The Leylands is located in Wolverhampton. It is a service which provides accommodation and personal care for up to 21 older people, some of whom are living with dementia. There were 21 people living at the home on the day of our inspection.

Rating at last inspection:

At the last inspection, in November 2014, the service was rated Good. At this inspection, we found the service remained Good.

Why the service is rated Good:

People continued to be protected them from avoidable harm and abuse. Staffing levels continued to be sufficient to meet people's needs, as well as to enable staff the time to spend with people. People continued to receive their medicines safely.

People continued to enjoy the variety of meals provided, and continued to receive individual assistance with their eating and drinking needs. Staff continued to receive training which was relevant to the needs of the people living at The Leylands.

People continued to enjoy positive and respectful relationships with staff. People were able to enjoy their individual hobbies and interests. Staff continued to provide care which was tailored around people's individual preferences and needs.

The registered manager and provider had systems in place to monitor the quality of care people received. People, relatives and staff were positive about the running o the home, and felt their opinions and feedback mattered.

Further information is in the detailed findings below.

At our previous inspection in April 2014 the provider was not meeting the law in relation to assessing and monitoring the quality of service provision. Following our April 2014 inspection the provider sent us an action plan to tell us the improvements they were going to make. During this inspection we looked to see if these improvements had been made. This was an unannounced inspection and took place on 19 November 2014.

The Leylands - Residential Care Home provides accommodation and care for up to 21 older people. There were 20 people living at the service when we inspected.

The location requires a registered manager to be 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. The care manager was in the process of applying for registered manager status at the time of our inspection.

Most people were positive about their experiences of the service. People told us they felt safe and comfortable using the service. Staff were aware of how to protect people and their rights. For example, staff knew how to identify abuse and report it. The provider had provision in place in order to evacuate people as safely as possible in an emergency. People’s medicines were managed in a safe way which promoted their health. Staff managed risks to people to reduce the possibility of harm.

Staff we spoke with told us there had been improvements in the service since our last inspection. We found there were improvements since our last inspection in respect of the assessing and monitoring of service provision. However, we found that, while the standards of care records had improved; there was still some improvement required.

The provider sought people’s opinions in order to improve their experience of the service. The provider had a robust complaints policy and people told us they felt confident in raising issues with staff or the management.

Staff recruitment was carried out in a way that ensured staff were appropriate to support people. There were adequate numbers of staff to assist people in a safe way.

Staff demonstrated good knowledge of people’s needs and responded to these in an appropriate and flexible way. Staff treated people with kindness and ensured people had what they needed. They communicated with people in the most effective way for the individual. This included some staff’s ability to communicate with people in the person’s preferred language. Staff were skilled in delivering care to people.

People received adequate food and drink in order to support their health and well-being. People who had cultural food preferences had access to the foods they preferred, but this was not consistently available throughout the week. Staff ensured people attended appointments with external professionals as required in order to support their health.

We carried out an unannounced inspection to help us answer five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. We spoke with six people, four staff and the manager.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People we spoke with told us they felt safe and comfortable living at the service.

Systems were in place to make sure that managers and staff learned from events such as accidents, incidents and complaints. This helped to reduce the risks to people and helped the service to continually improve in this respect. However, we did find gaps in auditing practices for other aspects of care, such as care records.

No applications for the Deprivation of Liberty Safeguards had been submitted by the service. Staff showed good knowledge about how they should protect people’s rights.

The service was safe, clean and hygienic, although we did find issues concerning the premises and equipment, which the manager undertook to remedy.

Recruitment practice was safe and thorough. Records showed that management addressed issues through appropriate disciplinary procedures, when required.

Is the service effective?

People’s health and care needs were regularly assessed and records reflected people’s individual needs. Some people we spoke with told us that staff did ask them about the suitability of their care, but records did not reflect this practice. We did see that care plans were personalised and contained important information about how people’s health should be supported. We did find, however, that some people had been assessed at high risk of developing sore skin areas. Records did not detail how these people were to be supported to minimise this risk or how some people’s health should be supported, although we saw this happening in practice.

Is the service caring?

We observed staff interacting with people and saw that these interactions were positive, patient and caring. People were complementary about the staff. One person told us, “They do very well for us”.

The service did not carry out an annual survey with people, but staff interacted with people individually to understand their concerns. People told us they were able to talk with staff about any concerns they had.

Is the service responsive?

People told us that there was not always enough stimulating activity to keep them interested. One person told us, “I’m sometimes bored”. We saw from records that a range of activities were offered, but these did not suit everyone we spoke with. We did not see activities taking place during our inspection.

Although no recent complaints were recorded, people told us they would feel confident to speak the manager if they did have a concern. People we spoke with told us they had never had cause to raise a complaint.

We saw that accidents and incidents had been recorded and analysed, and action taken to minimise a recurrence of the same issues. This meant that people could be sure action was taken to keep people safe.

Is the service well-led?

The service did not have a registered manager at the time of our inspection. We saw evidence that the current manager was taking steps to apply for registered manager status.

We saw evidence of the service cooperating with others, such as the district nurse service, to promote people’s wellbeing. This meant that staff took into consideration external professional advice in order to promote people’s health and wellbeing.

The service showed some improvement in its quality assurance systems, although there were still some gaps, such as the lack of appropriate care record auditing. We saw evidence of the service using outside organisations to improve some of the shortfalls in identified areas. This included a recent fire risk assessment produced in January 2014. The service was yet to action most of the recommendations made.

On the day of the inspection, there were 17 people living at the home. We spoke with six people, three relatives, three staff members and the manager who was also the joint owner.

We observed staff respect people and promote their independence throughout the day. Records showed that people and their relatives were involved in the planning and delivery of care.

We found that people received care that met their needs. One person said, “I am quite happy here. They call a doctor when you need one, there is always someone around.”

Arrangements were in place for the safe handling of medicines. One person said, “I get my medicine on time.”

We found that there were positive interactions between staff and people. We saw that there were sufficient staffing levels to meet people’s assessed care needs. One staff said, “There is definitely enough staff.”

Systems to monitor the quality of the service were not robust and efficient.

Improvements were required in records relating to people’s care and for the management of the home.

We carried out this inspection to check on the care and welfare of people living at the home. On the day of the inspection visit, there were 12 people at the home. We spoke to four people, three relatives, three staff, and the manager.

There was a pleasant and friendly atmosphere in the home. People wore clothing that reflected individual choices and preferences. We saw that people were involved in discussions about their care needs and preferences. We found that people were encouraged to be independent and staff supported people appropriately to do this.

One person told us, “I really like it here, I am getting good care.” We found that staff were providing care that met people’s needs, although staff practices needed to be consistent. We saw that there were positive interactions between staff and people. One relative told us, “I brought my husband here as it is a home away from a home.”

We found that arrangements were in place to ensure that any allegations of abuse were identified, managed, and reported appropriately.

Staff we spoke to told us that they were supported in carrying out their role. We saw that some staff had received support through supervision, appraisals, and meetings. However, arrangements needed to be improved to ensure that all staff received training on a regular basis.

Systems in place did not ensure that shortfalls in the home were identified to make improvements in the way that the service was run.

We spoke with some people using the service they told us that they staff help them to do the things they are now unable to do for themselves. They told us the staff were kind and patient. One person told us there was some very good staff, others not quite so good.

Most people said the accommodation was good; their bedrooms were warm and comfortable.

One person said that they would like to go back to their family home and hoped that they could do so at some point.

Some people told us that they liked the food they had each day, they had more than enough to eat and drink. Other people told us that the food was grim; there was no choice and not enough fresh fruit.

People said that they had enough to do during the day, and that they liked to go out into the garden and have a breath of air. People said that they enjoyed the religious service that is provided each month at the home.

Some people were unable to comment about their experience of life at the home due to their very frail conditions. We observed the staff being very patient and understanding when care was required. Visitors we spoke with stated they were satisfied with the level of care and support that was provided; they had no complaints or concerns.