This was an unannounced inspection carried out on 17 January 2018. We last inspected the service on 24 May 2016 when the service was overall rated as 'Requires Improvement'.

Green Lane Intermediate Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. This service provides short term rehabilitation to maximise the independence of people and enable them to return to living in their own home in the community. The service comprises care and therapy (occupational therapy and physiotherapy) all based in the same building and provides a range of facilities and equipment for up to 60 people who require rehabilitation. At the time of our inspection 34 people were using the service.

At the time of our inspection there was no 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.

Since our last inspection the service had closed for 11 months before reopening in November 2017. At the time of this inspection people were only living on the top floor of the building.

Medicines were managed in a safe and proper way; we saw good practice in the administration and recording of people's medicines. People received their prescribed medicines in a timely way.

Some people were not always happy with the staffing levels, staff and relatives felt there were enough staff and this was confirmed in our observations. However meal times became busy and some people were left waiting. At other times we saw staff were available and responded promptly to people.

Robust recruitment procedures were in place, which helped ensure staff were suitable to work in the care service. Staff received the training and support they required to carry out their roles and meet people's needs.

People told us they felt safe and this was echoed by relatives we met. Staff understood safeguarding procedures and how to report any concerns. There were procedures in place to manage risk effectively and we found evidence throughout the inspection that all efforts were made to support people's safe mobility and prevent falls. Accidents and incidents were logged and monitored by the manager for trends and areas for improvement.

We found people's nutritional needs were met. There were choices for meals and fluids and dietetic advice was obtained when required. The lunchtime experience was busy but had a social atmosphere with lots of chatter and interaction from staff. People told us they liked the meals provided to them. The dining experience appeared disorganised and some people were left waiting for their food. We have made a recommendation that the provider reviews people’s dining experience.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff had an understanding of the Mental Capacity Act 2005 (MCA) and we saw the service worked in line with the principles of the MCA.

People told us they were not stimulated as no organised activities took place. We have made a recommendation that the provider revisits the provision of activities within the service.

People and relatives praised the staff who were described as kind, caring and considerate. People told us they were treated with respect and this was confirmed in our observations. We saw staff engaged positively with people, encouraging and supporting their independence and promoting their dignity. Staff had a good knowledge and understanding of people's needs and worke

The inspection took place on 24 May 2016 and was unannounced. We carried out a comprehensive inspection in May 2015 and rated the home as requires improvement. Where we found the provider was meeting all the regulations we inspected.

Bremner House (formally Castleton Care Home) is a detached purpose built property located in the Wortley area of Leeds. The home provides care and support for up to 60 older people, some of whom are living with dementia or related mental health problems.

At the time of this inspection the home did have a registered manager; however, they were no longer in day to day control of the home. An interim manager was in charge of 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 2008 and associated Regulations about how the service is run.

We found some areas of risk within the home. Appropriate steps had not been taken to ensure staff received timely training and ongoing or periodic supervision to make sure competence was maintained.

At the time of our inspection Deprivation of Liberty Safeguard applications were been carried out appropriately. However, the care plans we looked at did not contained appropriate mental capacity assessments.

People’s care plans did not always contained sufficient and relevant information to provide consistent, care and support. Complaints were welcomed but were not always investigated and responded to appropriately. Effective systems were not in place to ensure people received safe quality care. People had opportunity to comment on the quality of service through daily interaction.

We found people were cared for, or supported by, sufficient numbers of suitably qualified and experienced staff. Robust recruitment procedures were in place to make sure suitable staff worked with people who used the service and staff completed an induction when they started work.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm. Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. People were protected against the risks associated with medicines because generally the provider had appropriate arrangements in place to manage medicines safely.

There was opportunity for people to be involved in a range of activities within the home or the local community. People’s nutritional needs were met and people received good support which ensured their health care needs were met. Staff were aware and knew how to respect people’s privacy and dignity.

We found breaches in regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the end of this report.

The inspection took place on 19 May 2015 and was unannounced.

At the last inspection in October 2014 we identified that the provider had breached five regulations associated with the Health and Social Care Act 2008.

We found people did not experience care, treatment and support that met their needs and ensured their safety and welfare; there were not always effective systems in place to manage, monitor and improve the quality of the service provided. The registered person did not ensure staff received appropriate training, professional development, supervision or appraisal and did not take the necessary steps to ensure that, at all times, there were sufficient numbers of experience staff to meet people’s health and welfare needs. We also found people were not always protected against the risks associated with medicines as appropriate arrangements to manage medicines were not in place. We issued the provider with a warning notice with regard to this.

We told the provider they needed to take action and we received a report in December 2014 setting out the action they would take to meet the regulations. At this inspection we found improvements had been made with regard to these areas.

Castleton Care Home is a detached purpose built property located in the Wortley area of Leeds. The home provides care and support for up to 60 older people, some of whom are living with dementia or related mental health problems.

At the time of this inspection the home did not have a registered manager. The previous registered manager was de-registered in December 2014. 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.

The service had a very pleasant welcoming entrance, clean and fresh smelling, with pictures on the walls. En-route to the lounge we were met by a staff member who said, “We are very glad to see you.” They went on to explain the staff had been working very hard to improve, things had improved and they were now keen to demonstrate that via an inspection. During our discussions, the regional manager explained they were working really hard to eliminate some of the problem areas in the home and were using learning from other homes in the group to improve things. The home manager had resigned and a replacement manager had been appointed. Until they could start, the regional manager was overseeing things, with the help of a quality assurance manager.

The home had significantly improved since our previous visit. We saw evidence of good relationships between people who used the service and staff who understood their individual needs. Activities for people were more meaningful and people were purposefully engaged. We saw staffing levels were now determined by the use of a dependency tool and these were maintained and staff received regular supervision and training which helped to support people safely. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines safely.

People, their relatives and staff gave positive feedback about the service and how it had improved over recent months. The manager had improved the quality monitoring of the service, which enabled them to drive improvement.

People’s care plans contained sufficient and relevant information to provide consistent, person centred care and support. Mental capacity assessments had been completed and the service had made Deprivation of Liberty Safeguards applications where appropriate.

Robust recruitment and selection procedures were in place to make sure suitable staff worked with people who used the service and staff completed an induction when they started work.

People were happy living at the home and felt well cared for. People had good experiences at mealtimes and received good support that ensured their health care needs were met. Staff were aware and knew how to respect people’s privacy and dignity.

People told us they felt safe and knew how to make a complaint if they needed to. Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe.

This was an unannounced inspection carried out on the 14 October 2014.

At the last inspection in June 2014 we identified that the provider had breached three regulations associated with the Health and Social Care Act 2008. We found people did not experience care, treatment and support that met their needs and ensured their safety and welfare, people were not supported to eat and drink sufficient amounts to meet their needs and people were not protected from the risk of infection because appropriate guidance had not been followed. We told the provider they needed to take action and we received a report on the 1 August 2014 setting out the action they would take to meet the regulations. At this inspection we found improvements had been made with regard to these areas. However, we found additional areas of concern.

Castleton Care Home is a detached purpose built property located in the Wortley area of Leeds. The home provides care and support for up to 60 older people, some of whom have dementia or related mental health problems.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People were not always protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. This is a breach of Regulation 13 (Management of medicine); of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We found people were not always cared for, or supported by, enough skilled and experienced staff to meet their needs. Staff did not complete an induction on joining the home and opportunity was not available for staff to attend regular supervision meetings. This is a breach of Regulation 23 (Supporting workers); of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and a breach of Regulation 22 (Staffing); of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We observed interactions between staff and people living in the home and in the main staff were respectful to people when they were supporting them. However, at times interactions and communication between people living in the home and members of staff was poor. Some staff did not follow people’s care plans  putting people at risk of unsafe care and support. This is a breach of Regulation 9 (Care and welfare of people who use services); of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

There were not always effective systems in place to manage, monitor and improve the quality of the service provided. Staff were supported to raise concerns and make suggestions when they felt there could be improvements but it was not always clear who they should approach to do this. This is a breach of Regulation 10 (Assessing and monitoring the quality of service provision); of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Activities were provided both in the home and in the community. However, these were not always meaningful and simulating. Staff told us people were encouraged to maintain contact with friends and family.

We saw from the records we looked at and speaking with relatives that complaints were not always documented or responded to appropriately.

Staff were aware of the values of the service and knew how to respect people’s privacy and dignity.

People’s physical health was monitored. This included the monitoring of people’s health conditions and symptoms so appropriate referrals to health professionals were made.

People’s health, care and support needs were assessed and individual choices and preferences were discussed with people who used the service and/or a relative. The care plans included risk assessments. Staff had good relationships with the people living at the home and the atmosphere was relaxed.

People’s nutritional needs were being met. People were supported to eat and drink enough to maintain their health.

People lived in a clean, comfortable and well maintained environment and were protected against the risk of infection.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm.

The home had policies and procedures in place in relation to the Mental Capacity Act 2005. The regional manager told us the further work was needed to establish if people’s liberty was being restricted.

We saw staff had completed mandatory training and future training had been arranged.

We found breaches of the Health and Social Care Act 2008 (Regulated activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

At our inspection we gathered evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is the summary of what we found but if you want to see the evidence supporting our summary please read our full report. The summary is based on speaking with people who used the service, the staff supporting them, our observations and from looking at records.

Is the service safe?

People were treated with respect and dignity by staff. One person said, “I have no concerns, we are treated very well.”

We found care plans and risk assessments were not detailed or person centred to provide staff with clear guidance on how to meet people's health and social needs.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs.

Overall, the service was clean and hygienic with systems in place to ensure people were not put at risk from infection. However some work was still required and as such we have asked the provider let us know what action they are taking.

Is the service effective?

Health care needs were assessed however, there were no evidence showing people who used the service or their relatives were involved in developing their plans of care. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to involving people in planning their care.

Specialist dietary, mobility and equipment needs had been identified in care plans when needed.

Care records showed people had regular contact with health and other professionals.

Is the service caring?

People who used the service were asked about their care and able to make decisions. They were supported by kind and attentive staff.

People who used the service told us they were happy with the care and support received. Their comments included: “I do like it here, all very nice, staff are lovely” and “I have everything I need here.”

We saw people were happy, relaxed and comfortable with staff in their interaction with them.

Is the service responsive?

People who used the service told us they mainly knew how to complain or raise concerns if they had any.

We saw people who used the service were responded to promptly when they asked for any support or assistance

People were supported to be involved in activity of their choice within the home.

Is the service well led?

Staff said they felt the service was well managed and the Registered Manager was approachable. They said they had confidence any issues brought to her attention were always dealt with properly and thoroughly. Staff said they understood their role and what was expected of them.

The Provider had systems in place to assess the quality and safety of the service provided.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

At the time of our visit there were 48 people living at Castleton Care Home. During this inspection we spoke with 10 people who used the service, four visitors and seven staff. We also observed how people were cared for, to help us understand the experiences of people who used the service. This was because most people had dementia care needs, which meant they were not always able to give us their views. We saw people were treated with consideration and respect.

We reviewed five people’s care records. They contained care plans regarding people’s abilities in relation to consent and their mental capacity. We found the provider had processes in place to assess, support and monitor people’s capacity to make decisions. We saw appropriate action had been taken where people were not always able to make their own decisions and choices.

We saw evidence that care plans promoting wellbeing and safety linked to need were in place. Risk assessments had been developed according to need. Care plans were evaluated monthly or as changes occurred.

We reviewed staff rotas and found there were sufficient staff on duty to respond to people’s needs. The manager explained that the staffing levels were constantly reviewed according to people’s changing dependency requirements.

We found that all records were located promptly and kept safe and secure. Records were archived at the provider’s head office and after the appropriate period of time were shredded by an external contractor.

People who used the service were not able to tell us about their views of the service they received. However, through our observations, we saw that people seemed comfortable in their surroundings and in their interactions with staff.

People's rights and dignity were maintained and respected. We observed staff attending to people's needs in a discreet way which maintained their dignity. The three members of staff we spoke with were able to explain and give examples of how they would maintain people's dignity, privacy and independence.

We looked at seven care plans, which were reviewed regularly but we found them difficult to follow. However, they did contain sufficient information to provide care to people who used the service.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found the home to be clean. We observed staff wearing appropriate protective clothing and using hand wash alcoholic gel when supporting people with personal care. Their practices showed that there was attention to minimise the risk of cross infection and a good standard of hygiene.

We found that people's complaints were fully investigated and resolved, where possible, to their satisfaction. We saw evidence that the provider had a system in place for tracking and responding, including timescales, to complaints received.

People who use the service were not able to tell us about their views of the service they receive. However, through our observations, we saw that people seemed confident in their surroundings and in their interactions with staff.

We did speak to one person who said that the staff were lovley and nothing was too much trouble.

The previous inspection identifed some serious areas of concern. We issued urgent compliance actions. The provider responded quickly to rectify these concerns and has kept us up to date with improvements

We spoke with a relative who told us they were generally very pleased with the care and support their relative received. They said that medical needs were attended to promptly. Their only concerns were around the cleanliness of the home, particularly bedding.

We spoke to another relative who told us they had some concern about the care and welfare of people at the home. They said when they visited they often observed people being left for long periods in the lounge without staff attention.

Relatives of people who use the service said they felt people were treated with dignity and respect and were given choices about the way in which care was given. Their comments included:

“Staff are very respectful, treat them well, as human beings”

“Treat her well, look after her well”.

Relatives told us that they felt involved at the home. They said they were kept well informed on their relatives care and support needs. They said staff listened to them about care needs and were positive about any contribution they could make to the person’s care, for example, food and nutritional support, likes and dislikes.

People’s relatives told us they were happy with the care and support provided at the home. They said,

“Very good care, (name of person) always looks clean and tidy”

“She always looks well presented, just like she always used to be”.

People who use the service said they enjoyed the food in the home. One said, “Castleton- it’s lovely here, nice people and nice food”.

People who use the service were not able to tell us if they felt safe or protected from abuse. However, through our observations, we saw that people seemed confident in their surroundings and in their interactions with staff. They approached staff when they needed to and made good eye contact with them.

Relatives of people who use the service had no concerns about people’s safety. Their comments included:

“(name of person) must feel safe and secure here. She doesn’t keep trying to get out like she did at the last place”

“(name of person) has settled very well here, seems comfortable with all the staff”.

People’s relatives said they were happy with the standards of cleanliness at the home. They said:

“Always seems nice and clean”

“Seems clean to me”.

Relatives of people who use the service said they thought the home had enough staff. They said:

“Staff are lovely, very kind and patient, quite special people”

“Always enough staff around”.