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Leabrook House Nursing Home Requires improvement

Inspection Summary

Overall summary & rating

Requires improvement

Updated 7 November 2019

About the service

Leabrook House is a care home providing personal and nursing care to 38 older and younger people at the time of the inspection. The service can support up to 41 people.

People’s experience of using this service and what we found

There was a lack of systems and processes in place that would provide the registered manager with oversight of the service. The few audits that were in place had failed to highlight a number of areas for action that were identified on inspection.

People’s opinions were not consistently sought and any feedback that was gathered about the service was not analysed for any lessons learnt, or information sharing.

People knew how to raise complaints and raised issues directly with the registered manager. However, people were frustrated with the lack of communication regarding how their complaint was being dealt with and what actions were being taken in response to the concerns raised.

People were supported by a group of staff who had been trained to recognise signs of abuse, but not everyone at the service who we spoke with, felt safe. One person raised a safeguarding concern with us during the inspection and the registered manager acted promptly and appropriately to this.

Staff were aware of the risks to the people they supported and how to manage those risks. Staff were observed to support people safely in line with their risk assessments.

People were supported by a group of safely recruited staff. The majority of staff had worked at the service for many years and knew people well. A recruitment programme was ongoing to recruit more staff and increase staffing levels.

People received their medicines as prescribed, administered by trained staff. Medicines were regularly audited, but audits had failed to identify some protocols were missing for ‘as required medicines’. Audits had identified a number of missed signatures on medication administration charts but there was no evidence available to demonstrate what actions were being taken in response to this.

Staff felt well trained and supported in their role. New staff benefitted from an induction that included shadowing more experience members of staff. Staff supported people to access a variety of healthcare services to help them maintain good health but did not consistently act on issues identified.

People enjoyed the food on offer and assistance was offered at mealtimes for those who needed it.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff were seen as kind, caring and compassionate and had positive relationships with the people they supported. Staff knew people well and what was important to them, however, there was little evidence to demonstrate that people had been involved in the development and review of their care plans.

People were supported to take part in a variety of activities that were of interest to them. Staff knew people well, what was important to them and how they wished to be supported.

For more details, please see the full report which is on the CQC website at

Rating at last inspection The last rating for this service was Good (published 6 June 2017).

Why we inspected

The inspection was prompted in part due to concerns received about care delivery and some allegations regarding thefts at the service. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Well Led section of this full report.

You can see what action we have asked the provider to take at the end of this full report.

We found no evidence during this inspection that people were at risk of harm from this concern.


We have identified a breach in relation to good governance at this inspection.

Please see the ac

Inspection areas


Requires improvement

Updated 7 November 2019

The service was not always safe.


Requires improvement

Updated 7 November 2019

The service was not always effective.


Requires improvement

Updated 7 November 2019

The service was not always caring.


Requires improvement

Updated 7 November 2019

The service was not always responsive.


Requires improvement

Updated 7 November 2019

The service was not always well led.