The inspection took place on the 9 and 10 August 2018 and was unannounced on the first day. We informed the provider of our intention to return for a second day.

At our last inspection the service was meeting all the requirements and was rated as good.

Leyton 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.

Leyton House accommodates 15 people across three adjoining houses. Each house had its own kitchen and people had private bathroom facilities.

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.

Risk assessments were not always robust at the service. Information on mitigation was not clear and the detail on risk reduction was only provided from staff who knew the people at the service. This posed a risk as if new staff joined the service in the absence of existing staff this information was not in people’s care files. In some instances, there were no risk assessments for identified issues where one was required.

People gave mixed reviews about feeling safe and the service explained the reasons where people may have advised they did not feel safe at the service was due to their health condition.

Staff knew how to raise a safeguarding matter and the steps to escalate if they were not satisfied with the response of the registered manager. Staff told us how they kept people safe by always observing them discreetly and by offering them opportunities to discuss their concerns in confidence.

Staff were recruited safely at the service and the provider regularly checked staff suitability to work with people through criminal records checks.

Medicines were managed safely overall and the service supported people to become independent with their medicines.

Accidents and incidents were recorded and lessons were learnt to try and prevent them from occurring in the future. Staff wore appropriate protective equipment and used cleaning products to minimise the risk of infection.

Staff were supported in their role and received mandatory training, supervision and appraisal to enable them to deliver effective care and support to people using the service.

People’s needs were assessed and they were offered choices to encourage independent decision making as they had capacity. People cooked their own food or received staff support where appropriate.

Staff were kind and caring towards people at the service and people did not experience discrimination from staff. People’s information was kept private and confidential and people’s privacy and dignity was maintained.

People’s care plans were not always personalised but the registered manager sent us information to show they had updated this to make them more personal. People were supported by staff who were aware and responded to their needs at all times.

People’s cultural and religious needs were respected.

People were not afraid to make complaints and received support to do this. People told us where they had made a complaint they received outcomes they were satisfied with.

The registered manger failed to send statutory notifications of incidents to the CQC without delay as required by law.

People, staff and health professionals liked the registered manager and found them approachable.

The service performed a number of audits to check the quality of care.

We made two recommendations and found two breaches of the regulations. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and ap

The inspection took place on the 16 and 18 March 2016 and was unannounced on the first day.

Leyton House provides accommodation and 24 hour support for up to 15 people with mental health conditions. At the time of our inspection 13 people were using the service. Each room had en-suite facilities with either a shower and/or bath with toilet. The service was split over three houses which were all joined together. There were three kitchens and three living rooms in each home.

There was a registered manager at the service. 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 service kept people safe by following robust recruitment and selection processes. Staff had to complete an interview and provide references and complete a disclosure and barring service check to check their suitability to work with people.

People’s medicines were managed safely and received their medicine on time .The manager of the service carried out an audit of medicines to check for errors and to check that the medicines were being administered correctly.

Staff understood their responsibilities under safeguarding and the importance of keeping people safe. This was discussed in supervision and in meetings. People had residents meetings discussing safeguarding and they knew how to raise concerns. People we spoke to told us how staff kept them safe by advising them not to answer the main front door to people they did not know.

A detailed induction was provided to new staff that lasted three months and staff stated they felt it gave them the confidence to do well in the role. People, their relatives and local commissioners spoke highly of the staff. One probation officer said “Staff have the ability as they keep things very calm.”

The registered manager and staff demonstrated a good understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLs). People had capacity in the service and nobody was restricted under DoLs.

Staff were supported by the service through regular supervision and received an annual appraisal. Training was provided regularly by the service and staff said they completed this online.

The service monitored people’s health and diet. People were supported to attend health appointments and this was evidenced in people’s files that they had visited opticians, dentists, chiropodist, dietician, diabetic nurse and GP. Records showed that there was regular communication with health professionals and people’s health teams.

Records showed us that complaints and comments were listened to and action taken. People told us if they needed to they were confident to approach the manager and raise a complaint.

Staff were observed to be caring and people were seen speaking to staff and staff taking the time to respond in a kind manner.

Care plans and risk assessments were personalised and were regularly reviewed every three months. The service had detailed care files covering all aspects of people’s care needs and staff told us they had time to understand how to support people.

The registered manager had a robust quality assurance process included a self-assessment process and were also checked by the provider and the local authority.

People, staff and relatives were asked to provide feedback. Surveys we viewed had positive responses.

The deputy manager told us that people who used this service like to be called service users and we have used this term in this report. Service users who we spoke with told us they were well supported by staff in their daily lives. One person told us “I like this place, the staff are very good”. We observed that staff engaged and interacted with people using the service positively.

Service users were supported in promoting their independence and community involvement. They were given opportunities to express their choices and to make decisions in their daily lives.

Service users told us that they knew how to make a complaint if they needed to do so.

We saw the satisfaction surveys that had been completed by service users and they were happy with the care being provided in the home. The provider had a system to assess the feedback provided in the satisfaction questionnaires and to take action where required to address areas where improvement had been identified.

When we arrived for the visit we observed that staff were treating people in a respectful and dignified manner. We spoke to people who used this service who confirmed this.

We looked at care plans that were personalised and comprehensive in nature. Care plans also showed us that people received a high quality of care and had good access to health care professionals such as doctors, district nurses, dentists and speech and social workers.

People that we spoke told us that they felt safe at this home. Staff were able to confirm a comprehensive knowledge of safeguarding issues and knew how to escalate any issue that might occur appropriately.

Staff that we spoke to confirmed that they received appropriate training to provide an effective safe service. Training records that we read also showed us that staff were attending suitable vocational courses. Rotas confirmed that there was always enough appropriately trained staff on duty to ensure a safe service was being provided.

We looked at the provider’s policies and procedures and found that they were appropriate for this setting and ensured that an effective service was being delivered. Health and safety files showed us that the provider made regular safety checks and that all appliances were regularly maintained.