The inspection was unannounced, which meant the provider did not know we were coming. It took place on 9 May 2017. The home was previously inspected in April 2016 and was rated requires improvement with breaches of regulations in The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People did not always receive medication as prescribed and governance systems needed to be embedded into practice. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Layden Court’ on our website at www.cqc.org.uk’

Layden Court is a care home providing accommodation including nursing care for up to 89 older people. It is situated in the area of Maltby, approximately six miles from Rotherham town centre. It provides accommodation on both the ground and the first floor and has parking to the front of the building and gardens at the rear. At the time of our inspection there were 78 people using the service.

There was a registered manager at the time of our inspection. 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 home had a safeguarding policy in place to protect people from the risk of abuse. Staff we spoke with were aware of procedures to follow and the importance of reporting any incidents. Assessments identified risks to people and management plans to reduce the risks were in place. People we spoke with told us they felt safe and relatives also said the home provided safe care.

Systems were in place to make sure people received their medications safely; however some minor improvement could still be implemented.

People who lack mental capacity to consent to arrangements for necessary care or treatment can only be deprived of their liberty when this is in their best interests and legally authorised under the Mental Capacity Act 2005. The procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We found the requirements of the act were being met.

There was an infection control policy and a procedure in place and the service was maintained to a good standard of cleanliness. However, staff told us they could do with domestic hours in the late afternoon or evenings.

At the time of the inspection there was sufficient staff on duty to meet people’s needs. Relatives we spoke with confirmed when they visited there were sufficient staff on duty. The provider had a system to ensure safe recruitment was carried out. However we identified some issues in two staff files which were followed up and resolved during our inspection. Staff told us they felt supported and communication was good. However, some staff had not received formal supervision in line with the provider’s policies.

Improvements to the environment had been made to provide areas that were dementia friendly. The registered manager was continuously looking at ways to further improve the environment for the people living with dementia who lived in the home.

People received a nutritious and balanced diet. Snacks and drinks were offered throughout the day. People told us they enjoyed the food provided at the home. However, some improvements could still be made at mealtimes to further improve the experience for people living with dementia.

We observed staff interacting with people who used the service and found they were kind, caring and respectful. People we spoke with spoke very highly of the staff and the care they received.

We looked at care plans and other written records and found that in most cases, they reflected people’s current needs. However, we saw in some files there was no end of life care plan to ensure people wishes and decisions were recorded.

The home employed two activity

This inspection was carried out over three days on 8, 9 and 17 March 2016. The inspection was unannounced on the first day.

This was the third rated inspection for this service which had previously been rated inadequate in November 2014. In May 2015 we carried out a further comprehensive inspection and found improvements had been made, but further improvements were required to be implemented and was rated as requires improvement. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Layden Court’ on our website at www.cqc.org.uk’

Layden Court is a care home providing accommodation including nursing care for up to 89 older people. It is situated in the area of Maltby, approximately six miles from Rotherham town centre. It provides accommodation on both the ground and the first floor and has parking to the front of the building and gardens at the rear.

The home had a registered manager. 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 improvements to the service provided had continued to be made however we found these were not yet fully embedded into practice. We found and staff told us that the new Registered Manager was having a positive impact on the service. The main issues identified within this report related to management and staffing shortages that have now been addressed however the provider monitoring systems in place had failed to identify the impact of staffing shortages on the quality of the services provided to ensure risks could be managed or mitigated effectively.

We found that staff had a good understanding of the legal requirements as required under the Mental Capacity Act (2005) Code of Practice. The Mental Capacity Act 2005 sets out how support people who do not have the capacity to make specific decisions about their care.

People’s physical 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 home involved dieticians and tissue viability nurses to support people’s health and wellbeing. However, although staff knew people well and understood any risks associated with their care, we found these were not always documented in people’s plans of care and formal reviews had not been carried out.

People were supported with their dietary requirements. We found a varied, nutritious diet was provided. People we spoke with told us they enjoyed the food. However we found some meal times could be improved to meet the needs of people living with dementia.

We found staff approached people in a kind and caring way which encouraged people to express how and when they needed support. People we spoke with told us that they were able to make decisions about their care and how staff supported them to meet their needs.

People were not always protected against the risks associated with the unsafe use and management of medicines. Appropriate arrangements were in place for the recording, safe keeping and safe administration of medicines. However, we found these were not always followed.

There were robust recruitment procedures in place; staff had received formal supervision and an annual appraisal. Staff received training to be able to fulfil their roles and responsibilities.

We found that generally, there were enough staff to keep people safe, although people told us there were times when staff were very busy. We also found there was a lack of stimulation and social activities for people who used the service.

Staff told us they felt supported and they could raise any concerns with the registered manager and felt that they were listened to. Staff

Our inspection looked at our 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, speaking with the staff supporting them and looking at records.

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

Is the service safe?

People were treated with respect and staff maintained people’s dignity. People told us that the staff were very good and were always there to help them. One person said, “The staff look after me, it is alright here.”

We found some quality monitoring systems were in place. This ensured the risks to people were identified and reduced, to be able to continually improve.

Appropriate arrangements for the recording, safe keeping and safe administration of medicines were in place.

Staff supervisions and appraisals had not been kept up to date since the manager had left. This included clinical supervision for qualified staff. The provider had appointed a new manager who had implemented a schedule to address this. The staff told us the new manager was very approachable and if they needed to discuss anything they would not hesitate to speak with him.

During our visit we observed there were not effective systems in place to reduce the risk and spread of infection. Many areas were not maintained to an appropriate standard of cleanliness.

Is the service effective?

Most people’s health and care needs were reviewed, and if people were able they were involved in the reviews.

Audits and reviews had taken place, the audits were thorough and had identified shortfalls. For example the need to ensure staff supervisions were carried out. However the infection control audits and environmental audits had not been effective as the standards observed were not appropriate.

We observed activities on-going during our visit people were engaging in the activity and enjoying it. However it was a very small group of people engaging in the activity.

Is the service caring?

We observed care workers interacted positively with people who used the service. Staff showed patience and gave encouragement when supporting people.

We spent time in the dining room during lunch observing. We saw the experience was inclusive, calm, supportive and enjoyed by people who used the service. People were not rushed and their choices and preferences were respected. We observed staff giving appropriate sensitive support when required.

Is the service responsive?

The provider had redecorated a number of communal areas, however the redecoration programme had not continued and many areas were in need of improvement.

The new manager had already identified a number of improvements required and was in the process of implementing what was required to ensure the improvements were carried out.

Is the service well-led?

The provider had appointed a peripatetic manager to oversee the service until a new manager was appointed. At the time of our visit a new manager was in post, he had support from the peripatetic manager and the area manager.

The new manager told us he was in the process of submitting an application to CQC to become the registered manager.

We spoke with ten people who used the service to gain their views about living at Layden Court Care Home. We also spoke with seven relatives and a continuing health nurse who were visiting the home during this inspection.

We found people expressed their views and were involved in making decisions about their care and treatment. People were confident that their relatives would ensure they received appropriate care. One person we spoke with said, “They know what to do for you and they do it.” Another person said, “They look after you here, the staff are good and no matter what you want they will fix it up for you.”

We found staff had an excellent rapport with the people who used the service. One of the relatives said “The nurses are absolutely excellent, and I have no concerns about my relatives care.” Another relative said “Staff appears to be very caring with all of the residents which is important to me”.

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. Staff had a good knowledge of the needs of people who used the service.

People were cared for, or supported by, sufficient suitably qualified, skilled and experienced staff.

The provider had an effective system to regularly assess and monitor the quality of service that people received. Complaints were investigated and responded to in a timely manner.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector and joined by a practising professional and an Expert by Experience, who has personal experience of using or caring for someone who uses this type of service.

We also spent a period of time observing staff delivering care to people who used the service. This method of observation is called the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We observed three people who used the service for a period of 30 minutes during lunchtime. We recorded their experiences at regular intervals. This included people's mood, and how they interacted with staff members, other people who used the services, and the environment. People were treated with respect and staff offered appropriate support to have their meals in a suitable environment. One person said “I do not require any assistance but I feel that I am treated with dignity and respect.” Another person told us “I can go out in the garden when I want and watch the television and that is my choice.”

We have not spoken directly with people who used service at this inspection as we have only looked at outcome 14 which relates to supporting staff. Please refer to the inspection report dated December 2011 which contains the views of people who used the service.

People told us they had looked at several homes before choosing Layden Court and they had made the decision based on what friends had told them, which was that it was the best home in the locality. People told us they felt safe at the home and would tell the manager if they had concerns about anything. People said the food was good and there was lots of choice. One person told us “I like to go to the concerts, but I don’t join in the rest of the activities, and that’s my choice”.

We carried out an unannounced comprehensive inspection of this service on 6 and 11November 2014 in which breaches of the legal requirements were found. This was because people were not protected against the risks associated with not receiving adequate nutrition, care or treatment in accordance with their wishes, people were not involved in making decisions in their care and treatment, staff did not receive appropriate professional development, supervision or appraisal and the provider did not have an effective system to regularly assess and monitor the quality of the service provided. During that inspection we also issued two warning notices for beaches in relation to Regulations 9 (care and welfare) and 13 (medicines management) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook a focused inspection on 3 March 2015 to check that they had made the improvements in regard to the warning notices issued. We did not look at other breaches at this inspection as the provider was still in the process of implementing their action plan and embedding these improvements into practice. At the focused inspection we found that action had been taken to improve the safety and responsiveness of the service.

You can read the report from our last inspections, by selecting the 'all reports' link for ‘Layden Court’ on our website at www.cqc.org.uk’

Layden Court is a care home providing accommodation including nursing for up to 89 older people. It is situated in the area of Maltby, approximately six miles from Rotherham town centre. It provides accommodation on both the ground and the first floor and has parking to the front of the building and gardens at the rear.

The home did not have 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. The provider had a peripatetic manager overseeing the service. However, we were told at the time of our inspection that a permanent manager had been appointed and would commence in post on 23 June 2015.

We undertook this inspection on the 21 and 22 May 2015. The inspection was unannounced on the first day. We found that the provider had followed their improvement plan, which they had told us would be completed by the 30 March 2015, and all legal requirements had been met, although systems and practices needed to be embedded into practice to ensure improvements were sustained.

People were kept safe at the home. We found that staff had a good understanding of the legal requirements as required under the Mental Capacity Act (2005) Code of Practice. The Mental Capacity Act 2005 sets out how to act to support people who do not have the capacity to make a specific decision.

People’s physical 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 home involved dieticians and tissue viability nurses to support people’s health and wellbeing.

People were supported with their dietary requirements. We found a varied, nutritious diet was provided. People we spoke with told us they enjoyed the food.

We found staff approached people in a kind and caring way which encouraged people to express how and when they needed support. People we spoke with told us that they were able to make decisions about their care and how staff supported them to meet their needs.

People were protected against the risks associated with the unsafe use and management of medicines. Appropriate arrangements were in place for the recording, safe keeping and safe administration of medicines. We found new systems had been introduced and regular checks were being carried out, although these still needed to be embedded into practice.

There were robust recruitment procedures in place, staff had received formal supervision. Qualified nursing staff had also received a monthly clinical supervision. Annual appraisals had been scheduled. These ensured development and training necessary to support staff to fulfil their roles and responsibilities was identified. Staff training had been identified and booked to ensure staff had the knowledge to meet people’s needs. We found that generally, there were enough staff to keep people safe, although people told us there were times when staff were very busy. A new activities coordinator had been employed and their hours increased to help to ensure people’s needs could be met. Although they were not on duty at the time of our visit.

Staff told us they felt supported and they could raise any concerns with the manager and felt that they were listened to. Although staff were still apprehensive regarding future management, as there had been five different managers in the last year.

People told us they were aware of the complaints procedure and said staff would assist them if they needed to use it.

The provider had introduced new systems to monitor the quality of the service provided. We saw these were more effective.