This inspection took place on 13 and 19 November 2018 and was unannounced on the first day. Leighton Court 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 provide personal care and nursing care for up to 48 people. The ground floor accommodated people who had chosen to live at the home and people receiving respite care. The first floor provided rehabilitation for people leaving hospital as part of a scheme known as ‘Transfer to Assess’.

The home is required to have 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. The home had a registered manager who had been in post for several years.

At our last inspection of Leighton Court in July 2017, we found a breach of Regulation 18 of the Health and Social Care Act: staffing, because the provider had not ensured there were enough staff on duty at all times to meet people's needs in a timely manner. During this inspection we found that there were enough staff, but there was a heavy reliance on Agency staff which put pressure on the home’s staff.

Staff were recruited safely. Staff were supported in their role through an induction, supervisions and an annual appraisal. Training was provided to ensure staff had the knowledge and skills to work safely and effectively.

People told us they felt safe in the home and that they had no concerns regarding their care. They told us the staff were kind and caring and protected their dignity and privacy. The premises were clean and well maintained although ‘tired’ in places.

People’s medicines were managed safely.

Applications to deprive people of their liberty had been made appropriately. Records showed that consent was sought in line with the principles of the Mental Capacity Act 2005.

People were satisfied with their meals and with the choice of food available.

A range of social activities was provided to keep people stimulated and occupied.

The manager and the area director completed regular quality monitoring audits which identified any areas needing improvement. Action plans were agreed and implemented by the manager and the staff team.

At our last inspection of this service on 12, 13 and 16 January 2017 breaches of legal requirements were found. This was because risks in the delivery of care were not always properly managed. People did not always receive person centred care or care that respected their right to dignity and privacy. The provider had failed to ensure there were sufficient staff on duty at all times to meet people’s needs and some staff had not received an appraisal for some time. These failings meant the service was not well led.

We issued the provider with two warning notices. These related to breaches of Regulation 12 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was with regard to safe and appropriate care and good governance. A warning notice is an enforcement action used by the Care Quality Commission to direct a provider to improve their service to meet requirements of a specific regulation within a set time period. We gave the provider until the 30 April 2017 to meet their legal requirements in relation these regulations.

We requested an action plan from the provider for the other breaches found during our inspection and the provider submitted an action plan outlining the improvements they intended to make.

At this inspection, we found that improvements to the management of risk; the appraisal of staff; people’s right to privacy and dignity; the environment in which people lived and the way in which the service was managed had been made. These was a continued breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 with regards to staffing levels and further improvements were required with regards to the assessment and planning of some people’s care needs and preferences.

Leighton Court Nursing Home is a purpose built building close to Liscard town centre in Wallasey. There are 48 single occupancy bedrooms. The home provides support for people with both nursing and personal care needs. The home also provides an intermediate care service. This means the home offers support to people discharged from hospital but who need a period of rehabilitation before they are ready to return home independently. There are 25 beds reserved for this purpose on the first floor (the IMC unit). At the time of our visit 44 people lived at the home.

There was both a home manager and a registered manager 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 home manager had overall managerial control of the service with the registered manager acting as the deputy manager. At the time of our visit, the home manager and registered manager were not available so a manager from another of the provider’s homes assisted with the inspection.

During our visit, we asked people if they thought there was enough staff on duty. Their opinions were mixed. Our observations of care were similar to our last inspection when we found that there was not always sufficient staff on duty to meet people’s calls for assistance in a timely manner. We looked at staff rotas and saw that the number staff on duty did not always correspond with the number of staff determined as safe by the provider. This was mainly at night. Some staff had also worked excessive hours without a break. Overall, we found that little improvement to the staffing levels at the home had been made since our last visit.

We looked at the care files of five people and saw a marked difference in the quality of information available to staff in the delivery of care to people who lived on the residential unit as opposed to those people who lived on the IMC unit. People receiving residential c

At our last inspection on 1 and 3 December 2015, breaches of legal requirements were identified. These breaches related to unsafe medication management, a lack of staff supervision and support, a lack of appropriate systems to ensure people’s legal consent was obtained and ineffective management and governance. We asked the provider to take appropriate action to ensure improvements were made.

We undertook this comprehensive inspection on the 12, 13 and 17 January 2017. During this visit we followed up the breaches identified during the December 2015 inspection. We found that sufficient improvements to the way medicines were managed and how people’s consent was sought, had been made. We found however that although staff now received regular supervision, they did not always have an annual appraisal of their skills and we found that no appropriate action to ensure that the service was effectively managed had been taken. This was a continued breach of Regulation 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We also identified new breaches of the Health and Social Care Act 2008 with regards to Regulations 9,10 and12, These breaches related to the management of risk, the delivery of person centred care and poor staffing levels. You can see what action we told the provider to take at the back of the full version of this report.

Leighton Court Nursing Home is a purpose built building close to Liscard town centre in Wallasey. There are 48 single occupancy bedrooms. The home provides support for people with both nursing and personal care needs. The home also provides an intermediary care service. This means the home offers support to people discharged from hospital but who need a period of rehabilitation before they are ready to return home independently. There are 25 beds reserved for this purpose on the first floor. At the time of our visit, there were 45 people who lived at the home.

There was both a home manager and a registered manager in place at the home 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 home manager had overall managerial control of the service with the registered manager acting as the deputy manager at the time of our visit.

We spoke with eight people and two relatives during our visit. All of the people felt safe at the home and said staff treated them well. A relative however felt that the care of their loved one required improvement.

We looked at the care records of eight people. We found that people’s care plans did not cover all of their needs and lacked clear information about the management of some risks. We found that some of the risk management actions had not been acted upon consistently, to protect people from harm. Where people had challenging behaviours, appropriate risk assessments had not been completed to ensure people were appropriately supported. Dementia care and aspects of some people’s person centred care was poor with care plans lacking adequate information on people’s emotional and social needs.

We found the provider’s emergency procedures needed improvement to ensure people were safely evacuated in the event of an emergency. This was because the personal emergency evacuation plans in place for each person who lived at the home, were sometimes inaccurate and out of date.

Staff had been recruited safely but some staff member’s criminal conviction check had not been renewed since they first commenced in employment. For one member of staff this was six years ago. This meant there was a risk it could be out of date.

We looked at the support and training arrangements in place for staff and foun

A service user handbook and a statement of purpose were given to people before they began to use the service. The documents included information about the service and what could be expected. We saw that staff spoke to people in a respectful manner and explained what they were doing before they carried out any treatment and people were asked for their consent.

A full initial assessment was undertaken before people began to use the service and a person centred care plan was developed over a number of weeks. We spoke with six people who used the service and comments included; "The girls are great", "I feel respected and safe", "This is a brilliant place" and "I get what I need". Staff we spoke with were familiar with the needs of the people they were supporting and understood what was required to meet them.

The home co-operated with other providers and people were supported by health and social care professionals from other hospital and community services.

A new electronic medication system had been introduced to manage people's medications effectively and safely. We observed the medication round and were shown how the system highlighted errors to avoid them before they occurred.

We found that staff were recruited appropriately, induction was received and training was provided so that they could support the people using the service.

There was a suitable complaints policy and people knew how to access staff and speak with the manager if they had any concerns.

We spoke with six people living in the home who told us that they were looked after well. One person told us that she would prefer to live at home but realised this was not possible. We spoke with a visiting health professional who told us that they had no concerns regarding the care of their patients.

Three people told us that they had plenty to eat and they enjoyed their food. Two relatives told us that they felt their relatives were safe and well looked after in the home. One person living in the home said that the staff were “little angels”.

This comprehensive and unannounced inspection took place on 01 and 03 December 2015. It was triggered because we had received some information of concern.

Leighton Court Care Home is part of the HC One group of health care services. The home is registered to provide accommodation for up to 48 people who require residential, nursing or intermediate care. At the time of our inspection, there were 47 people in total living in the home.

The home is a modern building, with accommodation on the ground and first floor and other facilities on the second floor.

The ground floor has bedrooms for up to 24 people who need permanent residential or nursing care. The first floor is for up to 24 people receiving intermediate care. Intermediate care a short term intervention (usually up to six weeks) and is intended to give people who are discharged from hospital, time to recover and receive rehabilitation in order for them to return safely to their own homes.

The kitchen and other ancillary rooms such as the staff room are on the second floor. Stairs and a passenger lift link all the floors. Outside there is an enclosed garden area to the rear of the building and car parking to the front.

The home required and had in post, 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. The same person had been the registered manager for several years.

We found the service to be caring and people and their relatives and other visitors confirmed this. A relative and a staff member told us they would be happy to place one of their relatives in the home. People told us they were treated as individuals, with respect and dignity and that their privacy was also respected.

The home was clean, tidy and smelled fresh. We saw that there was a good relationship between the people living in the home and the staff. Relatives and other visitors were made welcome.

NHS staff, who were seconded to the home to support people in the intermediate care unit, were also friendly and relaxed, but professional and focussed on their jobs.

We found breaches of the Health and Social Care Act 2008. These related to the administration of medicines, staffing levels, staff training, the application of the Mental Capacity Act 2005 and the management of the home.

You can see what action we told the provider to take at the back of the full version of the report.