People’s experience of using this service: Staff had appropriate guidance to ensure they administered people’s medicines safely. Risks to people were assessed and records contained clear guidance for staff to follow.

People were safe and protected from avoidable harm. Staff knew how to respond to possible harm and how to reduce risks to people. Lessons were learnt about accidents and incidents and these were shared with staff, to reduce the risk of further occurrences.

Staffing numbers were sufficient to keep people safe. The provider followed safe recruitment procedures to ensure staff employed were suitable for their role.

People's needs were assessed and care provided in line with their preferences. Staff completed an induction 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 received enough to eat and drink and were supported to use and access other health and social care professionals. The principles of the Mental Capacity Act (MCA) were followed.

People were cared for by staff they knew well. Most of the staff had worked for the provider for a long time. People and their relatives told us they were happy with care provided. People had developed positive relationships with staff who had a good understanding of their needs and preferences.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Each person had a range of care plans which were detailed and included how they wished to be cared for. There was clear person-centred information and documentation had been regularly reviewed and updated. Information was made available in accessible formats to help people understand the care and support they had agreed.

The service continued to be well managed. People and staff were encouraged to provide feedback about the service and it was used to drive improvement. Staff felt supported and received supervision and appraisals of their performance. Effective systems were in place to monitor and improve the quality of the service provided through a range of internal checks and audits. The registered manager was aware of their responsibility to report events that occurred within the service to the CQC and external agencies.

More information is in the full report below

Rating at last inspection: Good (report published 25 June 2016)

About the service: The Spinney Residential Home provides residential care for up to 30 older people. At the time of the inspection there were 22 people accommodated.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

We inspected The Spinney Residential Home on 14 and 26 April 2016. The inspection was unannounced on day one, but we told the provider we would be visiting on day two. At the last inspection in June 2015 we found the provider was meeting all the regulations we inspected.

The Spinney Residential Home is large converted property with a modern extension. The service provides care and support for up to 30 older people and is registered to provide accommodation for people who require personal care. The service is close to all local amenities.

The home had 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.

Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. We saw people’s care plans were very person centred and written in a way to describe their care, and support needs. These were regularly evaluated, reviewed and updated. We saw evidence to demonstrate people were involved in all aspects of their care planning.

We saw staff had received supervision on a regular basis and an annual appraisal. Staff training was mostly up to date and the registered manager had a plan in place to ensure all staff received their training.

People told us there were enough staff on duty to meet people’s needs. We found overall safe recruitment and selection practices had taken place to ensure staff were suitable to work at the service.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

Systems were in place for the management of medicines so people received their medicines safely. However, the service was not always ensuring creams were signed for as administered.

There were positive interactions between people and staff. We saw staff treated people with dignity and respect. Our observations of the staff showed they knew the people very well and people told us they were happy and felt well cared for.

We saw people were provided with a choice of healthy food and drinks which helped to ensure their nutritional needs were met. People were supported to maintain good health and had access to healthcare professionals and services.

We saw there was a good supply of activities and outings available for people. Staff encouraged and supported people to take part; however recording of people’s activity levels was not robust.

The registered provider had a system in place for responding to people’s concerns and complaints. People were regularly asked for their views. We also saw the views of the people using the service were regularly sought and used to make changes.

There were systems in place to monitor and improve the quality of the service provided. We saw there were a range of audits carried out by the registered manager. We saw where issues had been identified; action plans with agreed timescales were not followed or signed off all of the time.

We inspected the service on 5 June 2015. The visit was unannounced. Our last inspection took place on 13 and 17 October 2014 and at that time we found the service was not meeting the regulations relating to care and welfare of people who used services, consent to care and treatment, safeguarding people who used services from abuse, management of medicines, requirements relating to workers, meeting nutritional needs, supporting staff and assessing and monitoring the quality of service provision. We asked them to make improvements. The provider sent us an action plan telling us what they were going to do to ensure they were meeting the regulations. On this visit we checked and found improvements had been made in all of the required areas.

The Spinney Residential Home is a large detached home in Armley. The home is registered to provide accommodation for up to 30 persons who require personal care.

At the time of our inspection there was no registered manager in post at the home. 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 the service was meeting the legal requirements of the Mental Capacity Act 2005. However, we felt staff lacked confidence in using the Act to make a best interest decisions for one person who lacked the capacity to make decisions relation to their care.

Medicines were administered to people by trained staff and people received their prescribed medication when they needed it. Appropriate arrangements were in place for the ordering and disposal of medicines however, we found there were issues relating to the storage of medication and written guidance was not in place for staff to follow when giving ‘as required’ medicines.

People received sufficient amounts to eat and drink. We found the dining experience for people who used the service was pleasant.

Robust recruitment processes were in place which ensured staff were suitable to work with vulnerable adults. Staff received regular supervision and annual appraisals. This gave staff the opportunity to discuss their training needs and requirements.

During our visit we saw people looked well cared for. We observed staff speaking in a caring and respectful manner to people who lived in the home. We observed interactions between staff and people living in the home and staff were respectful to people when they were supporting them. Staff knew how to respect people’s privacy and dignity. Staff demonstrated they knew people’s individual characters, likes and dislikes and had good relationships with the people living at the home and the atmosphere was happy and relaxed. Care plans were person centred and individually tailored to meet people’s needs.

Staff demonstrated a good understanding of how to protect vulnerable adults. They told us they had attended safeguarding training and were aware of the policies in place regarding reporting concerns.

People who used the service and their relative had opportunity to give their views and opinions on the service provision. There were regular resident and relative meetings and satisfaction surveys were also distributed to people who used the service on an annual basis.

We saw the provider had a system in place for the purpose of assessing and monitoring the quality of the service however, the audit tool used did not cover all areas of practice and did not allow the service to demonstrate areas of good practice within the home.

People’s health was monitored as required. This included the monitoring of people’s health conditions and symptoms so appropriate referrals to health professionals could be made.

The management team investigated and responded to people’s complaints, according to the provider’s complaints procedure. People we spoke with did not raise any complaints or concerns about living at the home.

A programme of activities was in place which meant people had their social needs met.

We carried out this inspection visit earlier than planned after receiving concerns from an anonymous source. The concerns raised were that people were got out of bed from 5 am, were left sitting in the lounge, not getting a drink or their breakfast until 8 am. The concerns also said there were insufficient staff to meet people’s needs.

Due to the nature of the allegations, two inspectors visited at 6.30 am. The questions we asked on this visit were: is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you wish to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

• Is the service safe?

People told us they felt safe. The home was well maintained, clean and homely. There were procedures in place to safeguard adults. However, an incident where one person who used the service had pulled another person from their chair had been dealt with as a complaint and the person who had perpetrated the incident had been spoken with by managers and told their behaviour was inappropriate. This caused us concern as the incident had not been recognised or responded to as a safeguarding incident. The response was not appropriate and showed a lack of understanding of safeguarding protocols and a lack of dementia awareness.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring understanding of safeguarding protocols and dementia awareness.

• Is the service effective?

On arrival at the service at 6.25 am we were greeted by the care staff on duty. We found nine people were up and dressed. When we questioned night staff about this they told us, “It’s what we do.” We saw a checklist staff used to record those people they had assisted to get up. We discussed ten people who remained in bed. Staff told us there were some people on the list who they would normally support to get up. Four people who remained in bed were identified as being more independent.

We discussed the routine within the service on a morning. Staff told us, “We get as many as we can up between 5am and 6am. We then break off to prepare breakfast. I have done breakfast whilst (other carer) got people up.” [On the day of our visit] We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to involving people in planning their care and exercising choice over their day.

People’s health and care needs were assessed with them, but they were not always involved in writing their care plans. Some people were not aware of what was in their care plans.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

• Is the service caring?

All the people spoken with who lived in the home were complimentary about the care and support they received. Some comments were: “We are well looked after and kept clean”

“The staff are very kind. Quite happy here; girls are very nice” and,

“The staff are brilliant; they look after us too” (Relative)

We saw that staff interacted kindly with people and this was confirmed by people’s comments. The number of staff on duty at the time of the inspection appeared to meet people’s needs during the day. However it was unclear how any additional activities people required support with could be managed.

• Is the service responsive?

We found people had hospital discharge documentation prepared in the event the person needed to be transferred to hospital. This showed the service had arrangements in place to promote effective communication to aid continuity of care.

• Is the service well led?

All of the staff we spoke with had a good understanding of the whistleblowing policy. All of the staff said that if they witnessed poor practice they would report their concerns.

Staff were complimentary about the Manager and said they had regular staff meetings. However, there were no meetings for people who used the service to allow them to help influence the running of the service and provide feedback regarding care.

The Spinney did not have an effective quality monitoring system in place. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance.

We looked at care records, which were reviewed monthly or as people’s needs changed. These records included full assessments carried out on admission and person centred care plans relating to people’s needs. The care plans were individualised, detailed and contained all the information staff required to ensure, people were supported in the way they preferred.

The people we spoke with during our visit told us they were happy with the food served at the home. One person said: “The food is excellent.” Another person said: “There’s a variety of food and it’s quite good.” We looked at the menu planning record which demonstrated choice and variety of food was offered to people who used the service.

We spoke with six members of staff about their understanding of protecting vulnerable adults. They had a good understanding of safeguarding adults, could identify types of abuse and knew what to do if they witnessed bad practice. They were confident that any issues would be dealt with promptly by the manager or care provider.

We reviewed staff rotas and found there were sufficient staff on duty to respond to people’s needs. We spoke with the manager who explained that the staffing levels were reviewed according to people’s changing dependency requirements.

The members of staff we spoke with said they had received relevant training and support to equip them with the right skills to do their job well. Staff told us they had received an induction and clearly understood their role and responsibilities.

We spoke with the registered manager, three staff members, four people who used the service and three relatives during our visit. People told us they felt their dignity and rights were protected by the staff and that the staff were kind and caring. It was evident that staff knew people who used the service well and what they liked and disliked. People we spoke with said they could follow their chosen daily routine. One person said "I like living here; I can get up or go to bed when I want, I pretty much do my own thing and I ask for help from staff when I need it." We looked at three care plans for people who used the service and found that they were up to date and provided good information about how people's care and support needs would be met. The four people who used the service and the three relatives we spoke with told us that they felt safe at the home and they would tell staff or the manager if they were worried about anything. One person said "I have no worries I am happy with everything." A relative of a person said "I know [my relative] is getting the best care available". People who used the service, their relatives told us they were asked for their views about their care and treatment and they were followed up appropriately and acted on, staff confirmed this. The provider took account of complaints and comments to improve the service. We saw that there was a complaints procedure in place. People or their relatives we spoke with said they could raise any issues.

The local authority Commissioners told us they had no concerns about the service. There have been no safeguarding issues or any other concerns identified.

People using the service and visitors told us they are satisfied with the service they receive and their dignity and privacy is respected. People said the environment is always clean and pleasant. People we spoke to said if they have any concerns they are happy to raise them with the staff or management and are confident they will be dealt with appropriately.

Staff told us that people receive a good service and they can make decisions about their care. They said people can choose what time to get up and go to bed, what to eat and what activities to get involved in. Staff said they are confident that the management of the home would deal with safeguarding issues or concerns appropriately and systems are in place to make sure people are safe.

We inspected The Spinney Residential Home on 13 October 2014 and on 17 0ctober 2014. The visit was unannounced. Our last inspection took place on April 2014 and, at that time, we found the service was not meeting the regulations relating to consent to care and treatment, care and welfare, safeguarding people and assessing and monitoring the quality of the service. We asked them to make improvements. The provider sent us an action plan telling us what they were going to do to make sure they were meeting the regulations. On this visit we checked and found improvements had not been made.

The Spinney Residential Home is a large detached home in Armley. The home is registered to provide accommodation for up to 30 persons who require personal care. The accommodation for people who lived in the home is arranged over two floors linked by a passenger lift. On the day of inspection 26 people were living in the home.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We found people’s safety was being compromised in a number of areas. This included how the home were managing medicines at the home. For example, the temperature was not being recorded in the area of the home used to store medicines. This meant the effectiveness of medicines could not be ensured.

Staff were not always following the Mental Capacity Act 2005 for people who lacked capacity to make a decision.

People were not protected from the risk of abuse. The registered manager told us they did not consider the incidents to be safeguarding incidents. The Registered Manager had not followed their safeguarding procedures by reporting incidents to the local safeguarding team.

People enjoyed the food, but choice and independence in accessing food and drink was not promoted. People’s nutrition and hydration needs were not always being met. People were not always receiving the health care support they required as their care was not planned or delivered consistently. For example, one person had been refusing meals on a regular basis and their weight record showed they had lost 5lb in two weeks. The staff at the home told us they were not monitoring the nutritional intake of this person. We also saw the person’s GP had not been contacted for guidance.

The home displayed activities on offer to people although we saw there were no activities being facilitated on the days of our visit. This led to people sitting in both communal areas and in their rooms for periods of time with no stimulation.

On both days of our visits we saw people looked well cared for. We saw staff speaking in a caring and respectful manner to people who lived in the home. Staff demonstrated that they knew people’s individual characters, likes and dislikes.

People told us there were enough staff to give them the support they needed and this was confirmed in our observations. While staff told us they had received induction and training, the records did not always reflect this. There were no induction records for some staff and training records did not show clearly the training staff had received. This meant people could not be confident staff had the skills to meet their needs.

Leadership and management of the home was poor and there were no systems in place to effectively monitor the quality of the service or drive forward improvements. There had been a lack of action in addressing shortfalls identified at the previous inspection.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.