This inspection took place on 28 February 2017 and was unannounced. Leen Valley Care Home is registered to provide personal care and accommodation for up to 36 people. On the day of our inspection there were 15 people using the service. The service has two floors with a passenger lift for people to access the upper floor.

There was a registered manager in post when we inspected the service. 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.’

People who used the service were safe; staff had a good understanding of how to protect people from potential abuse. The risks to people’s safety were assessed and staff used the measures in place to reduce risks to their safety.

People were cared for by sufficient numbers of staff who had received training for their roles. People received their medicines when they required them.

People’s right to make choices was respected and staff understood the need to obtain consent from people when providing care. Where people lacked the mental capacity to make their own decisions staff were aware of the legislation in place to protect people and had followed the principles of the Mental Capacity Act 2005 (MCA) to ensure people were not unlawfully deprived of their liberty.

People were supported to maintain a nutritionally appropriate diet according to their needs and their health needs were managed by the staff who cared for them.

People received care from staff who were kind and respectful, their views on their care were listened to and incorporated into their individual plans to ensure person centred care was provided.

People, who used the service, or their representatives, were encouraged to be involved in decisions about their care and their environment, and systems were in place to monitor the quality of service provision. People also felt they could report any concerns to the management team and felt they would be taken seriously.

At our last inspection of Leen Valley Care Home on 30 July 2015 we found people who used the service were not always protected from the risk of abuse and safe recruitment practices were not always followed. This was a breach of Regulations 13 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered provider sent us an action plan in August 2015 saying they had made the required improvements. We undertook this comprehensive inspection to confirm that the provider now met the legal requirements in relation to breaches of regulation we found. We found the registered provider had made the improvements they said they would and were no longer in breach of these regulations.

We inspected the service on 9 August 2016. The inspection was unannounced. Leen Valley Care Home is registered to accommodate up to 36 people. The home has two floors with a passenger lift for people to access the upper floor. On the day of our inspection seventeen people were using the service.

The service did not have a registered manager in place 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.

People were not always supported by enough staff to ensure they received care and support when they needed it. People did not always receive their medicines as prescribed.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned for to protect them from harm.

People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support. People were supported to make decisions and staff knew how to act if people did not have the capacity to make decisions.

People were supported to maintain their nutrition and staff were monitoring and responding to people’s health conditions.

People lived in a service where staff treated them with kindness and listened to them. People’s emotional needs were recognised and responded to by a staff team who cared about the individual they were supporting.

People were not always given enough opportunity to follow their hobbies and interests and could not be assured that if they raised concerns these would be resolved.

People were involved in giving their views on how the service was run and there were systems in place to monitor and improve the quality of the service provided.

We inspected the service on 17 March 2015. The inspection was unannounced. Leen Valley Care Home is registered to accommodate up to 36 people. On the day of our inspection 18 people were using the service.

The service did not have a registered manager in place 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.

When we last inspected the service on 25 September 2014 we found there were improvements needed in relation to how care was planned for people with diabetes and end of life care. The provider sent us an action plan telling us they would make these improvements by 12 November 2014. We found at this inspection that this had not been completed and the provider had not made all of the improvements in line with their action plan.

People felt safe in the service but we found the provider had not always shared information with the local authority when they should. This meant the systems in place to protect people from the risk of abuse were not effective.

Medicines were not always managed safely and staffing levels were not matched to the needs of people who used the service to ensure they received care and support when they needed it.

People were supported by staff who had not been given the training to provide safe and appropriate care and support. People were not always protected by the Mental Capacity Act 2005. People were supported to eat and drink enough.

The acting manager told us that they had considered the requirements of the Deprivation of Liberty Safeguards and assessed that applications were not needed at this point but there were systems in place to ensure the appropriate assessments would take place if the need arose.

Referrals were made to health care professionals for additional support or guidance if people’s health changed. However people who had a health related illness did not always have an appropriate care plan in place informing staff how to monitor the risk and how to respond if the person became unwell.

People were treated with dignity and respect and had their choices acted on. We saw staff were kind and caring when supporting people.

People enjoyed the activities and social stimulation they were offered. People also knew who to speak with if they had any concerns they wished to raise and they felt these would be taken seriously.

People were involved in giving their views on how the service was run through the systems used to monitor the quality of the service. Audits had been completed that resulted in recognising some improvements needed in the service. However a lack of oversight in relation to areas of monitoring safe systems had resulted in a decline in the service.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

This inspection was carried out by one inspector. At the time of our inspection 17 people were being supported by the service. We spoke with six people receiving care, the manager and three care staff working at the service. We spoke with a health professional who was visiting the home on the day of our inspection. We asked people about their experience of the care they received at Leen Valley. We spoke with three relatives during our inspection. We also examined care plans and other records.

We last inspected this service on 5 December 2013. At this inspection we found people were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not always maintained. At this inspection we found improvements had been made to record keeping. Senior care staff recorded information daily about people’s needs and how they were being met. We saw care plans were also reviewed monthly by the manager. A summary of what we found is set out below. We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

We spoke with six people the service supported. One person told us, "I think the care is excellent here. Staff listen and help me when I have lost something or I am not feeling too good.” One person we spoke with told us their relative had moved to the service. They said, “We can see [they] are happier and more relaxed.”

Another relative we spoke with told us, “When the phone rang I used to worry. But things have improved since the home came under new management."

A visiting healthcare professional told us the service was, “Good at contacting us for advice.” The service acted to protect people who were unable to make decisions, for example, about their finances. The service had arrangements in place to make decisions in people’s best interest if the person’s mental capacity meant they were unable to make some decisions. The process followed by the service met the requirements of the Mental Capacity Act 2005.

Is the service effective?

Peoples needs were assessed and care plans were reviewed monthly by the manager. Care staff we spoke with understood people’s needs. Senior care staff explained how they led a shift and ensured the care described in care plans was delivered. Care staff told us senior care staff allocated their work based on people's needs as described in the person's care plan. We saw senior care staff update people’s care plans to monitor the care delivered. Risk assessments had been carried out and were reviewed.

We found examples of gaps in the co-ordination of some people's care. It was not clear what action care staff had taken to respond to diagnostic test results in one instance and action had not been taken in response to a communication recorded in another person's care plan.

We found care staff had the appropriate training and experience to enable them to carry out their role effectively. Care staff told us they received regular supervision and appraisal. Care staff training was up to date.

Is the service responsive?

We spoke with a relative who told us that the service had improved considerably since the new owner provided the service. They said, “Looking after people with dementia is such a difficult task. Care staff now all seem very nice. I would know how to raise concerns if I had any.”

We spoke with people who were having their lunch and asked them about the food. One person said, “They know what we like. I don’t want spicy food or pasta or garlic. I like traditional food. The puddings here are really nice.”

Is the service caring?

One person we spoke with told us, “Staff are always polite and kind and if I had any complaints I would say something.” We observed care staff supporting people at lunchtime. Care staff sat at the dining table and engaged in conversation with people as well as supporting them to eat. We saw care staff were patient when they supported people.

Is the service well led?

People who used the service and relatives told us the service had improved over the last year. One relative told us, “The manager makes sure things get done.”

The provider had developed a quality assurance process which consisted of audits and checks designed to identify and manage the risks to people ‘s health and welfare. The service had also obtained feedback from people who used the service and staff. The manager met with relatives and people who used the service to discuss improvements to the service.

We spoke with two people who were using the service, one person told us, “I love it here. Everything is lovely” and another person said, ”I am happy here, the staff are lovely.” We spoke with two relatives of people using the service. One relative told us, “The home is good because of the staff and the manager.”

There were effective systems in place to reduce the risk and spread of infection. We looked at nine bedrooms, all communal areas, the laundry and the sluice room to assess the cleanliness and how the risk of the spread of infection was being managed. Improvements had been made to the environment such as new carpets and curtains and there were plans for further improvements.

There were systems in place to make sure people received their medication as prescribed by their doctor. The provider also had systems in place to gain the views of people using the service and to monitor the quality of care provided.

Records did not always reflect the care people were receiving. For example, one person had a history of falls and had been assessed as being at risk of further falls. The care plan was basic in relation to how staff should support this person to reduce the risk of further falls. We saw staff were taking appropriate measures to reduce the risk and that equipment was in place and being used. This meant the care was being delivered but the records were not fit for purpose.