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 and drink and to ensure their welfare was monitored in this area. They sought advice promptly, and acted upon it, where there were concerns about people's diet and weight, or any other concerns about people's health and welfare.
People, and their relatives, valued the caring approach of staff and had developed warm relationships with them. They felt that their privacy and dignity was respected and that staff were kind. People had opportunities to make choices about the support they wanted staff to offer, with assistance from their relatives with this if it was necessary.
People received a service that was responsive to their needs. They were able to engage in activities that were of interest to them. Where they needed staff support and encouragement with this, the needs of individuals who had limited contact with visitors to the service were prioritised, to help combat social isolation. Staff understood people's preferences about their care as well as their interests and backgrounds, and were flexible in the way they offered support.
People were supported to express their views about the quality of the service and any suggestions they had for improving it. They were able to make these suggestions both formally, in survey responses, and informally at regular meetings between them, their families and the management team. People and their visitors were confident that their views were taken into consideration and also that the management team would listen to and respond to any complaints or concerns they raised.
Systems for monitoring and checking the quality of the service took people's views into account. They were effective in 'bench marking' Linden Court against other services to see how well it was performing and to drive any further improvements necessary. As a result of people's level of satisfaction with the service and evaluation of service quality, the providers had made an award to the team at Linden Court for "Putting Quality First."
People living and staff working in the service, and visitors had a high regard for the quality of leadership within the service. They would recommend the service to others and potentially be happy to use it themselves.