We carried out an unannounced inspection of Leftwich Community Support Centre on the 18 July 2016.

Leftwich Community Support Centre is a short stay and respite service, where people stay for a short period of time and do not live there permanently. They are registered to provide accommodation for persons who require nursing or personal care for up to 31 people. On the day of our visit, 20 people were staying at Leftwich.

The home is situated in its own grounds in a residential area of Leftwich, close to Northwich town centre.

The service 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.

Records were not always consistently completed. These related to documents relating to consent, risk assessments and fluid charts. This demonstrated a potential flaw in the auditing of records which could have posed a risk to the wellbeing of people.

People told us they felt safe staying at Leftwich and were happy with the service they were provided with. They told us they felt cared about and were positive about the approach of the staff team.

Medication was well managed and promoted the health of people who used the service

People lived in an environment that was clean and hygienic. The environment was designed to enable people to move independently and remain safe.

The registered provider demonstrated that staff received up to date training on topics which related to the needs of people.

Staff demonstrated a good understanding of the Mental Capacity Act 2005 and associated safeguards.

We made a recommendation at our last visit about the activities programme. On that occasion we saw that there were no planned activities in place. We saw that improvements had been made with people who used the service telling us that there were planned activities in place which they could pursue if they wanted to. We saw evidence of a weekly activities programme as well as photographs of key events that had happened in Leftwich during the year.

Care plans were available and outlined each person’s health and social needs. Care plans were reviewed regularly.

People did not have any complaints but were aware of who to speak with if the need arose. A complaints procedure was in place and where complaints had been made; there was evidence that these had been investigated fully.

Our last visit noted that while a registered manager was in place, they were not in day to day control of the service. We concluded that the service was not well led as a result. Since our last visit, a new manager had been appointed. This person was also the nominated individual. Given this, a new manager had been appointed from within the service yet had yet to make an application with us to become registered. This new manager was working alongside the current registered manager. The staff team were complimentary about the management team and considered that the service was well led. Improvements made since our last visit indicated that the management team had taken their regulatory responsibilities into account.

The current registered manager undertook audits of medication, health and safety issues and care plans. The views of people were sought through a questionnaire. The results of these were available and indicated a positive view of the service that people had received.

We visited this service on 21st April 2015 and the inspection was unannounced.

The last inspection was carried out in November 2014 and we found that there were breaches in the regulations that related to consent and meeting the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS); assessment of people’s needs; medication administration; and quality assurance. These included breaches associated with the care and welfare of people who used the service.

Leftwich Community Support Centre provides accommodation for up to 31 people who require a respite or short stay service. A passenger lift and staircases provide access to all levels.

At the time of our visit there were 14 people staying at the service.

The service 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. At the time of this inspection the registered manager was not in day to day control of the service. An interim manager was in place and had worked at the service for four weeks.

At the last inspection in November 2014 we asked the registered provider to take action to make improvements with the administration and management of medicines, the lack of staff training and knowledge with regard to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS); the care and welfare of people who use the service and risk assessments and with assessing and monitoring the quality of service. We received an action plan from the registered provider and they stated they would meet the relevant legal requirements by 31st March 2015. We found on this inspection that the action has been completed and the necessary improvements made.

People told us that they were happy staying at the service and they felt that the staff understood their care needs. People commented "The staff are lovely” and “There is always staff around here.”

We found that people, where possible were involved in decisions about their care and support. We saw that the staff team understood people’s care and support needs, and the staff we observed were kind and respectful towards people.

We found the service was clean, hygienic and well maintained in all areas seen.

We looked at the care records of three people who were staying at the service. We found there was basic information about the support people required and that it was written in a way that recognised people’s needs. We noted that administration and records of medication had improved.

We found that the registered provider had systems in place to ensure that people were protected from the risk of potential harm or abuse. We saw the registered provider had policies and procedures in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS), safeguarding people and staff recruitment. Policies and procedures related to safeguarding adults from abuse were available to the staff team. Staff had received training in safeguarding adults and during discussions staff said they would report any suspected allegations of abuse to the person in charge. This meant that staff had documents available to them to help them understand the risk of potential harm or abuse of people who lived at the service.

We looked at the recruitment practices and saw that two of the four files seen did not have pre-employment checks in place. One person’s references were also not in place. Following the inspection visit we were notified by the registered provider that all pre-employment checks were in place but had not been placed in staff files. This has since been rectified. This meant that the people who were staying at the service could be confident that they were supported by suitable staff.

We looked at staff training however, we found it difficult to see what training staff had undertaken because training records were not available for some staff. Following the visit the manager provided details of staff training. This showed that staff had undertaken a wide range of training. We saw that staff supervision had started to be undertaken and that staff were involved in regular meetings.

We looked at staffing levels at the service. We saw that the staffing levels were good with plenty of staff available to meet the needs of people who used the service.

The service did not employ an activities coordinator and no planned activities were available to people. People confirmed there were no activities available apart from watching the TV and showed a desire for activities to be available to them. The manager said that they were looking into providing an activities coordinator and planned activities for people who were staying at the service.

We saw that the service had started to develop quality assurance systems. However, at the time of this visit these had not yet been fully completed, however, audits on medication had taken place and improvements were evident. Questionnaires were given to people when they left their short stay. We saw that people were very satisfied with the service and said staff were caring and very friendly.

People told us the food was good and that they enjoyed the meals.

We looked at three people's care records and all had an assessment of their health and social needs completed. There were individual support plans and risk assessments in place. This meant that the service could demonstrate they could meet the people’s needs and maintain their health and well being.

The expert by experience spoke to ten people who were currently staying at Leftwich Community Centre and several staff. Comments included “Nothing is too much trouble for the staff”, “Its lovely here. I’m well looked after, but it is sometimes too quiet” and “I have been here before and it’s very nice. The food is good and staff are helpful.”

General observations, including during lunchtime, saw people being treated in a dignified manner and with good responses to requests.

The inspector spoke with people about the food and care provided. People confirmed that they were very happy with the food and they had their preferred choice for breakfast. One person commented “You can have a cooked breakfast if you want.” People also said the staff are very kind and “I am well cared for by the staff.”

The home was clean and odour free.

We spoke with eight people living in the home. People told us they felt very comfortable and cared for. They said they knew all about the home before they came to stay for respite. Comments included “I was given lots of information about the home before I came to stay”, “I was given a brochure about the home and details of how I would be looked after.”; “staff asked me what name I liked to be called so I told them I liked to be called by my shortened name. Everyone calls me that now.”; “I was told about this home before I came here. I was given details of the care provided and it turned out to be better than I expected, it’s great here.”

The people using the service said that they were happy staying in the home. Comments included; “I am fine, I am very happy here”, “I have been back here many times for a short break”, “they provide excellent care and comfort”," staff are kind and I love it here.” “Good food, good staff, good company.” Relatives of people living in the home told us that they felt staff treated people with respect and made sure people got the social, health care and reassurance they needed. Comments included," Staff treat people with respect and provide good care and stimulation."

People told us the staff were kind and helpful and were able to provide a good level of care and support. Comments included, “The staff are good”,” staff are kind and helpful”,” staff assist me when I need help”.” We sometimes have to wait a while for staff to assist us, as they are very busy. However they do their very best.”

People told us they had monthly newsletters to let them know what was happening in the home. They said they also had meetings where they could make decisions about menus, activities and any other issues that may arise.

Leftwich Community Support Centre is a short stay and respite service, where people stay for a short period of time and are not permanent residents there. There is also a day centre attached to this service and some of the people who come to stay there also have regular day care there as well.

We spoke to people who use the service and they said:

“The staff are smashing and I am treated well. The food is quite good. I have no complaints.”

“I like it here, the staff are good and kind.”

“It is nice here, I am well looked after.”

We spoke with relatives of the people who use the service and they said:

“The staff are kind and friendly. I visit my relative regularly during their stay. I have no complaints or problems.”

“The staff are very good and showed us where our relative was. The staff are friendly and my relative likes it here. The meals are good. We have no concerns about the service”

We spoke with staff and they commented:

“I have worked here 5 years. I enjoy my work and talking to the people here. The staff are brilliant and work well together as a team. The manager is very good and her door is always open. She is supportive to staff. The training is good and we have regular refresher courses.”

“I have worked here for 11 years. We work well as a team. The manager is good. I enjoy working here.”

“The training is good”

“I enjoy working here and I like my job and taking to the people staying here.”

We also spoke with other professionals. They commented:

“No problems with this service. The staff are helpful, but sometimes I cannot find the staff member I need. People who have stayed here have said the staff are lovely and good to them.”

“Generally the service is ok. The staff meet the needs of the people staying there. It has a homely atmosphere. Staff are very helpful. “

“The manager is fine, she knows her role and likes things done well. The staff team work well together. The manager and staff appear to know the people who are staying there well. “

This inspection took place over two days on the 5 and 6 of November 2014.

Leftwich Community Support Centre provides accommodation for up to 31 people who require a respite or short stay. Accommodation is arranged over two floors and there is a passenger lift to assist people to get to the upper floor. The home has 31 single bedrooms. There were 16 people staying at the home at the time of our inspection. The downstairs unit is used for people who require some further time and rehabilitation following a period in hospital. They are able to access the rehabilitation services provided by the intermediate care team. The upstairs unit is used for people who require a short stay for a number of reasons, such as to give their carers a break.

At the time of our visit, there was refurbishment underway to provide a seven bedded unit for people with dementia. We were told that the expected date of opening was January 2015.

There was a registered manager in post. A registered manager is a person who is 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

When we last inspected Leftwich Community Support Centre we found the service was meeting all the Regulations that we assessed.

At this inspection, we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The actions we have told the Provider to take are at the end of this report.

Staff knew how to keep people safe from abuse and were aware of how to report concerns. People told us they felt safe and cared for. However, we found that the care being provided was not always safe.

Staff were not following the Mental Capacity Act 2005 (MCA) for people who lacked capacity to make decisions for themselves, or the Deprivation or Liberty Safeguards ( DoLS) where restrictions needed to be put in place for their own health and safety or that of others. This meant that people’s rights were not always protected or taken into account.

Medicines were not always managed safely for people and people were not getting the correct medicines all of the time. There were discrepancies in numbers of medicines available and medicine records. Medicines were not always stored correctly.

We observed positive interaction with care staff but care was “task orientated” and there was very little to keep people occupied and socially stimulated.

The registered manager did not carry out her own assessment prior to a person coming to stay, which meant that staff could not always meet a person’s needs. The care documentation was not detailed or sufficient enough to explain fully to staff what care was required for each person. It was not reviewed or updated when a person’s physical or mental health changed. There was a risk that people would not receive the right care or medical intervention.

The provider did not have any quality assurance systems to monitor the quality of the service or identify and manage risks. This meant people were not protected against the risks of receiving unsafe or inappropriate care.