We carried out an unannounced comprehensive inspection of this service on 12 January 2015. The service was rated as inadequate. Breaches of legal requirements were found. These related to medicines, staffing levels, staff training and support, how people were treated with respect and dignity and how people’s consent was obtained. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We also found that the service required improvements in how they ensured the care and welfare of people who used the service and how the service ensured that they were providing a good quality service. We issued warning notices and told the provider when they should make improvements by 16 March 2015. We undertook a focussed inspection on 13 April 2015 and found improvements had been made and that the provider needed to, sustain these improvements over time and to independently identify shortfalls and take appropriate and timely action to address them.

Leopold Nursing Home provides accommodation, nursing and personal care for up to 32 older people, some people are living with dementia. There were 19 people living in the service when we inspected on 24 September 2015. This was an unannounced inspection.

Although some improvements had been made we found multiple breaches of regulation that affected the well-being of people using the service.

The overall rating for this provider is ‘Inadequate’. This means that 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.

There was a 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.

The leadership of the service was not robust enough to independently identify and address shortfalls. There had been some improvements which were ongoing but these were not made in a timely manner to ensure people were provided with a good quality service at all times.

There had been some improvement made in staff training. However, further improvements were needed, staff did not know enough about people or the care they needed to ensure that they received consistent and safe care at all times.

People’s privacy was not always respected.

Improvements were needed in how support and equipment were provided to people to maintain their independence, choice and cultural needs when eating and drinking.

People who were upset by others living in the service were not supported by staff to reassure them. In addition to this appropriate action was not taken to advise people on how their actions could upset others.

People’s care records had been reviewed and updated, however further improvements were required.

There were now appropriate arrangements in place to ensure people were provided with their medicines safely and when they needed them.

There were sufficient numbers of staff to meet people’s needs.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty (DoLS) which applies to care homes. Staff had been provided with training in Mental Capacity Act 2005 (MCA) and DoLS. The systems in place to obtain and act in accordance with people’s consent had been improved to respect people’s rights and choices.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

We carried out an unannounced comprehensive inspection of this service on 12 January 2015. Breaches of legal requirements were found. These related to medicines, staffing levels, staff training and support, how people were treated with respect and dignity and how people’s consent was obtained. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We also found that the service required improvements in how they ensured the care and welfare of people who used the service and how the service ensured that they were providing a good quality service. We issued warning notices and told the provider when they should make improvements by 16 March 2015.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Leopold Nursing Home on our website at www.cqc.org.uk.

During this inspection we found that improvements had been made. They now need to, sustain these improvements over time and to independently identify shortfalls and take appropriate and timely action to address them.

Leopold Nursing Home provides accommodation, nursing and personal care for up to 32 older people, some people are living with dementia.

There were 19 people living in the service when we inspected on 13 April 2015. This was an unannounced inspection.

There was a 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.

There were improved systems in place to meet people’s needs safely. People’s care records had been reviewed and updated to reflect the care and support they required. Improvements were made in how the staff respected people’s privacy and dignity.

There were now appropriate arrangements in place to ensure people were provided with their medicines safely and when they needed them.

People’s dietary needs were assessed and actions were taken when there were concerns about people’s wellbeing relating to their nutrition and hydration.

There were sufficient numbers of staff to meet people’s needs. Improvements had been made in how the staff were provided with the training and support they needed to meet people’s needs.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty (DoLS) which applies to care homes. Staff had been provided with training in Mental Capacity Act 2005 (MCA) and DoLS. The systems in place to obtain and act in accordance with people’s consent had been improved to respect people’s rights and choices.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

There were improvements made in how the service sought people’s views and experiences. Improvements were made in the service’s quality assurance processes. However, these needed to be embedded further to show that the service can sustain the progress made.

We carried out an unannounced comprehensive inspection of this service on 12 January 2015. The service was rated as inadequate. Breaches of legal requirements were found. These related to medicines, staffing levels, staff training and support, how people were treated with respect and dignity and how people’s consent was obtained. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We also found that the service required improvements in how they ensured the care and welfare of people who used the service and how the service ensured that they were providing a good quality service. We issued warning notices and told the provider when they should make improvements by 16 March 2015. We undertook a focussed inspection on 13 April 2015 and found improvements had been made and that the provider needed to, sustain these improvements over time and to independently identify shortfalls and take appropriate and timely action to address them.

Leopold Nursing Home provides accommodation, nursing and personal care for up to 32 older people, some people are living with dementia. There were 19 people living in the service when we inspected on 24 September 2015. This was an unannounced inspection.

Although some improvements had been made we found multiple breaches of regulation that affected the well-being of people using the service.

The overall rating for this provider is ‘Inadequate’. This means that 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.

There was a 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.

The leadership of the service was not robust enough to independently identify and address shortfalls. There had been some improvements which were ongoing but these were not made in a timely manner to ensure people were provided with a good quality service at all times.

There had been some improvement made in staff training. However, further improvements were needed, staff did not know enough about people or the care they needed to ensure that they received consistent and safe care at all times.

People’s privacy was not always respected.

Improvements were needed in how support and equipment were provided to people to maintain their independence, choice and cultural needs when eating and drinking.

People who were upset by others living in the service were not supported by staff to reassure them. In addition to this appropriate action was not taken to advise people on how their actions could upset others.

People’s care records had been reviewed and updated, however further improvements were required.

There were now appropriate arrangements in place to ensure people were provided with their medicines safely and when they needed them.

There were sufficient numbers of staff to meet people’s needs.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty (DoLS) which applies to care homes. Staff had been provided with training in Mental Capacity Act 2005 (MCA) and DoLS. The systems in place to obtain and act in accordance with people’s consent had been improved to respect people’s rights and choices.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

Prior to our inspection we had received information of safeguarding concerns from the local authority safeguarding team, who are responsible for investigating safeguarding issues. These incidents are currently being investigated by the local authority and other professionals. When we have received the outcomes to these concerns we will consider our regulatory responses. We undertook this inspection to check that people were being provided with safe and effective care.

We spoke with five of the 24 people who used the service and the registered manager. We observed the care and support provided to people to check that staff interactions were effective and caring. We looked at three people's care records. Other records viewed included staff training records, staff recruitment records and the staff rota. 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 a staff member looked at our identification and asked us to sign in the visitor's book. 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 that the staff were provided with training in subjects including 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. However, the provider needed to improve the ways that they kept their training records to be able to assure themselves that staff were provided with updates to their training to ensure that they were provided with the training that they needed to meet people's needs safely.

Staff recruitment records showed that the provider's recruitment procedures and processes were not robust enough. Robust checks had not been undertaken to ensure that people were supported by staff who were of good character and able to work with vulnerable people. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service effective?

People told us that they were happy living in the service. One person said, "I like it here, nothing has changed (we had spoken with them at previous inspections)."

Improvements were needed in the way that the service reviewed and updated people's care records to ensure that staff were aware of how people's changing needs and preferences were met.

Is the service caring?

People told us that the staff treated them with respect. One person said, "They (staff) are all very good, the boss (registered manager) is great."

We saw that when people requested assistance from the staff this was done promptly. Staff undertook the tasks required to meet people's needs, such as assisting them when they needed support to use the toilet, but there were no caring social interactions observed. A compliance action has been set in relation to this and the way that people's care records are maintained and the provider must tell us how they plan to improve.

Is the service responsive?

The service had taken action to ensure that the staffing levels were maintained during the absence of staff who had been suspended pending safeguarding investigations. We will continue to monitor the staffing levels in the service in the long term.

Is the service well-led?

The registered manager was able to provide the information we requested promptly.

The shortfalls which we identified in the care provided to people and the recruitment of staff identified concerns about how the service was led to ensure that people were provided with safe and effective care.

We spoke with nine of the 24 people who were using the service at the time of our inspection. We also spoke with two people's visitors, the registered manager and two staff members. We looked at four people's care records. Other records viewed included staff training records, health and safety checks, meeting minutes and quality assurance records. 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 a staff member asked to see our identification and asked us to sign in the visitor's book. 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.

People told us they felt safe living in the service and that they would speak with the staff if they had concerns.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications had needed to be submitted, guidance was in place about how to make one. Relevant staff had been trained to understand when an application should be made, and how to submit one. Staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and DoLS. This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

The service was safe. We saw records which showed that the health and safety in the service was regularly checked. This included regular fire safety checks to ensure that the fire safety equipment was in working order. This meant that people were protected in the event of a fire.

The service was clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. One person said, "Everything is alright." Another person said, "It is very good here."

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 the staff interacted with people living in the service in a caring, respectful and professional manner. People told us that the staff treated them with respect. One person said, "They treat me like gold." Another person said, "They are all very good."

People using the service and their relatives completed satisfaction questionnaires. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

People using 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 told us that they knew how to make a complaint if they were unhappy. We saw that where people had raised concerns appropriate action had been taken to address them.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and district nurse.

Is the service well-led?

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed.

Prior to our inspection we received information of concern about the staffing arrangements in the service. The purpose of this inspection was to check that people were supported by appropriate staff numbers.

During our inspection we spoke with the registered manager and looked at the staff rota. We also looked at the service’s training matrix, training book and the training certificates of three staff members. We were satisfied that the 23 people who used the service at the time of our inspection were supported by safe staff numbers who were trained to meet their needs.

We spoke with eight of the 22 people who used the service. We also spent some time sitting in the communal lounge in the service and observed the care and support provided to people. We saw that staff were attentive to people's needs and they interacted with people in a caring, respectful and professional manner.

People told us that they were happy living in the service. One person said, “I am very happy here.” Another person said, “I have everything I need really.” People told us that the staff treated them with respect and kindness. One person said, “They (staff) are so kind and polite." Another person said, “They (staff) are lovely people, they really are."

We spoke with three visitors to the service who told us that they were satisfied with the care and support provided to their relative and/or friend. One visitor said, "No worries about here, they are spot on." Another said, "Yes they look after (person) very well."

We looked at the care records of four people who used the service and found that they experienced care, treatment and support that met their needs and protected their rights.

We found that the staffing levels were monitored to ensure that the needs of the people who used the service were appropriate to meet their needs.