The inspection took place on 31 January 2017 and 1 February 2017. The first day was unannounced.

Linden Court provides accommodation and support for up to 46 older people who may be living with dementia or need support to maintain their mental health. Accommodation is spread over two floors linked both by staircases and by a shaft lift. There are sitting areas and small dining areas on both floors as well as a larger dining room on the ground floor. There is a secure garden area for people to use should they wish to. The home does not offer specialist support for dementia care but does offer care for some people who have developed the condition after their admission. At the time of our inspection visits, there were 44 people living in the home.

There was a registered manager in post who completed registration with the Care Quality Commission (CQC) in January 2016, a year before this inspection. A registered manager is a person who has registered with 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.

We found that some minor improvements were needed to the safety of the service that had not been identified until we raised them. There was an inconsistency between guidance about managing a specific risk and staff practice in managing recorded risks. Care being delivered at the time of our inspection, did not match what was identified within their assessment to keep them safe. There was also a risk to people's safety because thickening products used in drinks for some people, were accessible in communal areas. The management team took prompt action to address these, once we had pointed them out.

Staff were competent to administer medicines and this was checked to ensure they understood what was expected of them. However, the routine use of a medicine prescribed for occasional use to control anxiety, was not identified in medicines checks and not always shown as justified within the person's records. The registered manager undertook to investigate this, to ensure the person was not unnecessarily sedated and they received this medicine as the prescriber intended.

Staff were aware of the importance of reporting any concerns or suspicions that people may be at risk of harm or abuse. They knew what to look for and how to raise their concerns and were confident to do so. They were recruited in a way that contributed to protecting people from staff who were unsuitable to work in care. We noted that one staff member was confirmed as due to start work imminently without the benefit of the second reference required, but this was rectified during our inspection visit.

People received support from staff who were trained and competent to meet their needs. The competence of staff was reassessed from time to time to ensure they were able to fulfil their roles, and the management team monitored their training to ensure they completed it in a timely way. Staff understood what was expected of them and what represented good practice in meeting people's needs, including their obligations to seek consent to deliver care. Where people's ability to give informed consent was in doubt, staff were aware of the importance of acting in people's best interests as required by law. The registered manager had taken action to promote the rights of people who were subject to any restrictions on their freedom but that were essential for their safety.

People were offered a choice of what they wanted to eat and drink, with support from staff if they needed it. They could choose where they ate their meals and staff took great trouble to ensure people were offered a meal they would enjoy if they did not like what was on the planned menu. Where people were at risk of not eating and drinking enough, staff took action to promote and encourage their intake of food

We inspected Linden Court on 10 November 2014. This was an unannounced inspection. Linden Court provides accommodation and support for up to 40 older people.

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 and associated Regulations about how the service is run.

We received many positive comments about the home from people who lived there, their relatives and visiting health care professionals. People told us that staff treated them in a way that they liked and there were enough staff around to meet their needs. They stated that they received good quality responsive care which had maintained their health and well-being.  Medicines were stored correctly and records showed that people had received them as prescribed.  

Family members told us staff were good at keeping them informed of events that affected their relative and involved them in important decisions. Five of the six health and social care professionals we spoke with told us they would recommend it as a place to live for their family member, and spoke highly of the staff and manager.  

The Care Quality Commissions is required by law to monitor the operation of the Mental capacity Act 2005 Deprivation of Liberty Safeguards, and to report on what we find. We found that staff had a good understanding of this legislation and how to use it effectively it to protect people who could not make decisions for themselves.  

Staff had the necessary skills and knowledge to care for people safely and competently. They received good supervision, training and appraisal of their working practices to ensure that people received quality care. 

Leadership in the home was strong and created an open, positive and inclusive environment both for people living there, and staff working there. However, the type and frequency of activities available needed to be reviewed to better meet people’s individual likes and hobbies, and information about raising complaints needed to be made more widely available to people.

We spoke with people who lived at the home and relatives who told us that staff consulted them and respected and acted on the decisions they made about the care and support they agreed to.

Our observations showed us that people were given the support and attention they needed and had a positive experience of being included in conversations, decision making and activities.

We found that plans of care contained the information staff members needed to ensure that the health and safety of people was promoted.

Relatives told us that people received the care and support they needed. They said that staff were very kind but constantly hurrying about the home.

People had their nutritional and fluid needs met and monitored. They told us that they enjoyed the food provided and could choose from the menu.

We saw that medication was administered, recorded and stored accurately and safely.

People living at the home told us that they often had to wait for assistance from staff. They said that staff were, “Excellent and would do anything for you, but were very busy.” An increase in staffing levels was planned to ensure that everyone living at Linden Court received the care and support they needed.

People told us their complaints were listened to and resolved. We found that there was a complaints system in place that met the needs of people living in and visiting the home.

We spoke with people who used the service and their relatives who told us that staff consulted them and respected and acted on the decisions they made about the care and support they agreed to.

Our observations showed us that people were given the support and attention they needed and had a positive experience of being included in conversations, decision making and activities.

The plans of care contained the information staff members needed to ensure that the health and safety of people was promoted.

People who used the service and their relatives told us that people received the care and support they needed and that staff were very kind but busy.

Staff were trained and supported to provide an appropriate standard of care and support through regular supervision, staff meetings and appraisal.

People who used the service, their representatives and staff were asked for their views about their care and support and they were acted on.