This inspection took place on 28 November and 3 December 2018 and was unannounced on the first day. Lezayre 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 had a manager who was registered with the Care Quality Commission. 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 is a converted three-storey property set in its own grounds in a residential area. It is registered to provide accommodation and nursing or personal care for up to 36 people, however a number of these places were in double rooms which are no longer shared and the manager told us that the maximum number of people accommodated would be 32. Twenty-three people were living there when we visited.

Our last inspection of Lezayre was on 9 October 2017 and we found breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, because the provider had not made sure that the premises were safe or that arrangements were in place to prevent and control the spread of infection, and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, because the provider did not have effective governance arrangements in place.

During this inspection we found that improvements had been made to the safety and cleanliness of the environment and the service was no longer in breach of Regulation 12. The manager completed regular quality monitoring audits which identified any areas needing improvement. Action plans were agreed and implemented by the manager and the staff team. The service was no longer in breach of Regulation 17.

There were enough qualified and experienced staff to meet people’s needs and keep them safe. New staff were recruited safely. Staff were supported in their role through 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.

People’s medicines were managed safely.

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

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 care plans we looked at were written in a sensitive and person-centred style and gave details of people’s care needs and how their needs were met.

People spoke highly of the registered manager and told us she provided excellent support for the staff team and was always looking for ways to improve the service for the people who used it.

This inspection took place on 9 October 2017 and was unannounced.

The home is a converted three-storey property set in its own grounds in a residential area. It is registered to provide accommodation and nursing or personal care for up to 36 people, however a number of these places were in double rooms which are no longer shared and the nurse on duty told us that the maximum number of people accommodated would be 30. Twenty eight people were living there when we visited. The people accommodated were older people who required 24 hour support from staff.

Our last inspection of Lezayre was on 18 November 2015 and we found the service to be Good in all areas.

The home had a manager who was registered with the Care Quality Commission. 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. Before this inspection we had been notified that the manager would not be present in the home for a period of time.

During the inspection we found breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, because the provider had not made sure that the premises were safe or that arrangements were in place to prevent and control the spread of infection and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, because the provider did not have effective governance arrangements in place.

The home is an old building and requires continuous maintenance work to ensure people are safe. Flooring in one area needed urgent attention and floor-covering in other areas was damaged. Before the inspection we received concerns regarding infection prevention and control at the home. We found that the laundry, sluices and storerooms required improvements and a number of areas were dusty.

There were enough qualified and experienced staff to meet people’s needs and keep them safe. During the course of the day we observed staff being alert and responsive to people’s needs. Safe recruitment processes had not always been followed in full.

People we spoke with said they felt safe living at Lezayre. Staff received training about safeguarding and this was updated every year.

The members of staff we spoke with had good knowledge of the support needs of the people who lived at the home and had attended relevant training. The staff we met had a cheerful and caring manner and they treated people with respect. Visitors we spoke with expressed their satisfaction with the care provided.

Overall, we found that medicines were managed safely but some improvements were needed.

People we spoke with were happy with their meals and with the social activities provided. People were registered with local GP practices and had visits from health practitioners as needed.

The care plans we looked at gave details of people’s care needs and how their needs were met, however they were not easy to read or follow. Charts in people’s bedrooms were completed well to show the care that had been provided.

In the absence of the manager, the quality and effectiveness of the service had not been monitored for the last two months and the standard of record keeping had deteriorated.

The inspection took place on 18 November 2015 and was unannounced. The home is a converted three-storey property set in its own grounds in a residential area. There were bedrooms on each floor, some of which had en-suite toilet and wash basin. Communal areas were all on the ground floor.

The service is registered to provide accommodation and nursing or personal care for up to 36 people and 30 people were living there when we visited. The people accommodated were older people who required 24 hour support from staff.

The home had a new manager who had applied to be registered with the Care Quality Commission. 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.

People we spoke with said they felt safe living at Lezayre. All staff had received training about safeguarding and this was updated every year. There were enough qualified and experienced staff to meet people’s needs and keep them safe. The required checks had been carried out when new staff were recruited.

The members of staff we spoke with had good knowledge of the support needs of the people who lived at the home and had attended relevant training. The staff we met had a cheerful and caring manner and they treated people with respect. Visitors who we spoke with expressed their satisfaction with the care provided.

We found that the home was adequately maintained and records we looked at showed that the required health and safety checks were carried out. We found that medicines were managed safely and records confirmed that people always received the medication prescribed by their doctor.

People we spoke with confirmed that they had choices in all aspects of daily living. They were happy with the standard of their meals and the social activities provided.

People were registered with local GP practices and had visits from health practitioners as needed. The care plans we looked at gave details of people’s care needs and how their needs were met, however a new care plan format was being introduced which was designed to improve the recording of information about the person’s life and their preferences.

There was a friendly, open and inclusive culture in the home and people we met during our visit spoke highly of the home manager. Some quality audits had been carried out and these were being further developed.

One inspector carried out this inspection. The focus of the inspection was to answer the question: Is the service safe?

When we visited Lezayre on 30 April 2014, we were concerned that the premises had not been adequately maintained to provide a suitable home for people to live in. We also found that the required checks had not always been carried out before new staff were employed. We went back to the home on 16 September 2014 to check whether improvements had been made.

We saw that significant improvements had been made to the environment and maintenance work was continuing to improve bedrooms and communal areas. We saw records to show that the required checks had been carried out before a new member of staff started working at the home.

We gathered evidence against the outcomes we inspected to help answer our five key questions.

Is the service safe?

The premises had not been adequately maintained to provide a suitable home for people to live in.

Effective recruitment procedures had not been followed when employing new staff to check that they were of good character and had the necessary qualifications. New staff had not completed induction training.

Is the service effective?

People told us that they were happy with the care and their needs were met. Staff had a good understanding of people's care and support needs.

Is the service caring?

Staff were kind and patient to the people who lived at the home and we observed positive interaction between staff, visitors and people who lived at the home.

Is the service responsive?

People's needs were assessed before they moved into the home. Care plans recorded people's personal preferences and interests, and care was provided in accordance with people's wishes. People were asked to give their views of the service.

Is the service well led?

The manager was new to the service and had been registered with CQC. She had considerable previous experience in a similar role. An operations manager provided support in all areas of the service.

A relative we spoke with said that the staff were “delightful”. She considered that communication regarding her relative was very good and was sure that “they would even ring me if she had a cold”. She also said that the staff were “very good with people with dementia”.

We looked at a number of letters that had been written by family members of people who had lived at Lezayre. One person had written:

“We would like to pay tribute to Lezayre Nursing Home. From the management team down they created a homely, happy, caring and above all an extremely professional atmosphere especially when [our relative] became poorly. Not only did they cater for her every need, but towards the end of her life, our needs too, ensuring we ate their wonderful food and allowing us to sleep there, thus enabling us to share her last precious moments.”

People we spoke with were happy with the care that they received from the home’s staff and said that they were able to have a visit from their doctor as needed and received other community services for example ear syringing and flu vaccination. We saw that people’s weights were recorded every month and plans were written for those who were identified as being at risk.

We observed that everywhere was clean and there were no unpleasant smells. A visitor told us “they clean beautifully”. The home’s kitchen was awarded a five star rating by the environmental health officer.

People we spoke with considered that the home has changed for the better since the new manager came. People who live at the home said that they have choices in what they do and they are well looked after. People said that they enjoy their meals and always have a choice. One person said that her food and drinks are sometimes cold and she likes them hot.

People we spoke with said that they were happy with the care that they receive. They said that they felt safe living at Lezayre. People told us “the staff are smashing” and “the staff are very nice”.