The inspection took place on the 7 August 2018.

Legra Residential Care Home provides accommodation and personal care for up to 17 people some of whom may be living with dementia. At the time of our inspection 15 people were living at the service. The service was provided over two floors. There was access to the upper floor via a lift. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection

At the last inspection, the service was rated Good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. There were systems in place to minimise the risk of infection. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Medication was dispensed by staff who had received training to do so.

People were safeguarded from the potential of harm and their freedoms protected. Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People had sufficient amounts to eat and drink to ensure that their dietary and nutritional needs were met. The service worked well with other professionals to ensure that people's health needs were met. People's care records showed that, where appropriate, support and guidance was sought from other health care professionals. The environment was appropriately designed and adapted to meet people’s needs.

Staff were well trained and attentive to people's needs. Staff could demonstrate that they knew people well. Staff treated people with dignity and respect.

Records we viewed showed people and their relatives were involved in the planning and review of their care. Care plans were reviewed on a regular basis and when there was a change in care needs. People were provided with the opportunity to participate in activities which interested them at the service. These activities were diverse to meet people’s social needs. People knew how to make a complaint should they need to. People were provided with the appropriate care and support at the end of their life.

The registered manager had a number of ways of gathering people’s views, they held regular meetings with people and their relatives and used questionnaires to gain feedback. The registered manager carried out quality monitoring to help ensure the service was running effectively and to make continual improvements.

The inspection took place on the 22 February 2016.

Legra Residential Care Home provides accommodation and personal care without nursing for up to 16 persons some of whom may be living with dementia. At the time of our inspection 14 people were living at the service.

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.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Medication was dispensed by staff who had received training to do so.

People were safeguarded from the potential of harm and their freedoms protected. Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The manager was up-to-date with recent changes to the law regarding DoLS and knew how to make a referral if required.

People had sufficient amounts to eat and drink to ensure that their dietary and nutrition needs were met. The service worked well with other professionals to ensure that people's health needs were met. People's care records showed that, where appropriate, support and guidance was sought from health care professionals, including a doctor and district nurse.

Staff were attentive to people's needs. Staff were able to demonstrate that they knew people well. Staff treated people with dignity and respect.

People were provided with the opportunity to participate in activities which interested them. These activities were diverse to meet people’s social needs. People knew how to make a complaint; complaints had been resolved efficiently and quickly.

The service had a number of ways of gathering people’s views including talking with people, staff, and relatives. The manager carried out a number of quality monitoring audits to help ensure the service was running effectively and to make improvements.

We spoke with four of the 15 people who used the service. We spoke with one person's relative, three staff members and the registered manager. We looked at four people's care records and six medication administration charts. Other records viewed included staff training records, personnel records, health and safety checks, and satisfaction questionnaires completed by relatives and staff. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service the staff asked to see our identification. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

We saw records which showed that the health and safety in the service was regularly checked. This included regular checks on such areas as fire safety equipment, gas and electric appliances as well as checks on the environment. This told us people were looked after safely.

People were provided with their medication in a safe manner and at the prescribed times. We saw that medication was stored safely.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

We saw that staff were recruited appropriately and employed after appropriate checks were completed. This meant people were cared for safely by staff who were competent in their roles.

Is the service effective?

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

Is the service caring?

We saw that people were relaxed in the company of each other and staff. We saw that staff were attentive to people's needs. Staff we spoke with were able to demonstrate they knew people well. We saw staff treated people with dignity and respect.

Is the service responsive?

People who used the service were provided with the opportunity to participate in activities which interested them. People's choices were taken in to account and listened to. People's care records showed that where appropriate, support and guidance was sought from health care professionals, including a doctor, optician, chiropodist and district nurse. This told us that the service worked well with other professionals and that people's needs were met.

We saw that the service had a complaints process in place that responded to people’s concerns and acted appropriately to rectify any complaints.

Is the service well-led?

The service had a quality assurance system and records reviewed by us showed that identified shortfalls were addressed. As a result the quality of the service had been maintained.

People we spoke with and their relatives were mostly happy with the care and support provided at Legra Residential Care Home. One person told us , "I like it, it's alright."

We found that since our inspection in December 2012 the provider's arrangements for assessing and recording consent and capacity to consent had improved. People were asked for their consent before support was given. Where they lacked capacity assessments were generally completed.

We found that overall people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We found that the systems in place to ensure that people were given medicines appropriately were not satisfactory. For instance, we saw that required information had not been recorded on the medication records. This could result in people not receiving medication for their needs.

Staff were adequately trained and supported to care for people properly and to keep them safe.

We saw that there were some systems in place to assess the quality of service provision. However these were not sufficiently robust enough to enable the provider to highlight issues with service provision.

There was a system in place for people to raise complaints and comments, although on the day of our inspection this was not clearly displayed for people to see.

We spoke with three relatives and asked them why they had chosen Legra Residential care home for their relative, they all stated that they had chosen it because of its homely feel, "home from home." One relative told us that staff "do a good job" and that their relative was "always comfy, clean and well dressed." Another relative told us that their relative "does more here than [they] would at home".

During our visit we saw staff calling residents by their name, involving all residents in activities but respecting when they chose not to be involved. For those people whose dementia caused them to pace up and down the home, staff would distract them in a way that maintained their dignity and respected their individual needs. The staff interaction with people was good and showed that they were aware of people's needs.

When lunch was served we saw the chef took the food to people and chatted with them. We had seen the chef earlier during the visit and it was clear from the way people spoke with him that he did this everyday. The management team took on board comments and suggestions from visits and inspections by other agencies and produced action plans which were completed to improve the level of service provided to people using the service.