This inspection took place on 1 September 2017 and was unannounced.

Letheringsett Hall provides accommodation and care for up to 20 older people. At the time of this inspection 17 people were living in the home.

Our previous inspection in July 2016 identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to implementation of the Mental Capacity Act 2005 and the governance of the service. This September 2017 inspection found that improvements had been made in both of these areas and that the provider was no longer in breach of these regulations.

The provider was one of the two registered managers for the service. However, the registered manager who managed the service on a day to day basis had left five weeks prior to this inspection. A new manager had been appointed. They told us that they would be applying for registration. In the meantime the provider was at the service on a daily basis managing the home and overseeing the transition to the new 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.

People felt safe living in the home and were cared for by staff that treated them considerately and with respect. There were enough staff to meet people’s needs and provide them with caring, prompt and effective support. People’s medicines were managed safely and administered as prescribed for them.

Assessments of people’s ability to make decisions about their care had been completed and appropriate applications were made to the local authority’s DoLS team when required. People’s independence was supported without their safety being compromised. People’s healthcare needs were managed well and people had access to a range of healthcare professionals. The service regularly sought the views of people about the standard of service that they received.

People liked the food and the service sought to provide as much homemade food as possible. Staff were trained and well supported to undertake their duties.

The home was well led and worked effectively with healthcare professionals. People knew the provider and the manager well. A smooth transition to the new manager was underway.

This inspection took place on 18 and 21 July 2016. The first day was unannounced.

Letheringsett Hall provides accommodation and care for up to 20 older people. At the time of this inspection 17 people were living in the home.

A registered manager was in post and had been managing the service for seven years. 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 this inspection we found two 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.

The Mental Capacity Act 2005 was not well understood over and above the provision of day to day support to people to help them make routine decisions. This had resulted in concerns that the service was not acting in accordance with the legislation.

The provider had failed to ensure that a suitable evaluation of any risks presented by the legionella bacteria had taken place. The audits the service carried out were not robust and meant that suitable systems were not in place to ensure that areas for improvement were identified or acted upon.

There were usually enough staff on duty but at weekends staff were busier than during the week as they sometimes needed to fulfil functions carried out by the cleaner or kitchen assistant. This took them away from the direct provision of support to people on these occasions.

People felt safe at the home and staff were knowledgeable about indicators of possible abuse. They knew what actions would need to be taken.

Medicines were well managed and the manager had taken steps to ensure that people’s medicines were stored at a safe temperature.

Staff received a good standard of training which also tested their knowledge. The manager had a robust system in place for ensuring that staff administered people’s medicines safely.

People had a choice at mealtimes, although some people would have benefited from a menu or board to show what meals were being served.

Most staff were caring, but we observed some comments being made that were not respectful to people.

Care plans did not suitably reflect people’s emotional requirements and how people needed to be supported. There was limited social stimulation in the home.

During this inspection we looked at assessments made before someone was admitted to the home. This would ensure a person’s needs would be met by the care and support offered by this service. We looked at four care plans that were clear and individualised. We spoke with people using the service. One person said, “I am so well looked after. I could not wish for better. I was worried about the food as I like good meals but the meals are excellent.” Another person, who had been living in the home for a number of years said, “The staff are good. I am warm and comfortable with a nice bedroom and good food.” A third person showed us their room saying how they, “…loved their room.”

We looked at the equipment and methods used by staff and management to manage risks that were associated with the spread of infections. We found people were protected from potential infections by procedures followed and actions taken by staff within the home.

We walked around the home and looked at the suitability of the premises. We were told by one person, “I love my room. I have everything I need.” Another person said, “This home has character, much better than modern homes. However, we found that some bedroom doors were not closing properly and that this created a risk in the event of a fire.

Staff members in the home were found to be suitable, experienced and qualified to do the job required.

Systems were in place to monitor the quality of the care and support provided. Audits were carried out and people were asked their opinions of the service provision. Comments they made were acted upon.

During our visit to Letheringsett Hall we spoke with three people in private, staff on duty and the manager. We looked at three care plans and records we asked to see were made available. People were carrying on with their hobbies, watching television and reading newspapers.

We checked medication records and some policies and staff we spoke with confirmed they had attended regular training to keep up to date with their knowledge of care and treatment.

People we spoke with told us "It's a lovely place here, I wouldn't go anywhere else." "The staff attend to all my care needs, and they are really friendly." "There's lots of activities offered here, and it doesn't matter if you don't want to take part, but they make it fun." "I am looking forward to going to see the Christmas show."

On our arrival at the home on the 10 January 2012, people were chatting and people confirmed they enjoyed being in the home and that they were well cared for. One person told us that although they would rather be in their own home, they were happy to be at Letheringsett Hall as their next choice. We were told that staff "are marvellous" and "very kind."

Three people told us that the food was very good and they had a choice of whatever they wanted. One person explained that during the night they were offered a hot drink and sandwich if they were awake. They told us this was welcomed as they did not always feel like eating a great deal at the evening meal.

When speaking to one person in their room, we were told how well the space suited them and how comfortable they were living in the home. This person also told us that staff are "really very, very good. If I need anything I just press that button and they come and help me."

When discussing any problems or difficulties that may occur we asked what people would do. We were told people would talk to staff and they felt sure they would always be helped.

We reviewed the evidence we had obtained during our inspection and used this to answer five key 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 our findings. We also followed up on minor concerns relating to the premises which we identified at our previous inspection in December 2013. If you would like to see the evidence supporting this summary please read the full report.

Is the service safe?

Our inspection in December 2013 found that two doors did not close properly. This presented an increased risk to people’s safety in the event of a fire. This inspection found that these doors had been promptly repaired.

We spoke with the manager who advised us they had no concerns about people’s mental capacity to consent. We did not meet any people living in Letheringsett Hall who gave us cause for concern in this regard. The manager was aware of their responsibilities and what action they would take if necessary under the Deprivation of Liberty Safeguards in order to protect people who could not make decisions for themselves. Staff had received training in the Mental Capacity Act 2005.

Is the service effective?

People’s health and care needs were assessed and reviewed with them and their family members present if required. People were supported by healthcare professionals with whom the service had good relations and staff were able to call upon them for advice and guidance when required.

It was clear from our observations and speaking with staff that they knew people well and understood what people’s individual support needs were. One person told us, “The staff know me well here and they can tell when I need a bit of help.”

Is the service caring?

We saw that staff were kind and attentive. When supporting people we noticed that staff were patient and encouraging. People told us how kind and helpful the staff were. One person told us how staff provided them with the type of books they liked to read. Another person, who had a visual impairment, told us how staff read the newspaper to them, which they appreciated and enjoyed.

Is the service responsive?

People were able to engage in activities inside and outside of the home, with staff support if required.

We saw minutes of meetings and spoke with people and found that their views were sought and acted upon in relation to how the service was run.

Is the service well-led?

Staff we spoke with were confident in the management of the home and felt their opinions and suggestions were welcomed. People living at Letheringsett Hall told us they liked the staff and managers and thought they did a good job in supporting them.

The home had systems in place to ensure care and support was monitored and reviewed for effectiveness. Where shortfalls were found action had been taken to resolve any concerns.