This unannounced comprehensive inspection took place on 18 April 2018 and was carried out by one adult social care inspector and an expert by experience. An expert by experience is a person who has personal experience of using services or caring for a person who uses services. In this case the expert by experience had experience in caring for a person living with dementia. We last inspected this home on 6 February 2016 and it was rated as ‘Good’ overall and ‘Requires Improvement’ in the Effective key question.

Legh House 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. The home is registered to accommodate up to 19 older people in one adapted building. Nursing care is not provided by staff at Legh House. This is provided by the community nursing service. At the time of this inspection there were 18 people living in the home.

The service had a 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 2008 and associated Regulations about how the service is run.’

At our last inspection in February 2016 we rated the service good overall and requires improvement in Effective. At this inspection in April 2018 we found the evidence continued to support the rating of good overall and the rating in Effective had improved to good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Legh House provided elderly people living with dementia and other health conditions with accommodation, care and support. People were protected from risks relating to their health, their dementia related behaviours, mobility, medicines, nutrition and possible abuse. Staff had assessed individual risks to people and had taken action to seek guidance and minimise identified risks. Staff knew how to recognise possible signs of abuse.

Where accidents and incidents had taken place, these had been reviewed and action had been taken to reduce the risks of reoccurrence. Staff supported people to take their medicines safely and staffs’ knowledge relating to the administration of medicines were regularly checked. Staff told us they felt comfortable raising concerns.

Recruitment procedures were in place to help ensure only people of good character were employed by the home. The registered manager was working towards updating their staff files and ensuring all necessary paperwork was available. Staff underwent Disclosure and Barring Service (police record) checks before they started work. Staffing numbers at the home were sufficient to meet people’s needs. Staff had the competencies and information they required in order to meet people’s needs. Staff received sufficient training. The registered manager was working on improving the regularity and content of staff supervisions and appraisal.

Staff treated people with kindness and respect. We found staff had caring attitudes towards people and spoke highly of them, their personalities and qualities. There was a warm and pleasant atmosphere at the home where people and staff shared jokes and laughter. Staff knew people and their preferences well. People’s comments included, “All the staff are lovely” and “They are so kind.”

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and put it into practice. Where people had been unable to make a particular decision at a particular time, their capacity had been asses

Legh house is registered to provide accommodation and personal care for up to 19 people in a residential area of Weymouth. At the time of our inspection there were 16 older people living in the home.

There was no registered manager in post at the time of our 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. The long term manager had left in October 2015 and a new manager was recruited who stayed for two months. The provider was actively recruiting to find a suitable candidate to take on the role.

Deprivation of Liberty Safeguards had not been applied for when people did not have the mental capacity to consent to living in the home. Senior staff ensured that this was addressed immediately following our inspection.

People were engaged with activities that reflected individual preferences, including individual and group activities. Activities were provided by care staff and people’s individual preferences had been sought and recorded. Three people told us they would like more activities to be available.

Staff were consistent in their knowledge of people’s care needs and spoke with confidence about the care they provided to meet these needs. They told us they felt supported in their roles and had taken training that provided them with the necessary knowledge and skills. Not all training had been completed at the time of our inspection. There was a plan in place to ensure staff received refresher training as deemed necessary by the provider. Staff had not received formal supervision in line with the provider’s policy.

Staff understood how people consented to the care they provided and encouraged people to make decisions about their care. Care plans did not reflect that care was being delivered within the framework of the Mental Capacity Act 2005 when people did not have capacity to make decisions for themselves. However, staff showed they understood the importance of enabling people to make their own decisions wherever possible and providing care that is in a person’s best interests.

Quality assurance had led to improvements being made and people, relatives and staff were invited to contribute to this process. Where improvements were identified following feedback from external agencies action had been taken or plans were in place to ensure they happened. Some monitoring had stopped with the arrival of the new manager in November 2015 and no new guidance had been agreed about how to continue with this work. There had been a number of changes introduced at this time and the senior staff were not certain about which to continue implementing or how to develop systems further before a new registered manager was appointed. The provider was aware of this and weekly visits to the home had been introduced to deliver additional oversight during the period before a new registered manager could be appointed. Staff and people were positive about the abilities of the deputies providing day to day management of the home.

People felt safe. They were protected from harm because staff understood the risks they faced and how to reduce these risks. They also knew how to identify and respond to abuse. They knew how to access the contact details of agencies they should report concerns about people’s care to. Care and treatment was delivered in a way that met people’s individual needs. Staff kept records about the care they provided.

People had access to health care professionals and were supported to maintain their health by staff. Staff understood changes in people’s health and shared the information necessary for people to receive safe care. People received their medicines as they were prescribed.

People described the food as good and there we

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 our visit. Their name appears because they were still a registered manager on our register at the time.

We spoke with three people who live at the home. People told us that they understood the care choices available to them, and could have their views taken into account in the way their care was delivered. A person told us, “They always ask before they do anything.”

We found that people's needs were assessed, and care was planned and delivered to meet people's needs. A person told us, “I know I’ve got a care plan. I’ve seen it. I get the services they said I would get.”

People were protected from the risk of abuse and their human rights were respected and upheld. A person told us, "The staff are very kind and friendly."

We viewed a selection of staff records, and saw that relevant checks had been carried out when the home employed staff. Staff had opportunities to gain appropriate qualifications. A person told us, “The staff are very good.”

The provider had appropriate systems in place to monitor and improve the quality of care people received. The registered manager told us, "I monitor people’s comments on a daily basis. It’s a way of keeping me in the loop."

The registered manager was on leave on the day of our visit. We spoke to the registered manager on the telephone following our visit.

We inspected the home in January 2013 and found some concerns with the way medicines were handled in the home. We found some problems with medicines storage,

administration and recording, and we issued a warning notice.

During this inspection, we found that there were improvements in the way medicines were

managed since our previous inspection. We saw that medicines were kept and

administered safely, and people received their medicines in the correct way. Appropriate

arrangements were in place in relation to the recording of medicines.

People we spoke with told us that they received their medicines when they were needed, and that they were given by staff in a caring way

On the day of the inspection on the 24 January 2013 there were 18 people living at Legh House. We spoke with six people who use the service who all told us that staff involve them and their representatives in their care. One person told us "Family know you are being looked after. The home phones my daughter if I am unwell."

People who used the service were treated with dignity and respect. One person told us "Staff are very respectful. I love it here." People told us that staff always knocked their door before entering and asked them when they want to get up.

People who used the service told us that they were given their medicines when they needed them. People also told us that only staff who had been trained in administering medicines were able to give them out. However we found that the home did not protect people from the risks associated with medicines as records were not consistently maintained.

People told us they were treated with respect and were able to personalise their bedrooms. One person told us “I love it here, I really do, they are so nice and kind, they are really lovely”. People told us they received the care they needed and they valued the activities program. One person told us “The staff are so nice, they know what they are doing”.

People told us that they received their medication at the right time. One person told us “I take mainly pain killers, they are very good with the medication, it comes at the right time”.

People told us they were supported by skilled staff and were able to raise complaints if they felt necessary. One person told us “The staff here are very good, they always know if you are not feeling quite well”. Another person told us “I know how to complain, but there is nothing to complain about.

During our inspection we saw people being treated with consideration, however we also saw occasions where people were not treated with respect. For example, during lunch we saw a person was offered a choice of drink and the staff member walk away before they had expressed their choice. We also found people were not protected against the risks associated with medicines because the temperature of the medication refrigerator was not being adequately monitored and procedures for administering medication were not being consistently followed.

People, told us that their privacy and dignity was respected, they felt listened to, their wishes respected and they were treated as individuals. They told us staff were very kind and they were happy with the care provided.

People were positive about the choices they were given especially regarding meals. One person told us that they could not always go to bed or get up at exactly the time they wanted, but they were aware they had to fit in with the others at the home.

People told us that they brought pieces of their own furniture and personal effects to make the rooms more individual. Two people told us that when the home was refurbished and rooms enlarged they planned the lay out of furniture and pictures and chose the curtains.

People told us there were some activities at the home and that they liked to go into the garden when fine, but sometimes staff were not available to take them. Some told us that they enjoyed playing scrabble.

People told us that they felt safe and supported at the home. They told us there were enough staff to care for their needs, that the senior care workers were very experienced and new staff soon learnt what to do.

People told us that if they had any problems then they would ask the manager, who was very approachable. They told us that the manager is very aware of what was happening in the home. Some people told us they had completed a questionnaire about their views of the service. People told us that staff gave them opportunity to give suggestions and feedback.

Relatives, we spoke to, said they were kept informed and involved in care and that staff were responsive and acted on any concerns.