The inspection took place on 6 August 2018 and was unannounced. At the previous inspection we found the provider had not submitted all relevant notifications to the CQC. We found this was a breach of the CQC (Registration) Regulations 2009 Notification of other incidents. We found improvements had been made and the provider was no longer in breach of this regulation.

Lee Mount Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Lee Mount Residential Home accommodates up to 25 people in one adapted building. There are 25 single bedrooms; seven of these have en-suite toilets. There are two lounges and a dining room on the ground floor and an enclosed patio area at the rear of the building. There were 20 people who used the service at the time of inspection.

There was a registered manager in post at the time of 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 provider had systems in place to safely manage medicines within the home. Risk assessments were in place and kept up to date. We made a recommendation for the provider to produce an overview of people’s health needs, including equipment to ensure an overview of their current needs was easily accessible to staff.

We made a recommendation for the provider to have a clear inventory of all equipment including, cushions, wheelchairs and shower chairs. This was to ensure equipment servicing and checks were not overlooked.

Some areas of the home were in need of refurbishment. We saw redecoration was taking place and the registered manager had a refurbishment schedule in place.

There were enough staff to meet people’s needs. There was a robust recruitment process in place and staff received appropriate training and supervision.

People’s care and support was assessed and reviewed on a regular basis. We saw people had access to healthcare professionals.

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. People had a choice of food and drink. People were physically shown the food on a plate to help them make a choice, where appropriate.

People’s privacy, dignity and independence was respected and promoted.

The provider had a service user guide. However we found the guide was not easy to read or user friendly, particularly for people with dementia. We made a recommendation that information is available to people who use the service in a format that is easy for them to read.

Links had been made with the local community. A school worked with the home around healthy eating and a college was providing assistance with activities.

The provider had an up to date complaints policy displayed within the home. We saw complaints were logged, investigated and responded to appropriately. The provider had systems in place to assess and monitor the quality of the service. There were audits in place for areas such as, medicines, infection control and supervisions.

This inspection took place on 17 July 2017 and was unannounced.

At the last inspection on 12 December 2016 we rated the service as ‘Inadequate’ and in ‘Special Measures.’ We identified six regulatory breaches which related to staffing, fit and proper persons employed, safe care and treatment, need for consent, receiving and acting upon complaints and good governance. Following the inspection we took enforcement action. This inspection was to check improvements had been made and to review the ratings.

Lee Mount is a 25-bed service and is registered to provide accommodation and personal care for older people, including people living with dementia. There are 25 single bedrooms; seven of these have en-suite toilets. There are two lounges and a dining room on the ground floor and an enclosed patio area at the rear of the building. On the day of the inspection there were 13 people living at the home.

There was no 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. Since the last inspection a new manager had been appointed and they had submitted their application to be registered by us.

The new manager was supported by a care manager and senior care workers. The manager and care manager were providing good leadership and direction to the staff team and had brought about significant improvements to the service since the last inspection.

We saw staff were kind and caring and there were enough of them to keep people safe and to meet their care needs. Staff were receiving appropriate training and they told us the training was good and relevant to their role. Staff told us they felt supported by the manager and were receiving formal supervision where they could discuss their on-going development needs.

Care plans were up to date and detailed exactly what care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified. We saw appropriate referrals were being made to the safeguarding team, however, the provider was not always making sure these were sent to the Care Quality Commission as required by legislation.

People’s healthcare needs were being met and medicines were being stored and managed safely.

Staff knew about people’s dietary needs and preferences. People told us there was a choice of meals and said the food was very good. We also saw there were plenty of drinks and snacks available for people in between meals.

We found the service was working within the principles of the Mental Capacity Act and Deprivation of Liberty Safeguards and that staff had a good understanding of how these principals applied to their role and the care they provided. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Activities were on offer to keep people occupied both on a group and individual basis.

We saw systems had been introduced to monitor the quality of the service. We saw these had identified areas for improvement and action had been taken to address any shortfalls. People using the service and relatives were being consulted about the way the service was being managed and their views were being acted upon. We saw that the audit systems were helping to drive improvements in the service. It was clear the service had made significant improvements which now needed to be continued with to show the quality of care is sustained. It was too early for the provider to be able to demonstrate that the quality processes were fully embedded and that these improvements could be sustained over time.

This service has been in Special Measures. Services that are

We inspected Lee Mount Home on 12 December 2016 and the visit was unannounced.

Lee Mount is a 25-bed service and is registered to provide accommodation and personal care for older people, including people living with dementia. There are 25 single bedrooms; seven of these have en-suite toilets. There are two lounges and a dining room on the ground floor and an enclosed patio area at the rear of the building. On the day of the inspection there were 19 people living at the service.

There was no registered manager in post as they had left the service in November 2016. 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. A new manager had been recruited but was not registered with CQC.

When we inspected the service in June 2015 we identified four breaches of regulations and the overall quality rating for the service was inadequate. When we returned in December 2015 we found some improvements had been made but the service remained in breach of two regulations and the overall quality rating was requires improvement.

On this inspection we found some of the improvements we saw on the last inspection had not been sustained and there had been a further decline in the service.

The home was mostly clean and tidy and odour free, except for the smell of cigarette smoke in one of the lounges. A fire officer from West Yorkshire Fire and Rescue Service had inspected the premises and had told the provider they needed to make a number of improvements to fire safety in the home.

Staff were not being recruited safely and there were not enough staff to provide adequate supervision to keep them safe or to keep them occupied. Staff training was not up to date and there was a lack of understanding about the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards which meant the service was not always working within the principles of the MCA.

People’s individual care plans varied in quality but we did see some good person-centred care. People’s healthcare needs were being met, however, medicines were not being managed safely and this was the third inspection where this had been an issue.

Meals at the home were good and menus included people’s particular preferences.

We observed staff to kind, caring and patient in their approach to people. Staff were bright and cheerful and this was clearly appreciated by the people who used the service. We found staff helpful and friendly during our visit. However, written information about people was not being kept confidential and we saw reports left on one of the tables in the dining room.

Complaints and concerns were not being investigated or responded to properly.

We found there was a lack of effective management and leadership which coupled with ineffective quality assurance systems meant issues were not identified or resolved. We found shortfalls in the care and service provided to people.

We identified six breaches in Regulations; Regulation 18 (staffing), Regulation 12 (safe care and treatment), Regulation 19 (fit and proper persons employed), Regulation 11 (need for consent), Regulation 16 (receiving and acting upon complaints) and Regulation 17 (good governance). The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the servi

We inspected Lee Mount Residential Home on 15 December 2015 and the visit was unannounced. Our last inspection took place on 8 and 9 June 2015. At that time, we found the provider was not meeting the regulations in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and staffing. We took enforcement action and found on this inspection improvements had been made.

Lee Mount is a 25-bed service and is registered to provide accommodation and personal care for older people, including people living with dementia. There are 25 single bedrooms, seven of these have en-suite toilets. There are two lounges and a dining room on the ground floor and an enclosed patio area at the rear of the building. On the day of the inspection there were 16 people living at the home and one person was in hospital.

There has not been a registered manager at the service since February 2014. 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. Since the last inspection in June 2015 a new manager had been recruited and they were in the process of registering with CQC.

Staff told us the new manager was providing them with leadership and direction and wanted the best for people using the service. They were also keen to tell us about the improvements which had been made since our last inspection.

People who used the service told us they felt safe with the care they were provided with. We found there were appropriate systems in place to protect people from risk of harm.

Recruitment processes were robust and thorough checks were always completed before staff started work to make sure they were safe and suitable to work in the care sector. Staff told us they felt supported by the manager and that training opportunities were good. People and relatives we spoke with told us they liked the staff. We found staff friendly and helpful and there was a nice atmosphere in the home.

There were enough staff on duty to make sure people’s care needs were met and activities were on offer to keep people occupied . We saw people enjoying ball games and a game of ‘Play Your Cards Right.’

The home was well maintained and homely. People’s bedrooms were personalised and we found everywhere was clean and tidy.

We found people had access to healthcare services and these were accessed in a timely way to make sure people’s health care needs were met. We found some improvements were needed to the medication system to ensure medicines were managed safely.

On the day of our visit people looked well cared for. We saw staff speaking calmly and respectfully to people who used the service. Staff demonstrated they knew people’s individual preferences and what they needed to do to meet their care needs.

We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS).

Visitors told us they were always made to feel welcome and if they had any concerns or complaints they would feel able to take these up with the proprietor or the manager.

We saw systems had been introduced to monitor the quality of the service. We saw these were identifying areas for improvement and the manager was able to tell us what action was going to be or had been taken. However, there were no action plans being put in place to show when improvements would be completed. We also found people’s care records were not all complete and up to date. We concluded as the audits were relatively new the provider needs to ensure the development of their quality systems continues so they can be assured the service is being well managed and developed in line with best practice.

We found two breach's of regulations and you can see what

When we visited Lee Mount in May 2013 we found that the home did not have safe systems in place for managing medicines. We said that improvements must be made. This inspection was undertaken to see what actions had been taken.

Due to the focussed nature of our inspection we did not, on this occasion, ask the people who lived at the home for their views on the service they received.

We looked at the systems in place for managing medicines and found that, as a result of improvements, it was safe.

During our visit to Lee Mount we spoke with many of the people who live at the home. As the majority of people were living with dementia it was difficult for some of them to comment directly on the care they received. However people did indicate that they were happy at the home. One person told us that the food was "very nice".

We saw a quality assurance survey completed by some relatives of a person who lived at the home in February 2013. The relatives had said "Generally everything is good and I am happy with the staff and the care that my relative receives"

We also saw a letter of thanks sent to the home which said "Although you only knew our relative for a short time, you cared in the most meaningful way"

Staff we spoke with said that they enjoyed working at the home.

This inspection was carried out to check compliance with a warning notice we issued to the service in October 2012 relating to assessing and monitoring the quality of service provision.

This was a focussed inspection and whilst we spoke with people who lived at the home, we did not seek their views of the service on this occasion.

We spoke with a district nurse who told us that staff at the home did not always follow their advice.

We found that the provider and manager had taken sufficient action to become compliant with the warning notice but we identified some concerns relating to the health and welfare of people living at the home and with record keeping.

This was a focused visit to follow up on compliance actions set in June 2012. In view of this we did not seek the opinions of the people living at the home on this occasion.

People who live at the home said:

"it's not bad, most of the staff are quite good"

"As far as these places go it's alright"

"Food is alright but it's not like home"

A visiting relative told us that they were happy with the care their relative received.

“I enjoy the food there's plenty of choice”.

“The staff are really good and helpful and they'll do anything for you”.

“The back gardens much better, we've got somewhere nice to sit outside now”.

“Great improvements have been made”.

“I'm impressed that the care is centred on my relatives needs, not the home's routine”.

“I've no complaints”.

“They always try to include people in activities”.

We inspected Lee Mount Residential Home on 8 and 9 June 2015 and the first visit was unannounced. Our last inspection took place on 26 September 2013. At that time, we found the provider was meeting the regulations.

Lee Mount is a 25-bed service and is registered to provide accommodation and personal care for older people, including people living with dementia. There are 25 single bedrooms, seven of these have en-suite toilets. There are two lounges and a dining room on the ground floor and an enclosed patio area at the rear of the building. On the first day of our visit there were 19 people living at the home and on the second day there were 18 as one person had sadly died overnight.

There has been no registered manager at the service since February 2014. 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 current manager told us they would not be applying to register until systems were in place to support the improvements they wanted to make.

We found there were delays in getting essential equipment repaired and staff not following infection prevention procedures. The lighting levels in some rooms were poor and we found mattresses which smelt of stale urine.

We found there were not always enough staff on duty to care for people safely or to keep the home clean. Some staff told us they felt supported by the manager but had no confidence in the providers and did not feel valued by them.

The medication system was not well managed and there was no assurance people were receiving all of their medication as prescribed by their doctor.

Staff had attended safeguarding training but were not identifying situations which needed to be referred to the local authority safeguarding team.

We found the service was not meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS). There were a number of restrictions preventing people from moving freely around or leaving the home.

The cook had a good knowledge of people’s dietary preferences and spoke with them directly about the meals on offer. We saw a lot of the food stocks were of the supermarket ‘budget’ variety which may not have been to everyone’s taste.

We found staff were vigilant and involved a variety of healthcare professionals to make sure people’s healthcare needs were met in a timely way.

We saw staff were kind, caring and compassionate. People using the service responded well to staff and we saw good humoured exchanges between people.

There were no care plans in place. Staff were delivering care and support based on their knowledge of people’s individual needs and information from a variety of assessments.

There was a complaints procedure in place but this was out of date and complaints were not being recorded. This meant there was no evidence to show what had been done to resolve any concerns people had raised.

We found there was a lack of provider oversight and very few checks were being made on the overall operation and quality of the service. This meant there was no ongoing improvement plan to develop the service. We also found people using the service and their relatives were being asked for their views about the service but no action had been taken in response. This meant people views were not valued or acted upon.

Overall, we found significant shortfalls in the care and service provided to people. We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found.

The overall rating for this provider is ‘Inadequate’. This means it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.