Leominster Care Home is located in Leominster, Herefordshire. The service provides accommodation and care for up to 51 older people. On the day of our inspection, there were 36 people living at the home, some of whom were living with conditions such as dementia and Parkinson’s disease.

The inspection took place on 26 August, 1 September and 6 October 2016.

There was a registered manager at this home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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's safety and wellbeing was promoted by staff. People were encouraged to raise any concerns about their safety. People were involved in decisions about keeping them safe. People's individual risks associated with their care and support were known by staff.

There were sufficient staff to safely meet people's needs. People were cared for by staff who knew how to recognise signs of abuse or harm and what action to take.

People received their medicines safely and as prescribed.

People were supported by skilled and competent staff. Staff received the training and on-going support required to enable them to meet people's needs.

People were encouraged to eat a varied and healthy diet, including fruit and vegetables they had grown themselves. People's views and suggestions were sought about meals and these were used to plan the food provided.

People's health was maintained. People saw a range of healthcare professionals as and when required.

People enjoyed positive relationships with staff. People were involved in decisions about their care. People were treated with dignity and respect and their privacy was maintained.

People's individual preferences were known by staff. Staff adapted to meet people's changing needs.

People were encouraged to maintain their hobbies and interests, as well as take part in a range of in-house social and leisure opportunities.

People's opinions, comments suggestions were valued and acted upon. Where complaints had been made, these had been investigated and action taken.

The registered manager had created a positive and inclusive atmosphere in which people's and staff's views mattered. People had decided on the home's visions and values, which were known and shared by the staff team.

The registered manager and provider maintained oversight of the quality of care provided to people, and sought to continually improve this.

We considered our inspection findings to answer the questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found.

Is the service safe?

Both the people who lived in the home and their relatives were pleased with the care provided and felt that their views were respected and listened to. The staff worked in a safe and hygienic way and used appropriate protective clothing. There were enough staff to meet the needs of the people living in the home and a member of the management team was available on call in case of emergencies. One person said: “I feel safe. I would be the first to complain if I saw anything.”

Staff personnel records contained all of the information required by the Health and Social Care Act. This meant the provider could demonstrate that staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

The registered manager and the staff we spoke with understood the importance of safeguarding vulnerable adults, could identify potential abuse and knew how to report any incidents of abuse.

Is the service effective?

People told us that they were happy with the care that had been delivered and their care records were up to date and signed by them. One relative said: “She is well cared for.” Another relative said: “If there is anything wrong or they call the doctor they ring me.”

Care records confirmed people’s preferences and needs had been recorded and care and support had been provided in accordance with people’s wishes. One relative said: “She was very frail, skin and bone when she came here. Now she is a good healthy weight.”

We heard that information was shared effectively between staff. Several ways of sharing information included daily management team meetings, handovers, the black communications diary, daily records, and monthly reviews.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and encouragement when supporting people. One relative said: “They are very good.” One person who lived in the home said: “I consider myself very lucky.”

Is the service responsive?

People’s needs had been assessed before they were admitted to the home. Their needs for support and treatment were carefully described so that care workers knew exactly what tasks to undertake. Changes in people's care needs were reported to the team leader and they briefed care staff.

A monthly review of the home had identified a concern about people’s call alerts. Staff were briefed to make sure the call buttons were kept in reach. A survey had highlighted that the call system was very noisy so the provider had replaced this system.

Is the service well-led?

Staff had a good understanding of the culture of the home and quality assurance processes were in place. People told us they had received customer satisfaction surveys and we saw evidence that feedback had been acted upon. A meeting for people who lived in the home was held every three months to seek suggestions for any improvements required. Staff told us they were clear about their roles and responsibilities and were well supported. One said: “I can go to her (the manager) and ask something and she will give me an answer straight away.”

We talked with some of the people who lived in this home and they said that they were well looked after. They said the staff always asked them how they would like things to be done. They said staff were always mindful of their privacy and treated them with respect.

People told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. Staff told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were always available when they needed help. They said that the staff were friendly and always acted professionally. One person said, “Staff are excellent by and large” and another said, “The staff are very good”.

The provider had developed a system whereby they can monitor how well the home was meeting the needs of the people who live there.

People who lived in this home said that they were well looked after. They told us that the staff always asked them how they would like things to be done, always respected their privacy and treated them with respect. They said staff talked to them about how they liked their support to be provided.

Staff provided health and social care support well. Community services were accessed to support people with when necessary.

People told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. Staff told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were always available when they needed help. People’s relatives told us that staff were around and available to talk to when they visited. They said that the staff were friendly and always acted professionally. One person said that they were “Nice, very helpful and always busy” and another said “I like the staff. They are excellent”.

People we spoke with said their comments were listened to. A visitor said that they would not hesitate to talk to staff if something was wrong. The home’s management held regular meetings with the people who use the service to find out what people thought about how their care was delivered.