The Leys Care Home

The Leys Care Home is a residential care home providing personal care to up to 35 people. The service provides support to people with dementia and older people. At the time of our inspection there were 13 people using the service.

The home was ground floor with communal lounges and people had access to outdoor space.

People’s experience of using this service and what we found

People were safeguarded from abuse and avoidable harm. Risks to people were assessed and people were safe. Staff supported people to make decisions within the principles of the Mental Capacity Act (MCA). There were enough staff to meet people's needs and staff were recruited safely.

People were supported to receive their medicines safely. People were protected from the risk of infections, staff followed safe infection prevention and control practices. The home was visibly clean. Relatives were kept informed and visited without restriction.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People received person-centred care from staff who knew them well. The service focused on what was important to people and took account of their preferences. The provider and registered manager were committed to the continuous improvement of the service. The provider and registered manager acted on feedback from people, staff and relatives. Staff worked well with other services to ensure people received appropriate care which met their needs.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was good (published 10 January 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We inspected this service on 24 November 2017 and the inspection was unannounced. At our previous inspection in October 2015, the service was meeting the regulations that we checked and received an overall rating of Good.

The Leys is registered to accommodate 36 people in one adapted building. At the time of our inspection 20 people were using the service. The Leys accommodates people in one building and support is provided on one floor. At the time of the inspection two communal lounges and a dining area were available to people due to ongoing refurbishment. A garden and enclosed patio were also available that people could access.

There registered manager had resigned from post one month prior to the inspection and had been on leave for 12 months prior to this. 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 registered manager’s post was being recruited to the week following this inspection and the acting manager was overseeing the running of the service and was supported by two deputy managers.

Staff were clear on their role on protecting people from the risk of harm and understood their responsibilities to raise concerns. Individual risks to people and environmental risks were identified and minimised to maintain people’s safety. Assistive technology was in place to support people to keep safe. Systems were in place to prevent and control the risk of infection.

People were protected against the risk of abuse, as checks were made to confirm staff were of good character and there were sufficient staff available to support them. The skill mix of staff ensured people’s needs were met. Medicines were managed safely and people were supported as needed to take their medicine as prescribed and access healthcare services.

People were consulted regarding their preferences and interests and these were incorporated into their support plan to promote individualised care. The staff team knew people well and were provided with the right training and support to enable them to meet people’s needs. People were supported with their dietary needs and to access healthcare services to maintain good health.

People were supported to have maximum choice and control of their lives and staff understood the importance of gaining people’s consent regarding the support they received. The policies and systems in the service supported this practice. People were supported to develop and maintain interests and be part of the local community. The acting manager actively sought and included people and their representatives in the planning of care. There were processes in place for people to raise any complaints and express their views and opinions about the service provided.

A positive culture was in place that promoted good outcomes for people. People who used the service and their relatives were involved in developing the service; which promoted an open and inclusive culture. The provider understood their legal responsibilities and kept up to date with relevant changes. There were systems in place to monitor the quality of the service to enable the acting manager and provider to drive improvement.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

During our inspection visit we observed that people were being cared for in a clean, hygienic environment. We found bed linen, mattresses and equipment were clean and well maintained. However we found one toilet seat had a broken fixing and this meant that it could not be effectively cleaned.

We found that arrangements and systems for the prevention and control of infections did not always meet with recognised guidance. Staff and people using the service could not always wash their hands effectively and paper towels were not disposed of in line with the recommendations to prevent the risks of infection.

Staff told us that they experienced difficulty meeting people's needs when there were three members of staff on each shift instead of four. We found that nearly half of the four week period we reviewed had included days where shifts had been covered by three care staff.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Care plans we saw included where people had signed their agreement to the plan of support and had given consent for their information to be shared.

Is the service effective?

We found that risk assessments had been reviewed however staff did not have access to the latest records. This meant that people living at the service were not protected from unsafe or inappropriate care as reviews of risk assessments were not available for care staff.

We found supervision meetings with staff covered health and safety practices and different policies used in the service. We found that staff who had been absent from work through illness were supported to return back to work. This meant the staff received the supervision and support they needed.

We found that staff training was up to date and had included medication, moving and handling and falls prevention. This meant that staff were provided with the information they needed to do their job.

Is the service caring?

Staff we spoke with told us about a person using the service who did not like eating bread but was not given an alternative to sandwiches for afternoon tea. We spoke to the manager about this person and the manager told us they were not aware of this person's preferences. This meant that people's needs were not being assessed and cared for.

Is the service responsive?

We found there were care plans and risk assessments in place for specific areas of care. When we looked at the daily notes we found that staff had called the GP when people using the service had been unwell. This meant people living at the service had their care needs met.

Is the service well-led?

We reported a member of staff to the manager who told us they were aware this member of staff could talk abruptly to people using the service and this conduct had been investigated before. We found that the investigation into the conduct of the person employed by the service had not identified any learning or changes that had led to improvements.

The manager had gathered views on The Leys from people using the service, other agencies, families and staff in a questionnaire. Although most comments had been positive some comments made by staff had raised concerns. Some staff we spoke with on the day told us they still experienced problems with the concerns they had previously raised. This meant that some staff had not experienced an improvement or change when they had contributed their views and opinions.

Since our last visit in September 2013 the provider had taken steps to ensure people's support records and assessments were reviewed on an ongoing basis to demonstrate that their needs continued to be met effectively.

At our visit in September 2013 the people using the service and visitors we spoke with were all very positive about the support and services provided by the staff team at The Leys.

People told us that the meals served were very good. One person said, 'the food here is very nice, I can't fault it at all.' Another person told us, 'it's delicious, really good quality and cooked very well.' We observed the lunch time meal and saw that tables were attractively decorated and the meals served were well presented.

People were positive about the staff team. One person using the service said, 'the staff are very good here, they are all very friendly.' A visitor told us, 'the staff are very welcoming, they always offer me a drink and they genuinely care about the residents here, it's a lovely place.'

In general the care practices in place were good; however support plans and risk assessments did not always reflect the care that was given. For example some support plans and risk assessments had not been reviewed regularly and some areas of care where risk had been identified did not have risk assessments in place.