Leighton House Retirement Home is registered to care for up to 30 elderly people. The home is a spacious detached house, close to local community facilities and motorway networks. Bedrooms are situated on the ground, first and second floors and a lift is fitted for people who have mobility problems. Car parking space is available as well as a well-kept garden. There were 23 people accommodated at the home during the inspection.

At the last inspection of 14 October 2016 the service was rated as good overall but required improvement in safe. This was because risk assessments were not always up to date. The lack of accurate and up to date risk assessments meant there was a risk people who used the service might receive unsafe care. This was a breach of regulation 9 HSCA 2008 (Regulated Activities) Regulations 2010 and we issued a requirement action. The service sent us an action plan to show how they intended to make improvements. We saw at this inspection that improvements had been made.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service used the local authority safeguarding procedures to report any safeguarding concerns. Staff had been trained in safeguarding topics and were aware of their responsibilities to report any possible abuse.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow.

The home was clean and tidy. The environment was maintained at a good level and homely in character. Although there were some faults with some equipment we saw that arrangements had been made to fix the problems.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities. This helped to protect the health and welfare of staff and people who used the service.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies.

People were given choices in the food they ate and told us it was good. People were encouraged to eat and drink to ensure they were hydrated and well fed.

Most staff had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of her responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed there were good interactions between staff and people who used the service. People told us staff were kind and caring.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and they were regularly reviewed. Plans of care contained people’s personal preferences so they could be treated as individuals.

People were given information on how to complain with the details of other organisations if they wished to go outside of the service.

Staff and people who used the service all told us managers were approachable and supportive.

This was an unannounced inspection which took place on 14 October 2014. The service was last inspected in February 2014 when it was found to be meeting the regulation we reviewed.

Leighton House Retirement Home provides accommodation for up to 30 people who require support with personal care. There were 25 people living in the home at the time of our inspection.

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 and associated Regulations about how the service is run.

All the people we spoke with who used the service told us they felt safe in Leighton House. Comments people made to us included, “Staff are around 24hours, day and night, checking we are safe” and “Staff are thorough, this makes me feel safe.”  Relatives we spoke with also confirmed they considered their family members were safe and well cared for in Leighton House.

Staff had received safeguarding training and were able to tell us what action they would need to take if they had any concerns about the care people received in Leighton House. All the staff we spoke with were confident any concerns they might raise would be taken seriously and acted upon.

Risk management policies and procedures were in place. However, we found improvements needed to be made to the systems for completing, reviewing and updating risk assessments in order to ensure they accurately reflected the needs of people who used the service.

There were arrangements in place to help ensure medicines were safely administered. People told us they received their medicines when they needed them.

There were systems in place to provide staff with support, induction, supervision and training. Staff told us they enjoyed working at Leighton House and considered they received the training and support they needed to effectively carry out their role.

Staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. The registered manager was aware of the process to follow should they need to apply for the authorisation of any restrictions which were in place for people who used the service.

People who used the service received appropriate support and monitoring to help ensure their nutritional needs were met. All the people we spoke with made positive comments about the quality of food provided in Leighton House.

All the people we spoke with gave positive feedback about the staff in Leighton House. Comments people made to us included, “Staff are very respectful of me and always listen”, “I am extremely happy and satisfied with the way staff at Leighton House tend to my needs” and, “[My relative] is always treated in a professional but kind, safe and patient manner.” We observed positive interactions between staff and people who used the service.

People we spoke with who used the service told us there were enough staff on duty to meet their needs. Two people told us they sometimes had to wait for staff to respond to their requests for assistance if they were busy caring for other people, but they did not consider this to be for an unacceptable amount of time.

There were a number of quality assurance processes in place in Leighton House. This showed us the registered manager was regularly reviewing how the service could be improved.

We have identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have told the provider to take in the full version of this report.

This follow up inspection was to check whether the Registered Provider had taken action to address concerns we had identified around cleanliness and infection control at our previous inspection in September 2013. Following this last inspection, the manager of the home had sent us an action plan telling us how they would improve the service they provided.

We found that some improvements had been made to the way the home managed cleanliness and infection control and that they were continuing to make improvements. We saw that the home environment looked generally clean and that there were no unpleasant odours.

We spoke with one person who used the service who told us “all is satisfactory, staff are wonderful, they look after us”. We also spoke with two staff members who showed a clear understanding of the infection control process in place and their responsibilities.

During our visit to the home we spoke with one visitor and with two people using the service.

The visitor told us that they had been involved in the care plans for their family member and had been asked for consent where appropriate. The people using the service told us they felt they were being looked after properly and felt they had enough food.

The people we spoke with expressed concerns that during some busy times they felt there were not always enough staff on duty but overall there were sufficient staff.

One person told us “I enjoy the activities here; everyone makes us feel at home”. Another person said “The care is fabulous, the staff are caring and I have no qualms”.

People's care records were kept secure and contained enough information to show how they were to be supported and cared for. They also showed that people gave consent to their care and treatment.

Systems were in place to protect people who lacked the capacity to make decisions about their own care and support.

All the people we spoke with felt that the environment was suitable for the delivery of care. One person told us they felt the décor could do with some updates as it was old fashioned.

People we spoke with told us they didn’t have any need to raise any formal complaints, any small matters were dealt with by staff immediately.

During our visit we spent our time checking to see if the medicines were being handled safely. We found the management of medicines remained unsafe.

We also checked to see if there had been an improvement in the amount of care staff provided during the evening shift. We found there had been an improvement and that extra staff had been provided during this busy time.

We spoke with two of the people using the service. They told us, "I am well looked after" and "Oh yes, it's nice here, the staff are good to me".

We saw there had also been an improvement in the monitoring of the services and facilities provided.

During our visit to the Leighton House Retirement Home on 4 October 2012 we spent our time checking to see if the medicines were being handled safely. We found the management of medicines was unsafe.

We also checked to see if there were enough staff on duty at all times. We found there were insufficient staff on duty at certain times of the day. We spoke with two people using the service. They told us the following:

"The staff are very nice but they do not have time to explain things to me. There are not enough of them to look after people".

"I have to wait to be taken to the toilet and sometimes I have to wait before I can go to bed. It can be a contest as to who can go next".

We also looked to see if there had been any improvement in the monitoring of the service and facilities provided. There had been very little improvement.

Whilst we were in the home we spoke with two people using the service, three relatives and a visiting district nurse.

The people that we spoke with were complimentary about the staff and the care provided. Some of the comments were:

“They look after me very well”.

“I could go somewhere else if I wanted to but why should I? I am very happy here”.

“The staff are lovely; very kind and considerate”.

“The staff are amazing; they work very hard”.

A visiting district nurse told us the staff were very good at looking after people, especially those people who were very ill.