About the service: Leaholme is a residential care home which provides personal care for up to 17 people, some of whom are living with dementia. At the time of the inspection 13 people lived at the service.

People’s experience of using this service:

People were happy living at the service. Staff supported people to have a meaningful life and encouraged them to be independent.

Care and support was tailored to each person's needs and preferences. People and their relatives were involved in developing and updating their planned care.

Staff had received a wide range of training. Checks were made on the ongoing competency of staff.

Staff understood how to safeguard people from abuse. The staff team encouraged and supported people to make choices about what they wanted to do.

Appropriate recruitment checks were carried out to ensure staff were suitable to work in the service.

Medicines were managed safely. Records confirmed people received their medications as prescribed.

Staff were encouraging people who were under-weight to eat fortified foods. We found a range of menu choices were available.

The registered manager ensured that all incidents were analysed and ensured lessons learnt were shared with staff.

People who lacked capacity were supported to have maximum choice and control of their lives. Policies and systems supported them in the least restrictive way possible.

Detailed risk assessments were in place to support people and remain safe.

People participated in a range of activities that met their individual choices and preferences.

The registered manager demonstrated a commitment to providing person centred care for people. Staff felt the registered manager was supportive and approachable.

Rating at last inspection: Good (report published 8 November 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The inspection took place on 19 September 2016, and the visit was unannounced.

Leaholme provides residential care to older people including people recovering from mental health issues and some who are living with dementia. Leaholme is registered to provide care for up to 17 people. At the time of our inspection there were 15 people living at the home.

A registered manager was not in post. However, the provider has been appointed a manager who is due to commence their post the week following the inspection. 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 the last inspection of the service in 9 & 10 June 2015 we asked the provider to make improvements in the recording when people’s medicines were administered. We received an action plan from the provider which outlined the action they were going to take. This advised us of their plan to be compliant by November 2015. At this inspection we found that improvements had been made and medicine recording was undertaken when they were administered and stored safely. The system in place to monitor care records had also improved.

At the last inspection we also asked the provider to take action to ensure there were always enough staff members around to safely meet people’s needs. We found that improvements had been made and found staffing numbers were adjusted in line with people’s needs to ensure a safe working environment for people.

At the last inspection we asked the provider to take action to ensure risks to people had not always been assessed, and where risks had been identified and assessed, these had not always been reviewed regularly. We found that improvements had been made and risk assessments were in place and reviewed regularly.

At the last inspection we asked the provider to make improvements to the audits, checks and governance in the home. We found that improvements had been made and a series of checks had been introduced that were overseen by the deputy manager and group quality manager and then referred to the provider.

At the last inspection we asked the provider to make improvements to the efficiency of communication between members of the staff team. We found that improvements had been made and saw that detailed handovers were in place, as well as regular meetings and supervision for staff.

At the last inspection we asked the provider to take action to ensure staff recorded what food and quantity of fluids where people were at risk of dehydration and malnutrition. We found that improvements had been made and found nutrition and hydration were recorded in line with instruction from health professionals, and where staff felt the person’s diet required monitoring.

At the last inspection we asked the provider to take action to ensure staff gained people’s consent prior to care being offered. We found that improvements had been made and how people were asked for their consent to care prior to their admission to the home. This was in addition to staff agreeing their actions prior to each caring intervention.

Relatives we spoke with were complimentary about the staff and the care offered to their relations. People were involved in the review of their care plan, and when appropriate their relatives were included. We observed staff positively interacted with people at lunch, where people were offered choices and their decisions were respected. Staff had access to people’s care plans and received regular updates about people’s care needs. Care plans included changes to peoples care and treatment and people were offered and attended routine health checks, with health professionals both in the home and externally.

People were provided with a choice of meals that met their di

We spoke with four people who used the services of Leaholme and asked them for their views about the care and support they received. People’s comments included: “They’re very good to me, they have to do everything for me and if I need assistance I only have to press the buzzer. I feel that my views and wishes are respected.” “I’m very independent and the staff support my right to be independent.” “I think it’s beautiful here and I think it’s lovely and ideal. I’m contended and I can’t complain about anything.” People we spoke with told us that staff assisted them to visit local shops, parks and to attend Church.

We spoke with visitors who were visiting a relative and asked them for their views about Leaholme and the care the service provided. They told us: “She’s well looked after here.” The visitors told us that they had a positive relationship with the staff and that communication was effective.

We observed that people who used the services sat outside in the rear garden, whilst others walked around the garden. People were served refreshments throughout the day. People we spoke with made positive comments about the meals and our observations of the dining experience for people at lunchtime were positive.

We found staff were employed in sufficient numbers and had received the appropriate training which enabled them to meet the needs of people who used the service. People lived in an environment which was well maintained and records we viewed showed that the service used external contractors to maintain systems within the service. Records for the care and support of people who used the service and staffing records were up to date and accessible.

During the inspection we spoke to the majority of the people living at the home. The conversations gave us a good indication that all the people we spoke to where content at the home.

Several people said they thought that staff were respectful of their privacy and dignity, for example, always knocking on their bedroom doors, explaining what they were doing. All the people we spoke to said they were given choices during the day; what clothes to where; where they wanted to eat their meals.

Carers told us that two people living at the home were taken to church every week and two other people received communion within the home. The managing director told us that they were trying to encourage more independence for people living in the home by accessing activities in the community. People we spoke to said they were looked after very well. On the day of the inspection all the people at the home were appropriately dressed. This showed that staff had taken care to ensure people had access to all necessary facilities to make themselves look and feel good about themselves. This was confirmed by the people we spoke to. All the people we spoke to said they felt very safe and well looked after in the home.

This inspection took place on the 9 and 10 June 2015 and was unannounced.

Leaholme is registered to provide accommodation and personal care for up to 17 older people including people living with dementia. The accommodation is provided on three floors which are accessible via a passenger lift. There were 15 people living at the service when we visited.

The person managing the service [the acting manager] was in the process of applying to be the 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.

People told us they felt safe living at Leaholme and the staff team had received training on how to keep people safe from harm.

A recruitment process had been followed when new staff members had been employed. This included checks to make sure they were suitable to work at the service. The staff team had received training relevant to their role and ongoing support through team meetings and supervision sessions had been provided.

Risks to the people who used the service had not always been assessed. Where risks had been identified and assessed, these had not always been reviewed regularly so that people remained safe from possible harm.

We found some concerns regarding the management of medicines. Records had not always been completed and staff members hadn’t always signed when they had administered someone’s medicine.

We were told there were not always enough staff members around to safely meet people’s needs. Our observations confirmed this. The acting manager acknowledged this and told us they would look into the current staffing numbers.

People had been involved in making day to day decisions about their care and support and the staff team understood their responsibilities with regard to gaining people’s consent. It was not always evident within people’s records that formal consent to their care and welfare had been obtained.

People’s nutritional and dietary requirements had been assessed and a balanced diet was provided, with a choice of meal at each mealtime. Members of staff were not always recording when they were providing people with food and fluids. This meant they could not demonstrate that people had received the nourishment they needed to keep them well.

The staff team knew the care and support needs of those they were supporting though communication was not always effective.

People’s privacy was maintained at all times though their care and support needs were not always met in a dignified way.

People who were able to verbally communicate told us they knew how to raise a concern and they were confident that things raised would be dealt with promptly.

There were systems were in place to monitor the service being provided, though these were not always effective in identifying shortfalls, particularly within people’s care records.