff reviewed people's health needs regularly and made changes to support plans when their needs changed.

People were supported eat healthily and enjoyed the choice of meals prepared at the service. Staff were aware of people's dietary needs, their likes and dislikes. Medicines were stored and administered safely to people as prescribed.

Staff had regular supervision and an annual appraisal that helped identify training needs and improve the quality of care. The registered manager updated regularly and monitored staff training. Staff received specialist training on working with people living with autism and learning difficulties.

The registered manager sought people's views about the service and used feedback to make improvements as necessary. People and their relatives knew how to make a complaint and felt confident their concerns would be investigated and responded to.

Relatives and staff said the registered manager was easily available. Staff felt well supported by in their role. The management team encouraged a culture of learning and staff development.

People received the support they needed to attend healthcare appointments and had their needs met. The service effectively worked in partnership with other healthcare professionals to learn, develop and implement best practice to improve people's well-being.

The registered manager effectively used checks and audit systems in place to monitor the quality of the service. The registered manager put plans in place for improving the care and support people received.

This was a follow up inspection to look at consent to care and treatment. We spoke with the manager, deputy manager and two members of staff. The inspection was carried out by one inspector over two hours.

We considered all the evidence we had gathered and used the information to answer the question; Is the service effective? Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service effective?

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager knew when an application should be made and how to submit one and was aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. The provider was in the process of reviewing all of the people who used the service to ensure that any restrictions on liberty were identified and appropriate action taken.

We found that people were supported to make every day decisions, such as what to wear and when to get up. Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests.

People at the home had complex needs and were not all able to tell us about their experiences at the home. In order to get a better understanding we observed care practices, looked at records and spoke with staff. During the inspection we spoke with a deputy manager of a sister service and seven members of staff. We were unable to speak with the current manager who was not on duty at the time of our visit.

Our inspection team was made up of one inspector. We answered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

There were systems in place to make sure people were protected against the risks associated with medicines. Medication was stored safely and there were clear records of administration. Staff had received training in the administration of medication and there were regular audits to monitor the effectiveness of medication systems.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff understood when an application should be made, and how to submit one.

Is the service effective?

People who used the service had limited capacity to give their consent to care and treatment. We found that the provider had not always acted in accordance with legal requirements where people lacked the capacity to make decisions for themselves. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. Staff had received training to meet the needs of the people receiving care. Staff told us that they felt well supported and liked working at Linden Cottage. One staff member said "I love it" and another commented "I'm really enjoying it here".

Is the service caring?

People were supported by committed and caring staff. We observed that people appeared comfortable in the home and familiar with the staff that worked there. We saw that staff members spoke directly with people and supported them at an appropriate pace. One staff member told us "People are treated well" and added "It feels positive here. It's a happier place".

Is the service responsive?

People’s needs were continually assessed. Records confirmed people’s preferences, interests, goals and diverse needs had been recorded and support had been provided in accordance with people’s wishes. People had regular review meetings with keyworkers to make sure that changes in needs were identified and action taken.

Is the service well-led?

Staff had a good understanding of their roles in the service and that they were supported by management. There were quality assurance processes in place to maintain standards in the service. We saw that staff and people who used the service were given opportunities to express their views.

People who used the service had complex needs and were not able to tell us about their life at the home. We used a number of different methods to help us understand their experiences. These included looking at records, talking to staff and observing care practices. We also got feedback from two relatives of people who lived at the home.

We found that improvements had been made since our last inspection in November 2012 where we identified areas of non-compliance.

Relatives told us that "The house is welcoming, clean and well organised" and that staff were "Caring and nice". One relative commented that "The [staff] and management worked very well together". Another relative said "People could be more involved in daily tasks".

We found that people were treated with dignity and respect. Staff had a good understanding of people's complex needs and how to support them. People's needs had been assessed and up to date support plans were in place.

People were protected from the risk of abuse. Staff were confident about how to protect people and what action needed to be taken if they suspected abuse had occurred.

We found that staffing levels had increased at night time and that there were sufficient numbers of staff on duty to meet people's care and welfare needs.

There were systems in place to regularly assess and monitor the quality of service that people received. People were encouraged to communicate and feedback in a way that was meaningful to them.

We were not able to speak with people who used the service because of their complex needs and disabilities. We gathered evidence of people’s experiences of the service by observing care practices, talking to staff and looking at records.

We observed that people at the home looked comfortable in the environment and were appropriately dressed. We saw staff treated people with respect and dignity, however the records showed that decisions were sometimes made on people's behalf without due regard to the Mental Capacity Act 2005.

We found that people's personal care needs were met but the staffing levels meant that there was a lack of meaningful activities and community involvement. All the people at the home required a high level of support and monitoring during the day and throughout the night. We found that the staffing level at night could put people at risk if there was an incident or an emergency. Staff told us that they would benefit from more staff, particularly at night.

Staff were aware of safeguarding procedures and how to ensure people were kept safe from abuse. However, the system for reporting concerns meant that there could be delays in the local safeguarding authority being made aware of any allegations of abuse.