We inspected Spring Gardens on 4 January 2017. The visit was unannounced. Our last inspection took place in September 2015 where we identified three breaches of legal requirements which related to safe and care treatment, person centred care and good governance. The provider sent us an action plan telling us what they were going to do to ensure they were meeting the regulations and a clear time frame in which they would complete this. On this visit we checked and found improvements had been made in all of the required areas.

Spring gardens is a local authority care home. It provides personal care and support for up to 30 older people. The home is situated in the Otley area of Leeds. There are two floors with lift access and there are several communal lounge areas. There is an enclosed garden to the rear.

At the time of our inspection the service did not have 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. The manager had completed their application form and had been given a date for their interview with the Care Quality Commission.

There were systems in place in the home to ensure that people received their medication as prescribed.

There were enough staff to meet people’s needs. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. Staff were given effective supervision and appraisals.

Staff were up to date with all mandatory training in the home.

Staff were aware of the processes in place to report incidents of abuse; and had been provided with training on how to keep people safe from abuse and harm. Processes were in place to manage identifiable risks and to promote people’s independence.

People were supported to eat and drink well and to maintain a varied and balanced diet of their choice. People had access to healthcare facilities and support that met their needs. The home had a local GP who supported the home with weekly visits or calls.

People had developed good relationships with the staff team who treated them with kindness respect and compassion. Systems were in place at the service to ensure that their views were listened to; and their privacy and dignity was upheld and respected.

People's needs had been assessed and care plans outlined their preferences and how they should be supported. Staff showed a good knowledge of these preferences when asked about the people they supported.

People were able to enjoy activities of their choice. Arrangements were in place for people to maintain links with the local community, friends and family.

The service had quality assurance systems in place which were used to drive continuous improvements within the home.

We saw the provider ensured the premises and equipment were safe to use. We saw evidence of certificates in response to these.

The inspection was unannounced and took place on the 15 September 2015. The last inspection was carried out in September 2014 and we found the provider was breaching one regulation. We found people were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate medication records were not maintained.

After the inspection in September 2014, the provider wrote to us to say what they would do to meet the regulations in relation to the breach. They told us they would complete all actions by the end of September 2014. At this inspection which took place on 15 September 2015, we found the provider had taken action to meet the regulation they breached at the last inspection. However, we found other breaches at this inspection.

Spring Gardens is a Leeds City Council care home. It provides personal care and support for up to 30 older people. The home is situated in the Otley area of Leeds. There are two floors with lift access and there are several communal lounge areas. There is car parking to the front of the home and an enclosed garden area to the rear.

At the time of this inspection 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 2008 and associated Regulations about how the service is run.

We found some areas of the premises and equipment did not comply with current Health and Safety guidance and were therefore, a safety risk to people who used the service. Mental capacity assessments had not been completed accurately and Deprivation of Liberty Safeguards applications were made inappropriately.

People’s care plans did not contained sufficient and relevant information to provide consistent, person centred care and support. We saw some activities had been arranged but people told us they were often bored. The registered manager told us they needed to improve in this area and record when people do take part in activities.

Staff training and support equipped staff with the knowledge and skills to support people safely. Staff completed an induction when they started work. The registered manager told us they would update the training record and review the staff records and induction. There were enough staff to meet people’s needs. The provider had effective recruitment and selection procedures in place.

People were happy living at the home and felt well cared for. People had good experiences at mealtimes. People received good support that ensured their health care needs were met. Staff were aware and knew how to respect people’s privacy and dignity.

People told us they felt safe. Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines safely. People’s physical health was monitored and appropriate referrals to health professionals were made.

People got opportunity to comment on the quality of service and influence service delivery. Systems were not always effective to ensure people received safe quality care. Documentation was not up to date. Complaints were investigated and responded to appropriately.

You can see what action we told the provider to take at the back of the full version of the report.

Is the service safe?

People told us they felt safe and secure living at the home. People were protected against the risks associated with the use and management of medicines. They received their medicines at the times they needed them and in a safe way. Medicines were kept safely however there were some gaps in the records for medicines.

Everyone we spoke with told us that they felt happy living at the home. One person who was living in the home for a short time said they were given the level of support they needed.

The inspection visit was carried out by two inspectors which included a pharmacy inspector. During the inspection, we spoke with the home manager, care staff and people who used the service. We looked around the premises, observed staff interactions with people who lived at the home, and looked at records.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key 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. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.

Is the service safe?

In the care records we looked at we saw people had risk assessments which covered areas of potential risk. When people were identified as being at risk, their plans showed the actions required to manage these risks.

People were not protected against the risks associated with medicines because the provider had appropriate arrangements in place to safely manage them.

There were procedures in place to guide staff on the actions to take in response to medical emergencies.

Is the service effective?

People had an individual care plan which set out their care needs. We found people and/or their representatives were involved in the assessment and planning of their health and care needs. This meant people could be assured their individual care needs and wishes were identified and planned for.

The provider supported staff to deliver care to an appropriate standard. Training records showed that appropriate training was being delivered. We looked at a training plan which showed individual training needs were taken into consideration when training was planned. Staff we spoke with told us everyone worked well together and they felt well supported.

Is the service caring?

We found the care staff we spoke with demonstrated a good knowledge of people’s needs and were able to explain how individuals preferred their care and support to be delivered.

We found the atmosphere within the home was warm and friendly and we saw staff approached individual people in a way which showed they knew the person well and knew how best to assist them. People who used the service seemed comfortable with the members of staff who were supporting them.

Is the service responsive?

People’s needs were assessed before they moved into the home. We saw people’s care records had information about their individual needs and preferences.

People had access to a range of activities and were consulted about the types of activities they wanted to take part in.

We asked for and received details of complaints people had made and the provider’s response. The evidence we reviewed indicated the provider responded appropriately.

Is the service well-led?

People told us they had confidence in the manager and they were approachable and listened to what they had to say. We saw the home held meetings for people who used the service to give them the opportunity to share their views and make suggestions for improvements to the service.

The staff we spoke with said they enjoyed working at the home. They said they worked well as a team and felt supported by the manager.

The provider had an effective system to regularly assess and monitor the quality of the service that people received. We looked at a selection of reports which showed the provider had assessed and monitored the quality of service provision.

We spoke with four people who used the service and five members of staff. We reviewed six care plans. The people we spoke with were happy living at Spring Gardens. One person told us, "I like it here, they are nice people. I have a nice room, it's just been decorated and I chose the wallpaper." Someone else said, "The staff are lovely, I don't need them much but when I do I don't have to wait long." We saw there were daily activities and people were able to go out.

We saw that the communal areas and the bedrooms were clean and free of any malodours. A person said, "It's clean, they are forever cleaning." There were effective systems in place to reduce the risk and spread of infection.

During the visit we observed staff supporting people and saw that staff responded promptly to any requests for assistance. Staff told us that the staffing levels were sufficient to meet people's needs and had no concerns about the numbers of agency staff used.

A staff member said, "Spring Gardens is friendly relaxed and homely, after all we are visitors in their home."

People said they enjoyed living at the home. Comments included:

“Nothing is too much trouble for them here.”

“It’s a nice place to be.”

“Staff listen to what we want.”

People we spoke with said the staff looked after them well and treated them with dignity and respect. Comments included:

“Staff are very good, very nice to us.”

“It is lovely when I have a bath, they do it all very nicely.”

“Staff are very helpful.”

“I get all the help I need.”

“The food is good and always plenty of choice.”

“I am very happy here, it’s very relaxed, no strict orders.”

“I prefer my own company and everyone respects that.”

People said they felt safe at the home and would have no hesitation in raising concerns if they needed to. Comments included:

“I would go to the office and speak to someone.”

“We are in good hands here, staff are kind and polite.”

People said they got on well with the staff and that staff were very capable. We saw they were comfortable with staff and had a good rapport with them. People said they had enough staff to support them. People said that staff responded promptly when they pressed their buzzers.

Some people said they were ‘sometimes’ short of staff, usually due to sickness. They said they still got their needs met at these times but said staff were more rushed. One person said, “Things just get done a bit slower then.” Another person said they didn’t feel there were enough permanent staff in the home as they have to rely on agency staff due to vacancies in the home.