This inspection took place on 17 and 18 October 2018 and was unannounced. At our last inspection in August 2017, we found two breaches of the regulations, Regulation 15 (Premises and Equipment) and Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, we found the service had made the required improvements.

Paisley Lodge 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.

Paisley Lodge accommodates up to 45 people in one adapted building.

There was a registered manager in post at the time of the 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.

People and relatives of people we spoke with told us they felt safe. Staff had received training in safeguarding vulnerable adults, and were able to describe how they would protect vulnerable people from harm. Improvements had been made to the environment to keep people safe. People’s medicines were managed in a safe way and staff were knowledgeable about medicines administration.

There were appropriate checks and inspections carried out on the environment and equipment, and people had individual risk assessments to reduce risks to people’s health and wellbeing. There were up to date policies and procedures in place in the event of an emergency.

There were enough staff to meet people’s needs. Staff were recruited safely, and staff received an appropriate induction, programme of training and ongoing supervision to make sure they were competent to meet people’s needs.

Staff made sure people had enough food to eat which took their preferences into account. Mealtimes were a pleasant experience and staff supported people to choose what they wanted. People’s health and wellbeing were monitored by staff who communicated well with external health and social care providers where necessary.

The home had a warm and friendly atmosphere. Staff demonstrated an in-depth knowledge of the people they cared for, their personalities, routine’s and preferences. We observed kind, caring interactions between people and staff, and people were universally positive about staff’s attitude. Staff understood how to protect people’s dignity and privacy.

People’s care plans were written in a detailed, person centred way with good information for staff on how to meet people’s needs. Care plans were updated regularly and reviewed with people and their relatives.

The service had policies and procedures for managing complaints, and complaints were managed appropriately and analysed for trends and themes. People we spoke with were confident their concerns would be listened to.

The service’s quality assurance processes were effective in monitoring care quality and ensuring improvements were made. The registered manager conducted a range of audits and spot checks, and was well supported by the provider.

People, their relatives and staff spoke positively about the registered manager and the leadership of the service. There was good engagement with people, their relatives and staff. Where ideas or concerns were raised, they were acted upon. We saw examples where people’s suggestions were listened to and in some cases implemented.

This was an unannounced inspection carried out on 24 July and 2 August 2017. At the last inspection in May 2016 the provider was in breach of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. Regulation 12, Safe care and treatment which related to the safe moving and handling of people.

At this inspection we found that people were being appropriately and safely assisted to move because staff were trained to do so, and staff competency was refreshed with supervisions. Therefore the regulation was met. However, we found that clinical waste was not always secured safely, and doors that were required to be locked were not always secured. There were malodours observed in the corridors on both floors.

People’s consent was not always recorded accurately and best interest’s decisions were not recorded as being made in partnership with others.

People did not receive regular and stimulating activities, and activities provision had been limited by a vacancy for an activities co-ordinator that had not been filled. Although there was a quality monitoring system in place this was not always effective in identifying concerns or resulting in the required improvements. This was a breach in regulation. You can see what action we told the provider to take at the back of the full version of the report.

Paisley lodge is a care home located in the Armley area of Leeds. The home has 45 beds, providing care for older people and people living with dementia. The building was split into two floors, with dining rooms and communal areas on both floors. The building was wheelchair accessible, with security provided by keypad entry. There were 36 people living at the service at the time of the inspection.

The service had a registered manager who had been in post for two weeks. 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.

Medicine records were accurate and detailed, and pain charts were used to monitor the effectiveness of painkillers.

Staff were recruited safely, and there were enough staff to deliver care safely.

People were supported with their nutrition and hydration by competent and well trained staff. Food was highly regarded and people’s food and fluid intake was assessed using nationally recognised monitoring tools.

People were cared for by compassionate and caring staff who created a warm, welcoming and friendly atmosphere. People spoke highly of staff who were looking after them.

Staff understood the importance of people’s privacy and dignity, and told us how they ensured this was maintained.

People’s care plans were detailed and person-centred. They were created in partnership with people and their loved ones. People’s relatives told us the service contacted them frequently with any changes or updates to their relatives’ wellbeing.

Complaints were recorded and responded to in a considerate, professional and timely way.

Staff told us the enjoyed working at the service and were supported with regular supervision. We also saw that staff meetings were held.

This was a comprehensive unannounced inspection carried out on 22 and 27 June 2016. This was our first inspection of the registered provider’s location.

Paisley Lodge is situated in Armley, Leeds. Care is provided on two floors for up to 45 older adults living with Dementia. At the time of the inspection, the service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We saw positive practice whilst medicines were administered. However, not all relevant staff had received medication training.

Relatives and staff expressed mixed view about staffing levels. Staff rotas showed nearly all shifts were fully staffed over a four week period, although the registered provider was unable to show us how they calculated staffing levels.

Risks to individuals were recorded and provided staff with sufficient information in order to lower levels of risk. These were reviewed regularly. We identified one person needed an epilepsy risk assessment.

Infection control was mostly well managed, although the kitchen area needed further attention. Regular building maintenance was carried out and the necessary fire safety checks were completed.

People told us they felt safe and relatives agreed with this. Recruitment procedures were mostly safe, although one candidate failed to report a conviction which was not formally assessed. People had good access to healthcare as appropriate referrals were made to a range of services.

Staff were satisfied with the induction they received. Most staff received regular supervision and nearly all staff had a recent appraisal.

Mental capacity assessments were decision specific and covered a wide range of areas. Staff had received training in the Mental Capacity Act 2005 (MCA) and demonstrated their knowledge. Deprivation of Liberty Safeguards (DoLS) were generally well managed, although one application had been submitted for a person who had capacity.

People had a positive mealtime experience. People enjoyed the food and drink provided and we found they received adequate nutrition and hydration. The provision of activities had recently increased which meant they were being provided seven days a week. Records showed people engaged with activities when they wanted to.

Staff were very attentive to people’s needs. We saw positive interaction between staff and people and we found staff knew people very well. Privacy and dignity was protected based on our observations and what people told us.

Care plans were detailed, although we found some examples where information recorded did not match actual practice. Reviews were carried out on a monthly basis and every six months, people and relatives were invited to attend a full review.

Complaints were well managed and people knew how to complain as this information was made available to them. There was a positive culture amongst the staff team who worked well together. Staff told us they were warming towards the registered manager. The area manager had an active presence in the home. We noted audits were carried out, although action plans needed to be formalised. We saw a comprehensive service action plan was in place.

We found a breach of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of this report.