Linden House is a care home which is registered to provide care for up to 34 people. The home specialises in the care of people who require general nursing care. At the time of this inspection, there were 27 people living at the service.

At the last inspection the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good:

People remained safe at the service. People told us they felt safe. There were sufficient staff on duty to support people and recruitment was safe. People received their medicines as required and staff understood how to identify and keep people safe from abuse or avoidable harm. People’s risks were assessed and incidents and accidents were monitored. The environment and equipment within it were maintained.

People continued to receive effective care, however, we have made a recommendation in relation to ensuring legislation is followed relating to applications for the Deprivation of Liberty Safeguards. DoLS is a framework to assess the requirement to lawfully deprive a person of their liberty when they lack the mental capacity to consent to treatment or care and need protecting from avoidable harm. Staff received training to ensure they had the skills and knowledge required to effectively support people. People’s healthcare needs were monitored by staff and they had access to healthcare professionals when needed. People received support to eat and drink sufficient amounts.

The service continued to provide a caring service to people. People told us, and we made supporting observations that staff were kind and patient. People and their relatives had sent compliments to the service to express their gratitude and thanks. Staff understood the people they supported and people’s visitors were welcomed. People were supported to have a dignified death in line with their wishes.

The service remained very responsive to people’s individual needs. Following an assessment before admission, care and support was personalised to each person which ensured they were able to make choices about their day to day lives. There was a system to ensure complaints would be appropriately dealt with. People were supported with their hobbies and the service continued to use innovative methods to enhance the quality of people’s lives.

The service continued to be well led. Staff spoke positively about their employment and told us there was support available. The provider had systems to offer staff confidential support. There were systems to seek the views of people, their relatives and staff through surveys. There were links with the local community and the service supported national charities. There were effective governance systems in place.

Further information is in the detailed findings below.

Linden House is a care home which is registered to provide care for up to 34 people. The home specialises in the care of people who require general nursing care. There is a registered manager who is responsible for the home. 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.

This inspection took place on 5 November 2014. This was an unannounced inspection which meant the staff and provider did not know we would be visiting.

Throughout our inspection we observed staff interactions were kind and respectful. There was a cheerful atmosphere in the home and people appeared relaxed and comfortable with the staff that supported them.  One person said “all the staff are delightful. I can’t grumble about any of them.” Another person said “we do have a laugh here. Never a dull moment.” The visitors we met with told us about the kind and compassionate care their relative had received during their time at the home.

People told us they were well cared for. They told us staff knew about the things that were important to them. One person said “I really couldn’t get better care anywhere else.” Another person told us “I cannot grumble about anything. I am very well looked after.” Two people we met with told us how staff were “always prepared to go the extra mile.” One person said “I was very anxious about a letter that needed posting. [member of staff] offered to post it on their way home. They telephoned me to let me know they had posted it. That was such a relief to me.” Another person told us “I needed to go to the bank to sort things out and [member of staff] offered to come with me in their own time.”

People told us they could see a doctor or other health care professionals when they needed to. One person said “I have regular appointments at the hospital. A member of staff comes with me. They are very good.” Another person said “the nurses are brilliant. If you feel unwell, the doctor is called straight away.”

Before someone moved to the home, they were visited by the registered manager or a nurse to make sure the home was the right place for them. One person said “it wasn’t an easy decision to move into a home, but I have to say, I’m glad I chose this one. They went out of their way to make sure they knew about all the things that were important to me before I moved here.” The cook/housekeeper told us “ the nurses assess people and I go and have a chat with people when they move in. It’s important to know about people’s likes and dislikes and whether they need a special diet.”

Each person had a care plan which provided information about their needs, abilities and preferences. Care plans also detailed any risks to the person and gave clear information about how risks could be minimised. Staff demonstrated a good knowledge and understanding of the people they cared for. They told us they attended a meeting at the start of every shift where they would be updated and informed about any changes or concerns with people. We saw care plans had been regularly reviewed to make sure they reflected people’s current needs.

People received their medicines when they needed them. We found people’s medicines were managed and administered in a safe way.

The service offered a varied programme of activities. These included visits from musical entertainers, outside speakers, arts and craft sessions and social get togethers. People were positive about the activities offered. One person said “it’s amazing really. There is so much going on. I really enjoyed a talk we had recently. Someone came in and talked to us about cider apples and making cider. It was really interesting.” Another person told us about the “social suppers.” They said “they are such fun. We decide in advance what we want to eat. For example fish and chips or a buffet. Just something different really. We sit at long tables and have a laugh and chat. It really is a real social affair.”

We were also told about the numerous “themed events” which took place at the home. A visitor said “they really do pull out all the stops to make it special for people.” On the day we visited the dining room had been decorated in preparation for bonfire night. Decorations were impressive and the cook had made a very creative “bonfire cake.” One person said “you should have seen it here at Halloween. It was amazing. All the staff dressed up, the decorations were out of this world and you should have seen the cake!”

The service made sure staff knew how to care for the people who lived at the home. Staff received on-going training and their skills were regularly monitored through formal one to one meetings and observations of their practice. One member of staff told us “as long as the training relates to the needs of the people here, then it is arranged straight away.” Another told us “you can’t fault the training opportunities.”

The service was safe and well maintained. Equipment used by people had been regularly serviced to make sure they remained safe.Risks of scalding from hot water outlets were reduced because these were regularly checked to make sure they remained within safe limits. There was an emergency plan in place to appropriately support people if the home needed to be evacuated.

Staff were up to date with current guidance about how to support people to make decisions  and to keep them safe. 

People knew how to raise concerns about the care or supported they received. One person told us “we have regular meetings and the manager is always there. One of the things we are encouraged to talk about is whether we are unhappy about anything. I haven’t heard any grumbles.” Another person told us “I am very satisfied but I know for sure if I wasn’t, they would be straight on it.”

The people we spoke with, staff and visitors told us they found the provider and registered manager very approachable. One person told us “[the provider] came to see me shortly after I moved here. They asked if I had settled in and whether I was happy with everything. She [the provider] is very nice.”

During this visit we spoke with four people who lived at the home and five staff members. We also spent time observing care practises. We looked at key documentation including care plans and risk assessments. We looked at training records and spoke with staff about their training and how well they felt supported to do their job. We also reviewed records relevant to the management and administration of the service.

People who lived at the home told us “It’s like one big family” “I really like it here” “I am very happy here” “Everyone is so friendly” “ I feel very safe”

People were confident in the skills and ability of the staff caring for them.

We found that people were consulted and involved in decisions concerning their welfare and in all aspects of their everyday life. We found that the care they were provided with met their individual needs and preferences. Care needs were assessed planned and reviewed and the home was proactive in listening and acting upon peoples preferences and acting on their requests.

Records were accurate and demonstrated care and support being delivered in line with the assessed needs

As well as care needs the home was very proactive with providing social events and activities and encouraging people to remain engaged and involved in their surroundings. They appeared committed to assisting people to live as fulfilled lives as possible.

Staff understood the safeguarding process this helped to keep people safe and protected. There were also appropriate policies and procedures in place to ensure this.

There were 26 people living at the service. We met and spoke with eleven people who used the service and a visitor to the home. We spoke with eight staff who were on duty at the time of the visit. We looked at the care records for four people and the recruitment records for three staff. We also reviewed records relevant to the management and administration of the service.

People told us they liked living in the home. One person told us, “I enjoy it, I’m quite happy here.” Another said the staff treated them well. People told us they had enough activities to do if they wanted to join in. We saw people enjoying the company of others, reading books, watching television, talking with staff and joining in planned activities at the home. People received the support they needed to meet their physical health needs. People were complimentary about the staff working in the home. They were confident that the staff working in the home had the skills to care for them.

We looked at how people’s medicines were managed. We found systems in place which ensured people received their medicines safely. We also looked at records of staff recruited to work in the home and saw these were robust ensuring that staff employed had the right skills and attributes to work with vulnerable older people.

We were informed anonymously of concerns about the service. We were told that there might be problems with the general care of people and with the food. When we visited the home we found no evidence to support these concerns.

People we spoke to were positive about the care they received in the home. One person told us "We do very well here. They do as well as they can for us."

People told us that the food in the home was "excellent" They told us that they were offered a choice of meals and that staff tried hard to ensure that they enjoyed their meals. One person on their way into lunch said "This is usually lovely."

People told us that staff were kind and polite. They told us that carers came quickly when they rang the bell.