Linden Manor

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

People, relatives and staff felt the registered manager had a positive impact on the service. We were able to observe the improvements made since our last inspection, but more time was needed to ensure they were fully embedded. The atmosphere and ethos within the service was positive and compassionate, but staff did not always seem clear on their caring roles. Support towards staff who had health needs was good. Ensuring staff training and compliance was thorough. There was an emphasis on working closely with the local community to help to ensure people had enriched lives. We found 1 breach of the legal regulations in relation to governance and oversight.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The home had a shared vision, strategy and culture, Staff felt there was a listening culture within the service to promote learning and development, staff felt able to raise concerns.

The management were holding regular staff meetings and relative and residents’ meetings to identify concerns and to help shape the culture of the service .

Staff told us the registered manager was approachable and caring, and “is fair, she is supportive of the staff, she listens to any concerns we might have. She has good working relationships with the families.”. Staff appreciated the flexibility they had if they had health issues or needed to change their hours on a rota. We saw evidence in team meeting minutes how approachable the staff found the registered manager to be, and they advised us they were made aware of any changes being planned so they “could share concerns and ask questions.” We saw evidence of the provider having confidence in the registered manager and offering good support. Within the audits in place, staff could also log any maintenance concerns they had, and they told us they can make suggestions for changes which are listened to. We reviewed 2 incidents where the registered manager had not sought clear explanations of what happened from the staff involved. This limits the opportunity for lessons to be learned.

The provider’s Operations Director, and the administrator provided additional support to the manager to maintain oversight of the service. We saw some audits, and maintenance logs which gave us more assurance of the safety of the building and people living there including pressure mattress and cushions checks. However, we saw out-of-date and incorrect information which had not been identified. An example of this was a diet requirement list in the kitchen dated 2022. We are not aware of any harm being caused due to this. The management team were carrying out more robust audits. However, these needed further development to ensure they consistently identified and managed risk, drove improvement, and to ensure they were sustained. We reviewed recruitment records and saw evidence that the needs of staff were considered and changes to job roles and working patterns made if needed. Staff sickness levels were reported as being low, and we observed risk assessments encouraging staff to support each other and ask for help if needed. We reviewed care plans and assessments which had significant amounts of information missing so we could not be assured they were accurate or had been completed in a considered manner. This means people were at risk of harm. An example of this was a person who was described as independent with dressing in one form but needing help in another. These discrepancies meant that the staff might not be aware of the level of assistance needed. Not all documentation had been reviewed within the stated time frames. We reviewed an incident which had happened when a person fell from their wheelchair. There did not appear to have been any investigation or lessons learned from the incident. The staff had appropriately contacted 111 for advice. The person's relatives had not been informed and the reasons for the incident were inconsistent. We were not assured that risks were well managed, and the Duty of Candor policy followed.

The home appeared to foster a positive culture where people felt they can speak up and that their voices will be heard.  Staff told us they feel confident their voices were heard, however staff appeared to lack confidence in voicing concerns and reporting incidents fully. We were not assured staff and leaders were always open and transparent.

There were processes in place to ensure staff had the freedom and autonomy to speak up when needed. We saw there was a whistle blowing policy in place. Staff were also encouraged during team meetings and daily catch ups to share any issues or concerns

Systems were in place to engage with all staff via Team meetings and supervision, which gives those less likely to speak up in a group, the opportunity to do so. One member of staff commented, “I give my comments, and suggestions on how to improve things for people and the home.”

The provider employed a multi-cultural and diverse workforce. They had made reasonable adjustments to support staff with protected equality characteristics to carry out their roles well.

Staff had knowledge of their roles and others and felt supported. However not all staff were aware of audits or what they are. The Registered Manager failed to recognise the proper and safe management of medicines.

We were not assured the home had adequate systems of accountability and good governance to enable them to manage and deliver good quality, sustainable care. The management team completed daily walk round audits this failed to pick up the diet chart in the kitchen was out of date. The service’s governance processes were not always effective to monitor the quality of the service. Due to timing of recording care plans this meant risks to people may not always have been identified which meant there were not mitigations to safeguard them from abuse, accidents and incidents.  We were not assured the Registered Manager always followed robust procedures, completed comprehensive risk assessments to ensure they were acting in the best interests of the staff and people. Quality monitoring and Audits review and action plan all in place.

Most relatives told us there were no problems with communication with them, the staff and manager. They told us the registered manager was always visible when they visited, and they all felt they could approach staff with any concerns/problems, and they felt they would be listened to. One said that “if I need to ask anything I just go and speak with her (manager). She is always attentive to what you have to say.”

Staff advised us that they felt they were a supportive and friendly team who worked well together.

The local authority quality improvement team visited this service in June 2024 to check if improvements had been made since their previous visit. We saw a letter sent to the registered manager advising them they had exceeded the minimum standards needed for compliance with them. The letter included a small number of improvements which were recommended by them.

The registered manager told us they had systems to engage with people, their relatives, visitors, and health professionals to obtain feedback about the service and share learning. There are newsletters and we saw evidence of questionnaires for staff and relatives to obtain feedback. An activities coordinator was employed who contacted various outside communities to visit.

The management and staff told us they held regular team meetings where they have opportunity to review learning from incidents as well as celebrating what has worked well. RM told us following the death of a person and arrests of staff they had started to implement extensive first aid training, however it was not clear that staff were aware of severity of situations and when to call 999.

We saw the improved compliance with quality teams, and audits since the previous CQC assessment. It was not clear that these were used to drive improvements.  There was a service improvement plan which included actions to be taken to review incidents to identify trends, we were not assured this was embedded. People were not consistently supported to exercise full choice and control over their lives. The standard of care records and risk management for individuals requires improvement and consistency.