St Leonard’s Court provides accommodation and personal care for up to 25 older people some of whom may be living with dementia. At the time of our visit there were 22 people using the service. The home was situated in the village of Mundford in Norfolk.

St Leonard’s Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. This comprehensive inspection took place on 7 August 2018 and was unannounced.

At our last comprehensive inspection on 13 April 2017 we rated the service ‘Requires Improvement’ overall. At that inspection we found improvements were needed in relation to the safety of bed rails in use for some people. We found covers (bumpers) in use at that time were ill-fitting and posed a potential risk to people of injury and entrapment. These concerns were a breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulation 2014. We found at this inspection that improvements had been made. We checked the beds of people living at the home who were using bedrails and bumpers and found these were safely fitted. The provider is no longer in breach of the regulations.

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 was mixed feedback about staffing levels. Staff were busy however we observed that there were sufficient staff to meet people’s needs in a timely manner. We have recommended the provider continue to closely monitor staffing levels. Staff were recruited safely.

Risks to people were assessed, monitored and updated as and when necessary. Action was taken to reduce the risk of incidents and information about risks to people were documented in their care records so that staff were aware.

Staff were supported through training and supervision to perform their roles effectively.

People's individual nutritional needs were met. People were supported to access a range of health professionals to maintain their health and well-being. People were treated with kindness, respect and compassion, and their privacy and dignity was upheld.

Clear information about how to make a complaint was available for people. The service worked in partnership with health and social care professionals and other organisations, to ensure people's care needs were met and that staff kept up with good practice.

The provider had quality assurance processes in place, which helped to maintain standards and drive improvement. People who lived at the home, relatives and staff told us the service was well led. Staff were aware of their roles and responsibilities and were well supported.

The inspection took place on the 13 April 2017 and was unannounced. The last inspection of this service took place on 25 November 2014. At that time, the service was rated overall as good. However, they had been rated as requires improvement within the safe domain. This was because we found that the systems in place when recruiting staff had not been sufficiently robust. This has resulted in a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014. At this inspection we found that the required improvements had been made and that the provider was no longer in breach of this regulation. However we have again rated safe as requires improvement given concerns identified at our most recent inspection concerning bedrail safety.

Since the last inspection there has been a change in registered manager. The new manager registered with us in the last year. 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 service is registered to provide accommodation and care to up to 25 older people with or without dementia. It does not provide nursing care. At the time of our inspection there were 24 people using the service but one had been transferred for a period of assessment so there were twenty three people.

We found that the current manager had made many improvements to the service since their appointment. There was a strong emphasis on personalised care based on people’s wishes. The atmosphere was calm and staff regularly interacted with people to ensure their well- being. The service had regular staff that were familiar with people’s needs and they had a good insight into their previous life experiences and their care preferences.

We found there were enough staff and systems in place to support and help retain staff including good recruitment and induction processes and improved compliance with training. This was readily available to staff and updated as required. Lots of staff had additional qualifications. The service also had developed strong links with health care professionals and provided a seamless service for people living in the home. The service was actively involved in the wider community. Staff were observed to be kind and caring in their actions and there was a lovely, calm atmosphere in the service and people were supported to manage their anxiety and distress in a positive way.

There were good systems in place to audit and monitor the service and the manager was open, resourceful and an excellent communicator who lead by example. We also found the documentation of a good standard and care plans and risk assessment clearly reflected people’s needs and how these should be addressed.

However we did find some gaps. These included some risks to people in terms of ill-fitting bumpers to protect people from the risk of injury and entrapment. We identified gaps in records so we were unable to see if risks from dehydration were adequately monitored. We found records of a high standard but found information duplicated and not all containing the same information which made records unreliable. It would be helpful if records were cross referenced. Staff might be aware of where documents are but we asked the provider to consider how an agency person would access the current recording system.

We found some conflicting information in terms of the Mental Capacity Act with staff drawing different conclusions about a person’s capacity and not always demonstrating how they communicated with relatives holding power of attorney for care. Medication practices were acceptable and staff were knowledgeable of the underpinning policies concerning safe administration of medicines. However a little more knowledge of the actual medicines

During our inspection on 06 August 2013, we found that not all of the people’s plans of care and the review of these plans of care had been signed and agreed by the person using the service or their appropriate next of kin. We also saw that people's consent to be photographed had not always been documented in the care records we reviewed.

During this inspection on 08 October 2013, we found that the provider had made the required improvements around the documentation of people using the services to consent to be photographed and agree to their plan of care.

We used a number of different methods to help us understand the experiences of people using the service. This was because people who lived at the home had limited verbal communication and this meant they were not able to fully tell us their experiences. We spoke with one person, a person's relative and two healthcare professionals to gather further evidence. We also used the Short Observational Framework for Inspection (SOFI) and general observation. SOFI is a specific way of observing people who could not talk with us.

Two healthcare professionals and a relative we spoke with raised no concerns over the care people received. The healthcare professional told us that, "(Staff) do everything well."

People who used the service had the right level of information to make a decision about their care and support. However, we found that their consent was not always documented.

Care records and risk assessments were reviewed regularly to ensure that people received safe and appropriate care in a consistent way.

We saw that the provider had taken steps to provide care to people who used the service in an environment that was in good decorative order.

There were service contracts in place for all of the equipment being used. We saw that staff had received the appropriate training before using any equipment to ensure that people were not placed at risk of harm.

We saw that the provider had good staff, care and maintenance records which were kept in a secure location.

We used a number of different methods to help us understand the experiences of people using the service. This was because people who lived at the home had limited verbal communication and this meant they were not able to fully tell us their experiences. We spoke with three relatives of people who lived in the home and one healthcare professional to gather further evidence. We also used the Short Observational Framework for Inspection (SOFI) and general observation. SOFI is a specific way of observing people who could not talk with us.

The healthcare professional and relatives who we spoke with raised no concerns over the care and support people received within the home. The healthcare professional told us, “(Staff) are lovely with the patients and take their time.” One person told us that, “Care is very good.” And another relative told us that when they visited the home they, “Were made to feel welcome.”

Care records and risk assessments were reviewed regularly to ensure that people who used the service received safe and appropriate care in a consistent way.

People were protected from the risk of infection spreading as there were effective systems in place to reduce the risk.

Effective staff recruitment was in place to ensure that people who used the service received safe and appropriate care from suitable staff.

There was an effective system in place for people to make a complaint.

People with whom we spoke told us that they felt that their needs were appropriately assessed and met. They told us that they were provided with the opportunity to choose and participate in activities both inside and outside. One person told us how much they enjoyed trips in the home’s minibus.

Everyone was very complimentary regarding the staff and stated that staff were excellent. People also commented how well they “get on with each other” and proudly emphasised the friendly atmosphere in the home.

People made a special point about the number of visitors, both their relatives and other professionals such as GP’s and a hairdresser.

All people with whom we spoke liked the food and were happy with the choice and quality of food provided.

This inspection took place on 17 and 25 November 2014 and was unannounced. We carried out an inspection in August 2013 where there was a breach in one regulation as we had concerns about records kept to show that consent had been obtained from people. A follow up inspection was carried out in October 2013 and the home had taken the appropriate action to comply with the regulations.

St Leonards Court is a residential care home providing care and support for up to 25 older people living with cognitive impairments such as dementia. The home has a registered manager, who has been in post for over five 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 and associated Regulations about how the service is run.

Staff were aware of safeguarding people from abuse and would act accordingly. Individual risks to people were assessed and reduced or removed.

There were enough staff available. Staff members all said that staffing levels were high enough to allow staff members to complete care for. Not all of the required recruitment checks were obtained before new staff started working, meaning the service could not be sure that new staff members were of good character or safe to work with people.

Medicines were safely stored and administered, and staff members who gave out medicines had been properly trained. Staff members received other training, which ensured they were able to care for people appropriately. Staff received supervision from the manager, which was supportive and helpful, although formal individual meetings were not frequent enough.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA), the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service was meeting the requirements of DoLS. The manager recognised when people were being deprived of their liberty and was taking action to comply with the requirements of the safeguards.

Staff members understood the MCA and presumed people had the capacity to make decisions first. Where a lack of capacity had been identified there were written records to guide staff about who else could make the decision or how to support the person to be able to make the decision.

People enjoyed their meals and were given enough support to eat the meal of their choice. Drinks were readily available to ensure people were hydrated.

Health professionals in the community worked together with the home to ensure suitable health provision was in place.

Staff were caring, kind, respectful and courteous. Staff members knew people well, what they liked and how they wanted to be treated.

People’s needs were responded to well and care tasks were carried out thoroughly. Care plans contained enough information to support individual people with their needs.

A complaints procedure was available. No concerns or complaints had been made in the last 12 months, although the provider had procedures in place to make sure any were dealt with appropriately.

The manager was supportive and approachable, and staff felt that they could speak with her at any time.

The home monitored care and other records to assess the risks to people and whether these were reduced as much as possible.