This inspection took place on 09 December 2016 and was unannounced.

Linden House provides personal care and support for up to 32 older people, many of whom may be living with dementia. On the day of our inspection 21 people were living in the home.

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.

At our last inspection we found breaches of regulation. At this inspection we found actions had been taken to ensure the regulations had been met and the service had improved.

People’s legal rights were not fully protected as care was not always provided in line with the Mental Capacity Act (2005). Correct procedures weren’t followed when depriving people of their liberty. The provider had taken actions to make improvements following our last inspection, however the improvements had not led to people’s rights being fully protected. We recommended that the provider reviews their MCA assessments and DoLS applications.

People’s medicines were stored and administered safely and staff worked alongside healthcare professionals to ensure that people’s health needs were met. Staff responded quickly to changes in people’s healthcare needs.

Accidents and incidents were recorded and measures were taken to prevent a reoccurrence. Staff routinely carried out risk assessments and created plans to minimise known hazards whilst encouraging people’s independence. Staff understood their responsibilities in safeguarding people and knew what to do if they suspected abuse had occurred.

People told us that they enjoyed the food and we saw evidence of people being provided with choice and also being consulted on food during meetings and reviews.

There were sufficient staff present to meet people’s needs safely. The provider carried out checks on staff to ensure they were appropriate for their roles.

People lived in an inclusive atmosphere in which they had access to a range of meaningful activities and were involved in making decisions about their home. Staff provided care in a way that was personalised and caring.

People’s privacy and dignity was promoted by compassionate staff who knew people well. Staff were trained for their roles and received regular one to one supervision. Care plans reflected people’s preferences, personalities and needs.

Staff felt well supported by the registered manager and had input into how the home was run. Systems were in place to ensure care at the home was of a good quality. People’s feedback was regularly sought and complaints were responded to appropriately.

Linden House provides personal care and support for a maximum of 32 older people, some of whom may be living with dementia. On the day of our inspection 24 people were living in the home.

This was an unannounced inspection that took place on 9 December 2015.

The home 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 and associated Regulations about how the service is run. The registered manager assisted us with our inspection on the day.

People may not always be receiving safe care and treatment from staff because we observed staff struggling to transfer people from chairs to wheelchairs in an appropriate and safe manner. Staff did not always follow correct and appropriate procedures in dispensing medicines.

Although there were a sufficient number of staff on duty we found deployment of staff could have been better organised to ensure an appropriate number of experienced, permanent staff were on duty during a shift.

Although staff understood their responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards we found the legal requirements in relation to these were not always followed by staff. For example, decisions were made on behalf of people without evidence to show how this had been done.

Staff were not always aware of people’s dietary requirement and we saw people being given inappropriate foods.

People were not always treated with respect and dignity by staff and staff did not take the time to make sure people knew what they were about to do. However, we did see some good examples of kind care from staff.

Care plans were individualised and contained information to guide staff on how someone wished to be cared for. However, this was not always followed by staff and we found some care records lacked detailed information about the person.

We saw evidence of checks carried out by staff to check the quality of care being provided to people. However shortfalls identified from these weren’t always acted on. The registered manager did not always have a good management oversight of the home.

Accidents and incidents in relation to people were recorded and monitored by the registered manager to identify trends. Risk assessments were in place for people for particular issues, such as risk of falls or particular behaviours.

Should there be an emergency in the home, there was guidance in place for staff to follow in order to ensure people’s care was not interrupted and if people needed to be evacuated this would be done in a safe way.

Staff were aware of their role in relation to safeguarding people from abuse and were able to tell us how they would report any concerns they may have. Robust recruitment practices were followed, which meant the provider endeavoured to employ staff who were suitable to work in the home.

Care was provided to people by staff who were trained and received relevant support from their manager. This included regular supervisions and undertaking training specific to their role. Staff were involved in the running of the home as regular staff meetings were held.

People’s health was maintained as staff involved external health care professionals when appropriate.

Visitors were welcome in the home and felt the registered manager was approachable and supportive. People were given information on how to make a complaint and we were told if people had any concerns they would approach the registered manager.

During our inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We visited Linden House to look at the care and welfare of people who used the service. We did this because we had received concerning information about the home.

We were told that people who used the service were being woken early. It was stated they were up between 5am and 6am. It was also stated there were insufficient staff numbers to meet the needs of the people who used the service. We were also told that radiator thermostats were not working in some rooms which meant some rooms were cold and others too hot.

We visited at 06:00 and found the home to be quiet and peaceful. One person was up and dressed but the carer told us this was because that person thought it was time to be up. Another person was being assisted to get up again we were told it was because they wanted to be up.

The home was clean and tidy and felt warm. We looked around the home and checked many bedrooms and all were warm.

We discussed staffing arrangements with the manager. We were told the home had enough staff to meet the needs of the people.

During our inspection we spoke with five people who used the service, three members of staff and the manager.

People who used the service told us staff would ask for their permission before they undertook or helped them with certain tasks. They told us they made choices about their lives. One person told us, “I choose the clothes I want to wear and the food I want to eat.” Another person told us, “Staff always asked me if I would like any help. If I need help I say yes, but I like to do things for myself and staff let me.”

People told us they liked the food, they made choices about their meals and they could have a drink or a snack at any time of the day or night.

People told us that the home was always clean and tidy. They told us that they liked their bedrooms and they were pleased with the new refurbishment that had recently been completed. They told us there was plenty of staff on duty and they responded to their call alarms quickly.

People told us they knew how to make a complaint, but they had never had the need to.

We found the service was compliant with the five outcomes we looked at.

On the day of the site visit there were fourteen people living at the home. The majority of the people who used the service had Dementia and loss of memory. We used a number of different methods to help us understand the experiences of people using the service because people had complex needs which meant that not all the people who used the service were able to tell us about their experiences. We spoke to five people who used the service and two relatives. We observed interaction between staff and the people who used the service and we looked at care records.

Most of the people who used the service told us that they made choices every day. Some of their comments included, “I choose my own clothes,” and “I can choose what activities I want to do and the meals I like to eat.”

Most of the people we spoke to could not remember if they had a care plan. One person told us, “My relative knows all about that and he would have signed it.”

All of the people whom we spoke to told us that they felt very safe living at the service.

People who used the service told us that their bedrooms were nice. One person told us, “My bedroom is cleaned every day.”