About the service:

Levanto Residential Care Home is a care home for older people. The care home accommodates 20 people in one adapted building. The service was providing personal care to 17 people aged 65 and over at the time of the inspection. Most people were living with dementia.

People’s experience of using this service:

People told us they felt safe living at Levanto Residential Care Home. There was a relaxed atmosphere between people and staff. Staff knew people well and were kind, caring and attentive.

Care and support was personalised to each person to ensure this was carried out to meet their needs and preferences.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were protected from the risk of harm. Risks were managed safely and safe processes were in place.

Staff had enough time to meet people’s needs and spend time with them in conversation. Staff had completed training to ensure they had the knowledge they needed to meet people’s needs effectively.

The environment was well maintained and equipment was regularly serviced. Signage helped people living with dementia to identify rooms. Some carpets had been replaced and were matt and even coloured. However, there were still some highly patterned carpets in communal areas. These are not suited to the needs of people living with dementia. The assistant manager told us there were plans to replace these.

Quality assurance processes ensured people received high quality care.

More information is in the full report.

Rating at last inspection:

Good (The comprehensive report was published on 17 August 2016); Good (The focused report was published on 15 March 2017).

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about this service until we return to visit as part of our re-inspection programme. If we have any concerns, we may inspect sooner.

We undertook this unannounced inspection on 30 January 2017. Levanto Residential Care Home is registered to provide personal care and accommodation for a maximum of 20 older people some of which were living with dementia or physical disabilities. At this inspection there were 19 people living in the home.

At our last comprehensive inspection on 27 May 2016 we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the registered provider had not ensured staff had acted in accordance with the requirements of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards for people living at the home.

After the comprehensive inspection, the registered provider sent us an action plan telling us how they would meet legal requirements. We undertook this focused inspection on 30 January 2017 to check they had followed their plan and to confirm they now met legal requirements.

This report only covers our findings in relation to the specific breach of regulation from the last inspection, and one question we normally asked of services; 'Is the service effective?'. The other four questions; whether the service is 'safe', 'caring', 'responsive' and 'well led' were not looked at on this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Levanto Residential Care Home on our website at www.cqc.org.uk'.

There was a registered manager in post. 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 in May 2016 we found although staff sought people's consent for their day to day care, where people appeared to lack capacity, people's rights were not protected. This was because staff did not complete mental capacity assessments for all of the people that required them. There were no records to demonstrate staff involved relatives and other professionals in 'best interest' decisions about people's care and treatment. Some people were subject to restrictions on their liberty for their safety and well-being. We saw that only some applications had been made to deprive people of their liberty. this was not in line with the requirements of the Mental Capacity Act 2005.

At this inspection, we found that the provider had taken action to comply with the requirements of the Mental Capacity Act 2005. Improvements had been made in all of these areas and the breach of regulation had been met.

The provider sought authorisation if restrictions were in place to keep people from coming to harm. Staff understood which decisions people were not able to make for themselves and how to appropriately support them in their best interests.

People had their health needs met and had access to a range of health care professionals and records were kept of any visits or appointments along with any action required. People were supported to eat a healthy balanced diet and appropriate action was taken when concerns with people's dietary intake were identified.

Staff received effective levels of support and one to one supervision. Staff told us they felt supported by the management team. People were supported by staff who had completed relevant training to enable them to meet the assessed needs of the people who lived at the home. Staff were encouraged to develop their knowledge and skills by undertaking nationally recognised qualifications.

People’s rooms had room numbers and photographs displayed to help people recognise their rooms. There were picture signs on toilets and bathrooms.People's preferences and personalities were reflected in the décor and personal items present in their rooms.

This unannounced inspection took place on 31st May and 1st June 2016. We made another unannounced visit on the 15th June 2016 out of the normal working hours to follow up on concerns raised.

Levanto Residential Care Home is a care home for older people some of whom may be physically frail or living with dementia. Nursing care is not provided by the service. This service is provided by community nurses. At the time of our inspection there were 19 people living at Levanto. The home had two lounges, one of which was a smaller “quiet” lounge. The dining room leads off from the main hallway. All bedrooms were pleasantly decorated and all were fitted with a call system and had access to bathroom and toileting facilities.

The home 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 and associated Regulations about how the service is run.

Although staff sought people's consent for their day to day care. Where people appeared to lack capacity, people's rights were not protected. This was because staff did not complete mental capacity assessments for all of the people that required them. There were no records to demonstrate staff involved relatives and other professionals in 'best interest' decisions about people's care and treatment. Some people were subject to restrictions on their liberty for their safety and well-being. We saw that only some applications had been made to deprive people of their liberty. This was not in accordance with the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards (DoLS) and was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. .

We found risks to individuals were assessed and staff applied measures to minimise risk to people. We saw that some risk assessments did not contain detailed information about how the risk of harm could be reduced. We discussed this with the registered manager who immediately took action to update and amend risk assessments to show what action they were taking to respond to individual risks.

People were protected from harm and abuse because staff had suitable training and understood how to protect people. Staff knew of their responsibility to safeguard people in their care and knew of the whistleblowing procedure. Staff told us they were confident the management team would take action if any concerns of abuse were brought to their attention.

During the inspection people were calm and there was a relaxed atmosphere at the service. We observed kind and caring staff who supported people in a respectful and dignified way. People were encouraged to be as independent as possible. People received care and treatment that met their needs, and care was regularly reviewed to ensure it remained suitable and effective. When people required the attention of external healthcare professionals this was sought quickly, and care plans showed that the guidance of external healthcare professionals was followed by staff. People received their medicines as required and action was being taken in relation to infection control issues to reduce the risk of harm to people.

There were sufficient staff on duty to ensure the day to day welfare of people and staff were appropriately allocated throughout the home. Staff enjoyed working at the service and felt well supported and there was evidence of supervision taking place. They had access to training which equipped them to deliver their roles effectively. Recruitment processes had been followed to ensure staff were suitable for their jobs.

People's preferences and personalities were reflected in the décor and personal items present in their rooms. Important items and photographs were prominently displayed. All the bedrooms

The atmosphere in home was calm and relaxed. On the day of the inspection 19 people were living at the home and receiving care from the service. All the interactions we saw between staff, management and people who lived in the home were positive.

We observed that staff treated people with dignity and respect. Staff were polite and interacted well with people. Staff understood the needs of the people who lived in the home and supported them in line with guidance in their care plans.

Due to people's conditions we were not able to talk to them in detail about their experience. However, all the people we spoke with made positive comments. One person said "Everybody's nice and it's just like being at home." Another person said "We have someone in charge of us, we can go to them if we have a problem and I'm happy to tell them anything."

Staff understood the importance about asking people for their consent before any care was given.

People were provided with appropriate care and support that met their needs and promoted their wellbeing.

On the day of inspection 18 people were living at the home and receiving care from the service. We (the Care Quality Commission) spoke with three people, one relative, the provider (owner), three care workers and an external trainer.

Due to people’s conditions we were not able to discuss their experience in detail. However all the people we spoke with made positive comments. One person said “I think they’re very good here. They’re approachable.” A relative said “Staff are polite. They’d do anything for you.” All the people we spoke with described staff as kind.

We noted in the care plan of a person who had recently moved in to the home that a healthcare professional had commented that the person “already looked considerably better and more relaxed”.

We saw records that showed that care plans were being developed to improve people’s involvement in their care. More detail was also being added to guide staff on managing challenging behaviour.

The system for managing staff training in 2012 had not been effective. However training had taken place in 2013. The manager agreed to add the monitoring of staff induction, training, appraisal and supervision to the quality assurance system.

People were asked for their views on the service. People had been supported to complete a quality survey and many of the areas had been rated as very satisfactory.

The manager agreed to add the monitoring of accidents and incidents to the quality assurance system.

We visited this home to follow up on improvements made following our last review on 11th and 12th January 2011. Following this review the proprietor sent us information on the work she had undertaken or planned to take in response.

On this visit we spent some time observing the care being delivered to people and the interactions between the staff and the people living there.

Many of the people at the home have dementia so were unable to give verbal information about their experiences of Levanto, however one lady told us "It's good as these places go" and another said she felt like "it was home". Another person told us that their chair was comfortable.

We saw staff interacting well to support people, who were all looking well cared for. We saw staff dealing well with one person who was quite confused and asking to see her mother, and giving people information at a pace that was appropriate for them. All of the interactions we saw were respectful.

A high percentage of the people living at Levanto have dementia or memory loss and many of the people living at the home were not able to tell us directly about their experiences of living at Levanto. Six hours of the time we were at the home was spent talking to people, observing their care and how their day was spent. Some people were spoken to in private in their rooms, others we met in the communal areas.

.Most people were not able to tell us how they had come to be at the home, however one person was able to say that they had come to the home for a rest as they had not been well. They said "I was in the hospital for a while and then came to this place. I am quite content here". Another person had moved to the home to be with a close relative, with whom they were able to share a room.

The people we saw were engaged in the main in activities or in conversations with each other. The home was busy with a lot of interaction with staff. This was positive and people sought out staff to help them if they had a need.

The people who could talk to us about the home told us they were happy there. They said the staff were kind and looked after them well and “knew what they were doing” and were “Like friends”.

People told us the food was good, and that the home was kept warm and clean. One person said it "felt like a hotel" where they were having a break until they felt better.

People told us they did not have a sense of involvement in the records or care planning, and did not know much about the policies or running of the home.