The inspection took place on 3 and 6 October 2017 and was unannounced.

The service was previously inspected in August 2016 where it was found the provider was not meeting the regulations. Risks were not assessed appropriately for people receiving care and support. We asked the provider to complete an action plan to address our findings. We found during this inspection improvements had been made and the service was meeting the requirements.

St Leonards Care Home is a traditional style care home that is registered to provide accommodation for up to 45 older people some of whom are living with dementia. At the time of our inspection there were 41 people using the service. The service had 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.

We saw people were well cared for and comfortable in the home. Everyone we spoke with told us they felt safe living at St Leonards. Comments we received were, “I do feel safe here they look after me well” and “Yes very safe.”

People were safeguarded from abuse and neglect as staff demonstrated good knowledge of what to do if they suspected someone had been inappropriately treated. Medicines were managed safely and people received their medicines as prescribed by the GP. Staff received training in the administration of medicines and were assessed as competent before they supported people with their medicines.

Care records were personalised, up to date and accurately reflected people’s support needs. Information in care plans included life history, interests, likes and dislikes and provided staff with sufficient information to enable them to provide care effectively. We saw people were treated with kindness and compassion. We saw one person who was walking up and down the unit and did not appear to be settled. We saw staff intervene and encouraged the person to help them by carrying a folder into the office to distract them. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were cared for by staff that were well trained and motivated. One member of staff told us, “If you want to progress they are good.” They went on to say they were on the management pathway. Staff received supervisions from their line manager to ensure discussions could take place to highlight any concerns or training requirements.

Managers provided effective leadership and held regular meetings with staff and people who use the service to ensure everyone was involved in the running of the home.

The service was cleaned to high standards and we saw there were three members of domestic staff employed by the provider and were engaged in cleaning duties throughout the day.

People were actively involved with the local community and encouraged to engage in activities and entertainments available within the home.

Professionals who regularly visited the service told us they had no concerns. One told us, “They prefer to call us out to be on the safe side, which is fine by us.”

There were systems in place for monitoring and auditing to ensure the service delivered high quality care.

Regular fire testing and drills were carried out and people had individual emergency plans in place in the event of an emergency.

St Leonards is a care home that is situated in the Chiltern Hills in Buckinghamshire. The home is a traditional style care home that is registered to provide accommodation for up to 45 older people.

The home has two units; one supports people living with dementia, whilst the other is a residential unit where people live as independently as they are able.

The inspection took place on 18 and 19 August 2016 and was unannounced. The inspection was carried out by one inspector. The service was previously inspected in May 2014 when it was found to be fully compliant with the regulations. At the time of our inspection there were 45 people using 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.

People’s feedback regarding the home was complimentary one person told us, “Yes fine, very good, I am lucky”. Another person told us, “Everyone’s lovely, I don’t think we could find a better place”. We saw people were cared for with compassion and respect. Staff were well trained and motivated. The registered manager provided effective leadership to the service and held regular residents meetings to ensure people were involved in the running of the home. One member of staff told us, “Although the job is challenging, I feel supported, the registered manager is very hands on”.

People were safeguarded from abuse and neglect as staff demonstrated good knowledge of what to do if they suspected someone had been inappropriately treated. The provider was reporting instances where this had occurred to the local authority.

Staff had received training in safe handling of medicines and had been competency assessed to support them in the role. However, medicines were not always managed effectively. Staff had received training in areas such as fire safety, mental capacity and moving and handling. Regular supervisions and appraisals were taking place to ensure staff felt supported in their role.

People’s privacy was maintained and they were treated with respect.

Care plans and risk assessments required improvement to ensure high quality care was provided. We found examples where the risks identified were not followed through in people’s care plans. One person we spoke with told us “I think I have got a care plan I’ve heard them talk about it”. Whilst family members told us they were involved in regular reviews with their relatives care plan.

Activities were planned and people were encouraged to participate either in groups or on a one to one basis. We found people’s care was person centred; people were involved in activities or spending time on a task of their choice as they wished.

The atmosphere in the home was warm and welcoming one person told us their family chose this particular home because it was homely.

There were systems in place for monitoring, and auditing to enable improvements in the quality of care. However, internal audits did not always identify shortfalls.

We have made recommendations that care plan audits and medication audits are robust, to ensure areas for improvement are identified and action plans implemented as required.

We found breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to assessing the risks to people and ensuring care meets people’s needs. You can see what action we told the provider to take at the back of the full version of the report.

The inspection team was made up of two inspectors. They gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. This is based on our observations during the inspection and discussion with people using the service, their relatives, the staff supporting them and management team. Please read the full report if you want to see the evidence supporting our summary.

Is the service safe?

Care and support was planned and delivered in a way which ensured people’s safety and welfare both within the home and in the wider community. We saw any risks to providing people's care and support had been considered. Guidelines were in place to inform staff what measures were to be taken to manage the risk safely whilst maintaining people's independence.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS). Seven people who lived in the home had a DOLS in place. Correct procedures had been followed in that a referral to the Local Authority (as "Supervisory Body") had been made and all were approved. This showed the provider had identified seven people could have potentially been deprived of their liberty and understood that an application was to be made and knew how to submit one.

The provider had safe and thorough recruitment procedures in place to ensure only suitable people worked with people who lived in the home.

Is the service effective?

People told us someone from the home had visited them to assess their health, care and social needs before they moved into the home. They told us they were involved in the process as well as family members. This enabled the home to access any equipment prior to them moving in and to write an initial care plan according to people's preferences and wishes.

Where people lacked the capacity to make decisions and consent about particular aspects of their care and support, suitable arrangements were in place. This was to ensure the service acted in accordance with legal requirements and appropriate consultation had taken place to ensure people's best interests had been taken into account.

We found the care and support provided was reflective of people's needs, detailed in their care plans and were regularly updated where any changes in health were evident. Any accidents or incidents were recorded appropriately. They detailed the actions taken and risk assessments had been updated to document any further measures put into place to prevent a recurrence.

Is the service responsive?

People received co-ordinated care. We saw evidence in people's care plans which demonstrated people had been visited by their GP and other health care professionals and appropriate advice sought when required. Where there had been a change in people's care and treatment, their care plans had been updated accordingly. This showed staff worked jointly with other health care professionals to meet people's needs in the most appropriate way.

From observation of the staffing levels during the day, speaking with people who lived in the home and from looking at the staff training matrix and rotas there appeared to be enough qualified, skilled and experienced staff to meet people’s needs appropriately. However, it was not apparent that there was a needs analysis in place to help inform of the required staffing levels to meet people's needs appropriately.

Is the service caring?

People said they were happy with their care and support and their needs were well met. Comments included ''The staff are really lovely...they talk 'with' you not 'at' you.'' ''Everyone is so kind.'' ''The food is excellent, if there's anything we don't like we only have to say and they will change it.'' ''The staff are wonderful. I couldn't grumble about anything.''

Staff showed they had a good understanding of people’s needs and knew them well. We observed staff were gentle and patient with people and provided assistance to those who required help. They were respectful when they spoke with people and did not hurry them but enabled them to answer at their own pace.

Is the service well led?

People we spoke with told us they were consulted with about the care and support they were provided with and their views and choices were acted upon. We were told their views were sought through talking to people and their representatives on a day to day basis, during their reviews of care, through the use of surveys and regular quality review meetings.

There were a range of audits and systems in place to monitor the quality of service. The manager completed regular monthly audits to include health and safety, accidents and incidents, records and complaints. These were then collated and where any shortfalls were found an action plan was put in place to address them. This ensured they had a continuous regular system to assess and monitor the service and make changes to improve outcomes for people who used the services.

People's needs were assessed and their care and support was planned and delivered in line with their care plan. These were very detailed, regularly reviewed and updated accordingly. People's health was monitored and referrals to external health professionals were made where necessary, to ensure they kept healthy and well. Relatives were kept up to date about their family member's well being.

There were clear procedures in place for the management of people's medicines, which were monitored and reviewed regularly to ensure people received their medication safely and according to the GP's instructions.

We saw people were supported to attend a variety of social activities both within the home and in the local community if they wished to take part.

We saw adequate staffing levels were maintained to meet the needs of people who used the service. Staff had received training and supervision to support them in delivering care and support safely.

We spoke with seven people during our visit and one relative. People told us they were treated with respect and their privacy was respected and maintained. They told us they were well looked after and said the staff knew how they needed and wished to be supported. They told us they felt safe living at St Leonards care home and knew who to speak to if they had any concerns. One person said ''they take good care of me and I am convinced I made the right decision...all in all I am very happy.''

People told us that they had been given the opportunity to visit the home before they moved in to ensure it met with their needs and expectations. They said that the staff treated them as individuals and respected their views and choices. They told us they were consulted with about any changes to their care and support and were able to make decisions about their day to day care.

They said that they were supported to access health services when required and enabled to take part in activities. They liked the staff who worked at the home and said they were always very caring and attentive to their needs and well being.