We inspected this service on 24 November 2017 and the inspection was unannounced. At our previous inspection in October 2015, the service was meeting the regulations that we checked and received an overall rating of Good.

The Leys is registered to accommodate 36 people in one adapted building. At the time of our inspection 20 people were using the service. The Leys accommodates people in one building and support is provided on one floor. At the time of the inspection two communal lounges and a dining area were available to people due to ongoing refurbishment. A garden and enclosed patio were also available that people could access.

There registered manager had resigned from post one month prior to the inspection and had been on leave for 12 months prior to this. 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 registered manager’s post was being recruited to the week following this inspection and the acting manager was overseeing the running of the service and was supported by two deputy managers.

Staff were clear on their role on protecting people from the risk of harm and understood their responsibilities to raise concerns. Individual risks to people and environmental risks were identified and minimised to maintain people’s safety. Assistive technology was in place to support people to keep safe. Systems were in place to prevent and control the risk of infection.

People were protected against the risk of abuse, as checks were made to confirm staff were of good character and there were sufficient staff available to support them. The skill mix of staff ensured people’s needs were met. Medicines were managed safely and people were supported as needed to take their medicine as prescribed and access healthcare services.

People were consulted regarding their preferences and interests and these were incorporated into their support plan to promote individualised care. The staff team knew people well and were provided with the right training and support to enable them to meet people’s needs. People were supported with their dietary needs and to access healthcare services to maintain good health.

People were supported to have maximum choice and control of their lives and staff understood the importance of gaining people’s consent regarding the support they received. The policies and systems in the service supported this practice. People were supported to develop and maintain interests and be part of the local community. The acting manager actively sought and included people and their representatives in the planning of care. There were processes in place for people to raise any complaints and express their views and opinions about the service provided.

A positive culture was in place that promoted good outcomes for people. People who used the service and their relatives were involved in developing the service; which promoted an open and inclusive culture. The provider understood their legal responsibilities and kept up to date with relevant changes. There were systems in place to monitor the quality of the service to enable the acting manager and provider to drive improvement.

The inspection visit at The Leys Care Home took place on 1 October 2015 and was unannounced.

The Leys Care Home is a care home for older people, some of whom may have dementia. The home is located in Ashbourne, in Derbyshire. The service is registered for 34 people and at the time of our inspection 32 people were living at the service.

At our last inspection on 21 May 2014, we found the provider did not always protect people against the risks of receiving unsafe care and treatment. We found the provider had not sufficiently assessed and monitored the quality of the service and did not have effective systems to assess the risk of or prevent infection. We also found the provider had not consistently ensured the health, safety and welfare of people using the service. These were breaches of Regulations 9, 10, 12 and 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Following that inspection the provider sent us an action plan to tell us the improvements they were going to make. At this inspection we found that the actions we required had been completed and these regulations were now met.

At our inspection we were assisted by the registered manager and the deputy 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 were cared for by staff who had been recruited and employed once appropriate pre-employment checks had been completed. New staff participated in a period of induction which included a period of shadowing an experienced staff member. Staff felt they received training to enable them to meet the needs of people.

There were enough staff available to support and respond to people’s needs in a timely manner. The registered manager and provider were actively making attempts to recruit more care staff.

Staff and the provider were able to explain to us how they maintained people’s safety and protected their rights. Staff had been provided with training such as the Mental Capacity Act (2005), Deprivation of Liberty Safeguards (DoLS) and safeguarding.

Care records were regularly updated and staff were provided with the information needed to meet people’s needs. People’s care was planned in a way that was intended to ensure and maintain their safety and welfare.

Medicines were managed safely and in line with current legislation and guidance. There were systems in place to ensure medicines were safely stored, administered and disposed of. Staff who administered medicines received training to ensure their practice was safe.

People were offered drinks and snacks throughout the day. Nutritional needs of people were assessed and records were maintained. Where potential risks people were identified, staff ensured people were monitored and referred to the relevant professionals for assessment and any recommendations followed.

People and their relatives with the support and care that was provided and everyone felt people’s need were being met. Staff demonstrated a knowledge and understanding of people’s needs and preferences. Staff were aware of the importance of treating people in a respectful and dignified way. We saw and heard staff supporting people with compassion and respect.

The provider had procedures in place to ensure any complaints were documented and resolved as quickly as possible. People knew how to complain or raise any concerns.

The provider had implemented a number of quality monitoring audits to ensure the service ran safely and effectively. Audits included checks in relation to safe administration and storage of medicines and ensuring the environment was safe and repairs were dealt with in a timely manner.

The provider ensured people had the opportunity to voice their thoughts about the service and held regular meetings with the people, relatives and staff.

As part of our inspection we spoke with five people living at the service and four members of staff.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

During our inspection visit we observed that people were being cared for in a clean, hygienic environment. We found bed linen, mattresses and equipment were clean and well maintained. However we found one toilet seat had a broken fixing and this meant that it could not be effectively cleaned.

We found that arrangements and systems for the prevention and control of infections did not always meet with recognised guidance. Staff and people using the service could not always wash their hands effectively and paper towels were not disposed of in line with the recommendations to prevent the risks of infection.

Staff told us that they experienced difficulty meeting people’s needs when there were three members of staff on each shift instead of four. We found that nearly half of the four week period we reviewed had included days where shifts had been covered by three care staff.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Care plans we saw included where people had signed their agreement to the plan of support and had given consent for their information to be shared.

Is the service effective?

We found that risk assessments had been reviewed however staff did not have access to the latest records. This meant that people living at the service were not protected from unsafe or inappropriate care as reviews of risk assessments were not available for care staff.

We found supervision meetings with staff covered health and safety practices and different policies used in the service. We found that staff who had been absent from work through illness were supported to return back to work. This meant the staff received the supervision and support they needed.

We found that staff training was up to date and had included medication, moving and handling and falls prevention. This meant that staff were provided with the information they needed to do their job.

Is the service caring?

Staff we spoke with told us about a person using the service who did not like eating bread but was not given an alternative to sandwiches for afternoon tea. We spoke to the manager about this person and the manager told us they were not aware of this person’s preferences. This meant that people’s needs were not being assessed and cared for.

Is the service responsive?

We found there were care plans and risk assessments in place for specific areas of care. When we looked at the daily notes we found that staff had called the GP when people using the service had been unwell. This meant people living at the service had their care needs met.

Is the service well-led?

We reported a member of staff to the manager who told us they were aware this member of staff could talk abruptly to people using the service and this conduct had been investigated before. We found that the investigation into the conduct of the person employed by the service had not identified any learning or changes that had led to improvements.

The manager had gathered views on The Leys from people using the service, other agencies, families and staff in a questionnaire. Although most comments had been positive some comments made by staff had raised concerns. Some staff we spoke with on the day told us they still experienced problems with the concerns they had previously raised. This meant that some staff had not experienced an improvement or change when they had contributed their views and opinions.

We did not speak with people using the service regarding the support they received at this visit. This was a short, focused visit, to check that the compliance action left at our visit in September 2013 had been met.

Since our last visit in September 2013 the provider had taken steps to ensure people’s support records and assessments were reviewed on an ongoing basis to demonstrate that their needs continued to be met effectively.

At our visit in September 2013 the people using the service and visitors we spoke with were all very positive about the support and services provided by the staff team at The Leys.

People using the service and visitors we spoke with told us that they were happy with the care and services provided at The Leys. One told us. “I am very happy here thank you, I have no complaints at all, it’s a lovely place to live.” Another person said, “ I like it here, I had to move out to another home for a while because we had some flood damage and my room needed repairing, the place I moved to was lovely, but I was glad to come back here. “

People told us that the meals served were very good. One person said, “the food here is very nice, I can’t fault it at all.” Another person told us, “it’s delicious, really good quality and cooked very well.” We observed the lunch time meal and saw that tables were attractively decorated and the meals served were well presented.

People were positive about the staff team. One person using the service said, “the staff are very good here, they are all very friendly.” A visitor told us, “the staff are very welcoming, they always offer me a drink and they genuinely care about the residents here, it’s a lovely place.”

In general the care practices in place were good; however support plans and risk assessments did not always reflect the care that was given. For example some support plans and risk assessments had not been reviewed regularly and some areas of care where risk had been identified did not have risk assessments in place.

We were able to speak with most of the people that were using the service. The majority of people had some level of confusion and were not able to provide us with their opinion of the care and support they received. However from our observations throughout the day people did appear happy and comfortable with the support provided to them.

We did speak with four people who were able to give us their opinion of the support and services provided at The Leys. People told us that the support and services provided to them by the staff team was good. People confirmed that daily routines were flexible and felt that their privacy and dignity was respected.

People talked about the staff team in a very positive way. Comments included, “I think they’re brilliant, they’re all so friendly and nothing seems too much trouble for them” and “I can’t fault them in any way, it’s a marvellous place”.

People talked to us about the activities provided and were very positive about the activities co-ordinator. One person said, “I think she’s marvellous, I’m learning to use the computer and I get lessons every week, I didn’t realise how time consuming it was but I’m enjoying it.”