This unannounced inspection took place on 21 November 2018.

'The Leys' accommodates and provides personal care, without nursing, for up to 33 older people, some of whom have dementia care needs. The home is owned and managed by 'St Martins Residential Homes'. The premises had been adapted and consisted of two floors which included bedrooms, a main lounge and dining room, and a new dementia unit. At the time of our visit there were 28 people using the service.

The Leys 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.

At our last inspection we rated the service as ‘good’. At this inspection we found the evidence failed to support the rating of good and the service has been given a rating of requires Improvement.

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.

During this inspection we found that risks to people had not always been identified and managed safely. For example, where people were using thickener in their drinks because of a risk of choking, there were no risk management plans in place to cover the risk of choking or dehydration.

Although there were quality assurance audits in place, there was a lack of managerial oversight to ensure quality checks were used effectively to bring about improvements to people’s care and support. For example, records management was not always accurate and organised so records could be accessed easily. Falls and nutrition records were inconsistent and unreliable. People did not always receive their medicines as prescribed. Systems in place to ensure lessons were learnt from accidents and incidents needed to be strengthened. Significant incidents had not always been reported to the relevant authorities so they could be investigated and actions taken to reduce the risk of such incidents happening again. Confidential information was not always stored securely.

Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse and incidents of concern. The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. Staffing levels were sufficient to meet people’s needs. Systems were in place to ensure that people were protected by the prevention and control of infection. Systems in place to ensure lessons were learnt from accidents and incidents needed to be strengthened.

People’s needs and choices were assessed and their care provided in line with their preferences. Staff received an induction process when they first commenced work at the service and received on-going training to ensure they could provide care based on current practice when supporting people. People enjoyed the meals and told us they had a choice of meals every day. People were supported to access health appointments when required, including opticians and doctors, to make sure they received continuing healthcare to meet their needs.

There were no records of any best interest meetings specific to people or the support that they needed to ensure decisions were made in their best interests. This did not ensure the principles of the Mental Capacity Act (MCA) were always followed.

People received care from staff who were kind and caring. People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. People had developed positive relationships with staff who had a good understanding of their needs a

This unannounced inspection took place on the 8 August 2016.

The Leys accommodates and cares for up to 23 older persons with a range of mainly age related dependencies, including people with dementia care needs. There were 21 people in residence when we inspected.

A registered manager was in post. 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.

People were safe. People’s needs were assessed before they were admitted to the home and regularly reviewed to ensure they received appropriate and timely care. They had an agreed care plan that reflected their individual needs. Their care plans were regularly reviewed and provided care staff with the information and guidance they needed to do their job.

People benefited from being cared for by sufficient numbers of experienced care staff that had received the training they needed to do their job safely. Care staff knew what was expected of them when caring for older people, including those with dementia care needs, and they carried out their duties effectively and with compassion.

People’s healthcare needs were met and they received treatment from other community based healthcare professionals when this was necessary. People’s medicines were appropriately and safely managed. Medicines were securely stored and there were suitable arrangements in place for their timely administration.

People had enough to eat and drink and enjoyed their meals. People that needed support with eating and drinking received the timely practical help they required. People’s individual nutritional needs were assessed, monitored and met with appropriate guidance from healthcare professionals that was acted upon when required.

People’s individual preferences for the way they liked to receive their care and support were respected. People were enabled to do things for themselves by care staff that were attentive to each person’s individual needs and understood their capabilities. They received support from care staff that demonstrated that they understood what was required of them to provide people with the care they needed.

People were treated with dignity and their right to make choices was upheld. There were imaginative activities to keep people entertained and constructively occupied if they chose to participate in them.

People’s views about the quality of their service were sought and acted upon. The quality of the service provided was regularly audited so that people benefitted from any improvements that were made. People and their relatives or significant others were assured that if they were dissatisfied with the quality of the service they would be listened to and that appropriate action would be taken to resolve matters to their satisfaction.

People were safeguarded from abuse and poor practice by care staff that knew what action they needed to take if they suspected this was happening. There were recruitment procedures in place that protected people from receiving care from care staff that were unsuited to the job.

This unannounced inspection took place on 24 August 2015. The Leys provides accommodation for up to 18 older people who require residential and personal care. There were 15 people in residence during this inspection.

There was a registered manager in post. 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.

The manager had put in place all the relevant training, guidance and supervision of staff to enable them to gain the skills to meet people’s needs, but staff had not translated their training into practice which revealed that their learning had not been embedded.

Although there were enough staff on duty, peoples experience of care differed. When staff did not receive close managerial supervision their actions affected people’s quality of care. People were not always observed by staff to help prevent them from falling as staff had not been deployed to appropriate areas of the home.

People’s needs were assessed and care plans developed however when the registered manager was not on duty staff did not always provide care or support in a way which reduced risks and people were not always supported to make choices about their care. People were supported to have sufficient food to eat to maintain a balanced diet, however people were at the risk of not having enough to drink, as they did not have free access to drinks at all times.

People were safeguarded from harm as the provider had systems in place to prevent, recognise and report any suspected signs of abuse. The registered manager knew and acted upon their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005) and in relation to Deprivation of Liberty Safeguards (DoLS).

The provider had not ensured there was adequate managerial cover during the registered manager’s planned leave, as some systems and processes to monitor the quality and safety of the home had not been carried out. Action had not always been taken to drive the required improvements and we continued to identify areas where practice needed to improve i.e. medicines management, staff responsiveness and in the overall level of health and safety within the environment. Since the manager’s return these systems and processes were being re-implemented and there were early signs of improvement.

We identified that the provider was in breach of one of the Regulations of the Health and

Social Care Act 2008 (regulated activities) Regulations 2014 (Part 3) and you can see at the end of this report the action we have asked them to take.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive to people’s needs?

• Is the service well-led?

Is the service safe?

People were cared for in an environment that was clean and hygienic but some minor repairs to worn carpets in some corridors had not been made. This posed a potential trip hazard to both staff and people in residence. Prompt action was taken to rectify this when we identified the hazard.

When we inspected there were sufficient numbers of experienced and competent staff on duty to meet people’s care needs. We saw that the equipment in place for staff to use was appropriately maintained. This meant that people were protected from the risk of neglect or unsafe care.

There were suitable arrangements in place to respond to emergencies, with the manager or provider’s representative always being available ‘on call’ to support staff to manage the situation safely and effectively.

People’s needs had been assessed before they were admitted to ‘The Leys’. This meant that staff had the information they needed to minimise identified risks to people.

Is the service effective?

People said they received all the support they needed to enable them to do what they could for themselves. Staff had received the information, training and managerial support they needed to do their job effectively. We spoke with staff and observed them going about their duties and we concluded that they had a comprehensive knowledge of each person’s care needs and preferences.

One person commented, “All the staff are conscientious. They make me feel good about myself and that is really important to me.”

Is the service caring?

We saw that staff were purposeful and unhurried so they had not ‘rushed’ people. When we saw staff interact with people their manner of approach was patient, kind, and good humoured. They encouraged people who struggled to do things for themselves.

Is the service responsive to people’s needs?

We saw that there were enough staff on duty to meet people’s needs. This was confirmed by both the staff and people in residence we spoke with. One person said, “I only have to push my buzzer if I need help. There is always a smile on their face, no matter how busy they are. They always say I should use my buzzer to call them if I want anything. It’s reassuring.” We heard and saw that when someone used the call buzzer staff attended to them with minimal delay.

Is the service well-led?

Staff received a good level of practical day-to-day managerial support. The provider had ensured there were quality assurance processes in place but we identified some shortfalls in ensuring these were always effective, but there was not a breach of the Health and Social Care Act regulations.

There was not a registered manager in post when we inspected. The current manager is in the process of submitting an application for registration.

When we published our last inspection report in June 2013 we had identified a minor concern with staffing levels in the afternoon.

When we again visited ‘The Leys’ unannounced on the afternoon of 2 August 2013 we found that the home had been appropriately staffed in accordance with the provider’s action plan to ensure compliance.

We spoke with a visiting relative who has visited the home regularly and they commented that, “In my experience there are enough staff around. I have had no worries about the home being short staffed when I visit in the afternoon. The carers always seem attentive and never appear to be rushing around.”

We were informed by the provider that improvements were being made to the layout of the premises and that this building work had started since our last published report.

We found when we visited on 2 August 2013 that this work had been safely and sensitively managed with minimal disruption to the people in residence. The staff said that the builders had taken care not to upset anyone by creating noise and there had been no problems with dust or access to any of the rooms currently in use within the home. We also saw that people were relaxed in the communal lounge.

We spoke with four people in the home and they told us that they received the support and care they needed. We saw that people looked relaxed and the people we spoke with said the staff were attentive. One person said, "The staff are kind. If I need help they are always there for me. I think we are well looked after."

All the people we spoke with said they were comfortable. They all said they had enjoyed their lunch and had enough to eat and drink.

The staff we spoke with were friendly, helpful and knew about people's individual needs and preferences.

We found, however, that there were only two care staff on duty for several hours that afternoon. This was because the manager was on holiday and was not available as a third person to assist the care staff on duty if they needed additional help with people's personal care needs. On this occasion we found there had been no arrangements made to bring in extra staff to cover for the manager's absence. This meant that on several occasions when two staff were temporarily required to assist a person with their needs there were no other available staff to attend to people. We spoke with the provider who gave assurances that this will not happen again.

We saw that the communal areas of the home, such as the lounge, dining room and access corridors, were clean and free from odour.

The three people we spoke with were happy with their care at 'The Leys'. Some people were unable to speak with us because their dementia had impaired their ability to communicate verbally. We used a number of different methods to help us understand the experiences of people using the service. For example, we spoke with four visitors in private and they were able to tell us that the staff always welcomed them. They all said they were satisfied with the care their relatives or friends received. One person said, "Within reason, I visit whenever I like. All the staff are friendly."

We observed staff engage people in a quiz activity in the communal lounge. We saw that people enjoyed the activity and chatted with staff and were relaxed in their presence. We heard staff talk with people and their tone of voice was friendly, they explained what they were doing and they used words of encouragement when, for example, they physically assisted several of the more frail people to move from the lounge to the dining room for their lunch.

We found 'The Leys' homely, clean, comfortably furnished and well maintained throughout. Communal areas and bedrooms were free from odour. We saw evidence that people's rooms were personalised with their belongings, such as photographs and other personal items they valued.

People told us they received the care they needed at The Leys. They said staff were friendly, kind and attentive. Comments made by people we spoke with included, “It is up to me if I want to stay in my room. Staff encourage me to join in with activities but they always respect my wishes.”