We inspected Leeming Bar Grange Care Home on 19 June and 14 July 2017. The first day of the inspection was unannounced and we told the provider we would be visiting on day two. We last inspected this service in September 2015 and found the provider was meeting all regulations at that point.

Leeming Bar Grange Care Home is a large purpose built property. The service can provide personal care for up to 60 older people, some of whom were living with dementia. At the time of our visit 51 people were living at the service.

The provider is required to ensure a registered manager is in post as part of their registration. A manager was new in post and they had commenced the process to register. 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.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. We saw all incidents of suspected abuse had been reported to the local authority, however the provider had failed to ensure CQC had received notifications of these events. This is being dealt with outside the inspection process.

There were systems in place to monitor and improve the quality of the service provided. We saw there were a range of audits carried out both by the manager and provider. Where issues had been identified; action plans with agreed timescales were in place to help drive improvements. However, the provider audits had not highlighted that statutory notifications had not been sent to us.

Overall we saw people received their medicines on time and as prescribed. Better information to help staff make decisions about when ‘as and when required’ medicines should be given was needed. The manager had highlighted that pharmacy support was not helping them manage medicines and a new pharmacy supplier was arranged to take over in August 2017. We made a recommendation that the provider ensure all good practice medicines advice was implemented once the new pharmacy supplier was in place.

Risk assessments were in people’s care plans for areas such as moving and handling, falls and pressure care so staff knew how to support people to remain safe. Records to monitor people’s wellbeing improved significantly between day one and day two of the inspection. This meant staff could analyse quickly when a person required different support or a referral to a health professional. We saw the home worked well with visiting professionals and followed advice received to manage people’s wellbeing.

Staff knew people very well; they were able to tell us people’s preferences and dislikes. The manager was working with the team to review care plans to include more of the this detail.

Staff understood the principles of the Mental Capacity Act 2005 and they worked within them to ensure people were empowered to make their own choices. The manager was working with the team to record more clearly consent and decisions made in people’s best interests.

We made a recommendation that the provider use good practice guidance around positive behavioural support to develop their care planning approach.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. The manager told us they would develop the fire drill process.

The manager had implemented robust systems to ensure staff felt supported. Staff told us they felt positive about the changes and felt very well supported by the manager.

People and their relatives felt there was not enough staff at times. The manager felt how staff organised the shift was a factor in this. Additional staff to support people in the evenings

We carried out an unannounced comprehensive inspection on 03 and 05 March 2015. At that inspection we gave the service an overall rating of ‘Good’, but identified a breach of Regulation 23: of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 [This corresponds to regulation 18 (2)(a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014]. The provider had failed to ensure that adequate systems were in place to support workers, through the provision of training and supervision. After the comprehensive inspection in March 2015, the provider wrote to us with an action plan to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection on 02 September 2015, to check that the provider had followed their plan and to confirm that they now met with the legal requirements. This report only covers our findings in relation to that requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Leeming Bar Grange on our website at www.cqc.org.uk.

Leeming Bar Grange provides residential care for up to 60 people who are living with a dementia. The service is provided in a purpose built building located in Leeming Bar, with open countryside views, secure private gardens and a large car park. The registered provider of the service is Leeming Bar Limited, part of the Brighterkind group of care homes.

The manager of the service had changed since our last 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 time of this focused visit the new manager had been in post for just over a month and had not yet registered with us. We discussed the registration requirements with the new manager, who reassured us that they were in the process of applying to register as manager of the service.

Overall we found that the registered provider had taken action to meet the requirements of the regulations by providing training, supervision and appraisals for staff since our last visit. However, there remained areas for further improvement, which were discussed and agreed with the new manager at the time of our visit. The manager was able to tell us what they were doing to make further improvements, such as undertaking a full training audit and review of the arrangements for staff supervision. We will assess this at our next inspection.

People were supported to make decisions where possible, with best interest meetings and decisions being used where people lacked capacity to decide for themselves. Where appropriate relatives were kept informed and involved in people’s care.

People who used the service, and their relatives, were very satisfied with the care provided by the service. Comments made to us included “On the whole I think it’s lovely” and “they really do seem to care, to be interested in them.” People looked well cared for and feedback from a local health care professional was positive.

Safe systems were in place for the administration and storage of medication. Staff administered medication in a safe way and had received regular training and competency checks. The provider carried out regular audits to ensure that people had received their medication correctly.

People spoke highly of the staff, who received regular training and checks on the standard of their work. Comments made to us included “The staff are absolutely lovely, they laugh, joke and are lovely with them " and “The manager is on the ball with the care she wants them (people who use the service) to receive.”

Good systems were in place to monitor the quality of the service. People felt that they could raise any issues easily and that they were effectively resolved. Comments included “The manager is very, very good and if you have a concern she will do something about it.”

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because the inspection was part of an inspection programme to assess whether older people living in care homes are treated with dignity and respect and their nutritional needs are met.

The inspection team was led by a CQC inspector, and joined by an ‘expert by experience‘ and a healthcare professional. These are people who have experience of using services and can provide that perspective and professional advice.

People told us that they enjoyed living at the home and that the care they received was good. One person said ‘It’s top notch here.’ Another said ‘I like it; I am comfortable and looked after.’

We carried out this unannounced inspection on the 2 and 5 March 2015. We last inspected this service in July 2013.

Leeming Bar Grange provides residential care for up to 60 people who have a dementia type diagnosis. The service is provided in a purpose built building located in Leeming, with open countryside views, secure private gardens and a large car park.

Leeming Bar Grange has recently been taken over by Brighterkind. Brighterkind is a part of Four Seasons Health Care group of companies.

The home had a registered manager in place and they had been in post as manager since June 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.

People living at the service received good care and support that was tailored to meet their individual needs. Staff ensured they were kept safe from abuse and avoidable harm. People we spoke with were positive about the care they received and said that they felt safe.

Assessments were undertaken to identify people’s health and support needs and any risks to people who used the service and others. Plans were in place to reduce the risks identified.

Staff understood the principles and processes of safeguarding, as well as how to raise a safeguarding alert with the local authority. Staff said they would be confident to whistle blow (raise concerns about the home, staff practices or provider) if the need ever arose.

Accidents and incidents were monitored each month to see if any trends were identified. At the time of our inspection the accidents and incidents had highlighted that the majority of falls happened between eight and nine am and four and five pm. The registered manager had arranged for more staff to be on duty at these times and the number of incidents had decreased.

We found people were cared for by sufficient numbers of suitably qualified, skilled and experienced staff. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers and we saw evidence that a Disclosure and Barring Service (DBS) check had been completed before they started work in the home. The Disclosure and Barring Service carry out a criminal record and barring check on individuals who intend to work with children and vulnerable adults, to help employers make safer recruiting decisions and also to minimise the risk of unsuitable people working with children and vulnerable adults.

We found that medicines were stored and administered appropriately. We found handwritten entries were not double signed. Any handwritten entries should be checked for accuracy and signed by a second trained and skilled member of staff before it is first used. Records around “when required” (PRN) medicines and covert medicines needed further information ( covert medication is the administration of any medical treatment in disguised form. This usually involves disguising medication by administering it in food and drink). For example one PRN record said Lorazepam to be administered when required, but there was no record of why this medicine would be required, the covert medicine said can be administered covertly but did not explain how.

We looked at the storage and administration of drugs liable to misuse called controlled drugs. We saw these were stored and recorded safely.

We saw that the service was clean and tidy and there was plenty of personal protection equipment (PPE) available. The head housekeeper was the infection control lead and they showed us evidence of audits and schedules they kept.

The registered manager had knowledge of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager understood when an application should be made, and how to submit one.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. Care plans provided evidence of access to healthcare professionals and services. At the time of our inspection care plans were being transferred to Brighterkind care plans. We found these to have little or no information on peoples lives, they were repetitive and had information that was not relevant to the person such as altered states of unconsciousness for someone who was active, alert and mobile.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments.

We saw people were provided with a choice of healthy food and drinks which helped to ensure their nutritional needs were met.

The services training chart highlighted that not all staff had received training that would support them to increase their knowledge to ensure people’s individual needs were met

Staff had not received regular supervisions and appraisals to monitor their performance. The registered manager was aware of this and had put a supervision and appraisal timetable in place.

Staff were supported by their manager and were able to raise any concerns with them. Lessons were learnt from incidents that occurred at the service and improvements were made if and when required. The service had a system in place for the management of complaints. Although the outcome of a complaint was not documented nor were minor concerns.

We saw safety checks and certificates that had been completed within the last twelve months for items that had been serviced such as fire equipment and water temperature checks.

We found the provider was breaching a number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of the full version of this report.