This inspection took place on 10 and 16 July 2018 and was unannounced.

St Leonards Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service was providing personal care and accommodation for up to 15 people. The service cared for older people, people living with dementia and people with mental health needs. Care and support took place in one adapted building over two floors. During the inspection there were 15 people living at the service.

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 our last inspection published on 12 January 2018 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. This was because people were placed at risk when staff were using wheelchairs to assist them to move around the service as staff were not using them safely. This was a breach Regulation 12 Safe Care and Treatment of the Health and Social Care Act 2008 (Regulated Activities). We found a breach of Regulation 13 Safeguarding service users from abuse and improper treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there were no records of best interest decisions being made where people did not have the mental capacity to make informed decisions about their care. We also found a breach of Regulation 17 Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there was a lack of accurate records to monitor, assess and make improvements to the service provided.

We asked the provider to complete an action plan to show improvements they would make, what they would do, and by when. The provider sent us an action plan stating that they had addressed the breaches by 28 November 2017, before the report was published.

We found during this inspection that these regulations had been met. However, we found that safe recruitment practices were not followed.

The registered provider was not following safe recruitment practices. Issues we found with the records had not been identified by the registered provider.

Accidents and incidents were investigated and followed up by the registered manager but oversight and analysis of trends in incidents were not documented. Care records were comprehensive and detailed but recruitment records needed improvement. We have made a recommendation about record keeping and governance of the service.

Medicines were appropriately acquired, stored, dispensed and disposed of.

Staff had received safeguarding training, were knowledgeable on recognising signs of potential abuse and knew how to raise concerns.

There were sufficient numbers of staff employed to support people.

Appropriate checks and documentation in relation to fire safety and health and safety was up to date. The environment was clean and tidy.

The service was working in accordance with the Mental Capacity Act 2005 (MCA).

Staff received regular training and were well supported. Newly employed staff members completed the Care Certificate. This is a set of nationally recognised standards of care which staff who are new to care are expected to adhere to in their daily working life to support them to deliver safe and effective care.

The registered provider and registered manager understood the importance of promoting best practice and were members of various organisations that shared information on improving practice.

People were treated in a kind and compassionate way.

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This inspection took place on 27 November 2017 and was unannounced.

St Leonards 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.

St Leonards accommodates 15 people in one adapted building. People may be living with dementia or a mental health issue. At the time of our inspection there were 12 people living at the home. People were accommodated in 11 single rooms and two double rooms, with two shared lounges, a dining room and an enclosed garden.

There was a registered manager in place. ‘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.’

Medicines were not always managed safely as accurate records were not always kept regarding administration.

Accidents and incidents were not monitored to ensure that appropriate action had taken place or analysed to monitor any patterns of behaviours.

Environmental risks were not always well managed. The use of equipment such as wheelchairs was not always safe.

Emergency systems had been put in place to keep people safe. These were to be upgraded.

Care records contained detailed information about how individuals wished to be supported. Generally, people's risks were managed, monitored and regularly reviewed to help keep people safe. However there was no guidance regarding the risks associated with some medicines.

There were no records of best interest decision making where people lacked the mental capacity to make informed decisions about their care.

Applications had been submitted to deprive people of their liberty, in their best interest.

People's individual communication methods and needs were taken into account and respected

People looked comfortable, relaxed and happy in their home and with the people they lived with. Relatives were welcomed into the home.

Staff had a good understanding of people's needs and spoke in a compassionate and caring way about the people they supported.

There were sufficient numbers of staff to meet people's needs and to keep them safe. The provider had effective recruitment and selection procedures in place and carried out checks when they employed staff to help ensure people were safe.

Staff were well trained and aspects of training were used regularly when planning care and supporting people with their needs and lifestyle choices.

People were supported by staff who had a good understanding of how to keep them safe. All staff had undertaken training on safeguarding adults from abuse, they displayed good knowledge on how to report any concerns and were able to describe what action they would take to protect people from harm.

People were supported to maintain good health through regular access to health and social care professionals, such GPs and district nurses. People's dietary needs and any risks were understood and met by the staff team.

We found three breaches 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 the full version of the report.

This inspection took place on 14 December 2015 and was unannounced.

St Leonards provides support and accommodation for up to 15 older people who may be living with dementia or a mental health issue. At the time of our inspection there were 14 people living at the home. People were accommodated in 11 single rooms and two double rooms, with two shared lounges, a dining room and an enclosed garden.

There was a registered manager in place. 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, their families and staff were complimentary about the atmosphere and culture in the home. People expressed affection for the home and its staff. Staff expressed pride in the service provided, and described it as homely and well run. We saw examples of care and support that were very good. The registered manager and staff were motivated to make sure people had a positive experience of care.

The provider had arrangements in place to protect people from risks to their safety and welfare, including the risk of avoidable harm and abuse. Staffing levels were sufficient to support people safely and in a calm, professional manner. Recruitment processes were in place to make sure only staff who were suitable to work in a care setting were employed. Arrangements were in place to store and administer medicines safely.

Staff received suitable training and support. They sought people’s consent for their care and support and had established caring relationships with people. They respected people’s individuality and dignity and encouraged people to participate in decisions about their care and support.

Staff made efforts to make meal times an enjoyable experience and encouraged people to eat and drink enough. Records showed people had access to healthcare services when they needed them.

People’s care and support was based on assessments and plans which took into account their needs, preferences and wishes. The provider had processes in place to review people’s care and check they received care according to their plans. There was a varied programme of activities and leisure interests which took into account people’s individual interests and preferences. There was a complaints process and complaints were followed up and investigated.

There was an open, friendly and positive atmosphere in the home. The registered manager and provider encouraged team work and motivated their staff. Staff responded to their management style and felt empowered to make suggestions. Systems were in place to monitor, assess and improve the quality of the service.

On the day of our visit there were 11 people living at the home. We spoke with two people and a member of staff and the providers.

One person told us "I try to do things for myself, what I cannot do, staff help me with. Staff are very helpful". They said that they could choose how they spent their day. This meant that staff respected people's decisions and choices. Another person told us how good the service was and that they were happy living there.

We sampled three care plans. We saw that care plans were individualised and detailed the support and care each person required. People had signed their care plans where applicable.

People we spoke with said they felt safe in the home and said they were confident that staff would respond appropriately to any concerns they raised.

During the visit we spoke with four people who used the service. One person told us "the staff are wonderful, could not wish for anything better".

We spoke with four relatives that were visiting residents during our visit. One relative told us "the provider communicates everything to me, it's great that I can still be so involved in the care of my mum".

We spoke to three care staff and both the registered providers. Staff comments included "the home is very friendly", "the providers are very approachable" and "turnover of staff is very low which speaks volumes".

Care plans were in place for each individual. We looked at four care plans which had been regularly reviewed to ensure they were up to date. People told us that "staff are always willing to help".

People we spoke with said that they felt safe in the home and that they would speak to a member of staff if they had any worries. Family members that we spoke with told us that they did not have any concerns about the home.

During our visit we spoke with seven people who live at the home, two relatives, a visiting health care professional, two staff and the provider. Following the visit we received calls from eight relatives and four staff, we were able to talk with them about their thoughts and experiences of St Leonards.

They told us that they like living at the home and that the staff were helpful with nothing being too much trouble and the senior staff are easy to talk to. There are three cats living at the home, one person told us that one cat is theirs and they do not mind sharing it with others. People liked having the cats as extra company.

We observed lunch being served and how staff interacted with people and ensured choice. One person told us there were activities and games, the activities on the day of our visit was communion and a quiz.

Staff told us that they receive regular training, are supported by the management of the home and that they can speak with senior staff about any concerns they have about the running of the home.

Relatives we spoke with told us that the home was ‘homely’ and spoke about the provider with high regard; although they could also speak freely with staff. The staff always conduct themselves in a caring and professional manner. There was some concern expressed that when it was busy, quiet people could be over looked or assumptions made.