The Leylands - Residential Care Home

The Leylands – Residential Care Home is a care home providing personal care to 19 people at the time of the inspection. The service can support up to 21 people. The service provides support to older people, people living with dementia, people with learning disabilities and people with physical disabilities.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Quality checks in place did not always identify where there were gaps in recruitment files. Checks did not always identify where documentation had been completed inconsistently or where records had not been completed accurately.

People told us they felt safe and staff understood how to keep them safe. Improvements had been made to medicines systems since the last inspection and people’s medicines were stored and administered safely. Risk assessments were in place that guided staff on how to meet people’s needs safely and staff followed them. People were supported by a sufficient number of staff to meet their needs safely. The home environment was clean and systems were in place to reduce the risk of infection.

Medicines audits were comprehensive and effectively checked whether medicines were being stored and administered safely. The registered manager and staff were clear about their roles and a positive and supportive culture was evident in the home.

People and relatives told us the registered manager and senior staff were approachable. Staff were able to engage with the service through supervision and team meetings. The provider worked proactively to improve care at the service and shared learning with other care home managers through local engagement groups.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 3 March 2022) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

The service remains rated requires improvement. This service has been rated requires improvement for the last five consecutive inspections. At this inspection we found improvements had been made but the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to falls not being reported, staff using unsafe moving and handling techniques and bullying at the home. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns. However, 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 looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Leylands – Residential Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Leylands - Residential Care Home is a residential care home providing personal and nursing care to 18 people at the time of the inspection, some of whom were living with dementia. The service can support up to 21 people.

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

Whilst people received their medicines as prescribed, people’s medicines records required improvement to support this practice. People did not consistently receive their topical medicines by the staff that were documenting they had administered these.

The provider had completed recruitment checks on staff however, these checks required review to ensure these were complete in line with current guidance.

Quality assurance tools did not consistently identify the improvements we highlighted were required in relation to medicines, the environment and recruitment. The provider worked with us to ensure improvements we identified at the inspection were made.

People felt safe and were supported by trained staff who understood their needs and risks. People were supported by sufficient staff and did not wait for care and support. People were supported in line with current government guidance around COVID-19 and infection control.

People and their relatives knew the management team and felt able to raise any concerns they had about the service if these arose. People and their relatives were regularly asked for feedback in the form of questionnaires and meetings. People had access to healthcare professionals as they required these. Professionals gave positive feedback about the staff and management team.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service requires improvement (published 10 October 2021). This service has been rated requires improvement or below for the last four consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about a person’s experience of care whilst at The Leylands- Residential Home. As a result, a decision was made for us to undertake a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained the same based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Leylands- Residential Home on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the governance and oversight at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Leylands - Residential Care Home is a residential care home providing personal and nursing care to 11 people at the time of the inspection, some of whom were living with dementia. The service can support up to 21 people.

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

People were protected from the risks of ill-treatment and abuse as the staff team had been trained to recognise potential signs of abuse and understood what to do if they suspected wrongdoing. The provider had revised their training and embedded the learning by checking staff members understanding.

The provider had assessed the risks to people associated with their care and support. Staff members were knowledgeable about these risks and knew what to do to minimise the potential for harm to people. People received their medicines safely and as prescribed. The provider checked staff members competencies to support people with medicines and engaged an external pharmacist to complete checks to ensure good practice.

People were supported by enough staff who were available to assist them in a timely way and who were recruited safely. Staff members followed effective infection prevention and control practices. The provider had systems in place to review and adapt when things went wrong.

The provider had improved their quality monitoring systems. However, they could not evidence consistent good practice over a sustained period of time. We will check this during our next planned inspection.

People and staff felt the service was well managed and were given opportunities to share feedback about the service.

The provider had kept the CQC informed about significant events.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (Published 14 April 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations associated with the key questions safe and well-led.

This service had been in Special Measures since 14 April 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced inspection of this service on 26 January 2021 where breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which we previously rated as inadequate. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Leylands - Residential Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Leylands is a residential care home providing personal and nursing care to 17 people at the time of the inspection. The service can support up to 21 people.

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

People were not safeguarded from potential harm, abuse and neglect. People were not supported by staff who were effectively trained and had guidance in place to meet their needs. Medicines were not consistently stored safely and people did not always have guidance in place where they were prescribed medicines on an 'as required' basis. People were not supported by staff who were working in line with the government COVID-19 guidance on isolating following a positive COVID-19 test.

People were not supported in a consistent way during periods of anxiety or distress. People were not supported to have maximum choice and control of their lives and the systems in the service supported this practice. People and those important to them were not involved in the planning of their care.

People and their relatives felt able to feedback about their care. However, feedback was not consistently acted on to ensure improvements were made. People were not supported to communicate in line with their preferences. People's care plans did not contain information about their preferences.

The provider had failed to ensure there were effective quality assurance and oversight at the service to identify where improvements were required and to ensure these are embedded within the service.

People were supported to have choice around their meals. People were supported by staff who were recruited safely. People had access to activities they enjoyed. People and their relatives felt able to complain.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 12 February 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the quality of care and oversight at the service. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive and well-led only. We did not review the key question of caring as this had previously been rated as good. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to people’s safe care and treatment, safeguarding people from potential abuse and neglect, compliance with the MCA, staff having sufficient and effective training, the leadership and governance of the service, failure to have a registered manager in place and failing to notify us of accidents and incidents at the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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

The care people received was not always responsive to their needs as staff offered an inconstant approach to how behaviours of concern were managed. When people were living with dementia their communication needs and how they could make choices were not always fully considered. Medicines were not always securely stored.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. Improvements were needed to ensure staff had received training and had an understanding in some key areas such as management of behaviours.

There was a lack of governance in the service and the provider did not have effective systems in place to monitor the home or use the information to drive improvements.

People were supported in a safe way. There were enough staff available for people. Risks to people were considered and reviewed and some lessons learnt when things went wrong. People were supported by staff they were happy with. People were encouraged to remain independent and their privacy and dignity was maintained.

People had access to health professionals when needed. They were supported to maintain healthy diets and enjoyed the food on offer. People's preferences were taken in to account. They had the opportunity to participate in activities they enjoyed. There was a complaints procedure in place which was followed when needed

Staff felt supported and listened to. People and relatives were happy with the care they received.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good. (Published 15 July 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the governance systems in the home as systems and audits were not always in place to identify areas of improvement.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Rating at last inspection:

At the last inspection, in November 2014, the service was rated Good. At this inspection, we found the service remained Good.

Why the service is rated Good:

People continued to be protected them from avoidable harm and abuse. Staffing levels continued to be sufficient to meet people's needs, as well as to enable staff the time to spend with people. People continued to receive their medicines safely.

People continued to enjoy the variety of meals provided, and continued to receive individual assistance with their eating and drinking needs. Staff continued to receive training which was relevant to the needs of the people living at The Leylands.

People continued to enjoy positive and respectful relationships with staff. People were able to enjoy their individual hobbies and interests. Staff continued to provide care which was tailored around people's individual preferences and needs.

The registered manager and provider had systems in place to monitor the quality of care people received. People, relatives and staff were positive about the running o the home, and felt their opinions and feedback mattered.

Further information is in the detailed findings below.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. We spoke with six people, four staff and the manager.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People we spoke with told us they felt safe and comfortable living at the service.

Systems were in place to make sure that managers and staff learned from events such as accidents, incidents and complaints. This helped to reduce the risks to people and helped the service to continually improve in this respect. However, we did find gaps in auditing practices for other aspects of care, such as care records.

No applications for the Deprivation of Liberty Safeguards had been submitted by the service. Staff showed good knowledge about how they should protect people's rights.

The service was safe, clean and hygienic, although we did find issues concerning the premises and equipment, which the manager undertook to remedy.

Recruitment practice was safe and thorough. Records showed that management addressed issues through appropriate disciplinary procedures, when required.

Is the service effective?

People's health and care needs were regularly assessed and records reflected people's individual needs. Some people we spoke with told us that staff did ask them about the suitability of their care, but records did not reflect this practice. We did see that care plans were personalised and contained important information about how people's health should be supported. We did find, however, that some people had been assessed at high risk of developing sore skin areas. Records did not detail how these people were to be supported to minimise this risk or how some people's health should be supported, although we saw this happening in practice.

Is the service caring?

We observed staff interacting with people and saw that these interactions were positive, patient and caring. People were complementary about the staff. One person told us, 'They do very well for us'.

The service did not carry out an annual survey with people, but staff interacted with people individually to understand their concerns. People told us they were able to talk with staff about any concerns they had.

Is the service responsive?

People told us that there was not always enough stimulating activity to keep them interested. One person told us, 'I'm sometimes bored'. We saw from records that a range of activities were offered, but these did not suit everyone we spoke with. We did not see activities taking place during our inspection.

Although no recent complaints were recorded, people told us they would feel confident to speak the manager if they did have a concern. People we spoke with told us they had never had cause to raise a complaint.

We saw that accidents and incidents had been recorded and analysed, and action taken to minimise a recurrence of the same issues. This meant that people could be sure action was taken to keep people safe.

Is the service well-led?

The service did not have a registered manager at the time of our inspection. We saw evidence that the current manager was taking steps to apply for registered manager status.

We saw evidence of the service cooperating with others, such as the district nurse service, to promote people's wellbeing. This meant that staff took into consideration external professional advice in order to promote people's health and wellbeing.

The service showed some improvement in its quality assurance systems, although there were still some gaps, such as the lack of appropriate care record auditing. We saw evidence of the service using outside organisations to improve some of the shortfalls in identified areas. This included a recent fire risk assessment produced in January 2014. The service was yet to action most of the recommendations made.

We observed staff respect people and promote their independence throughout the day. Records showed that people and their relatives were involved in the planning and delivery of care.

We found that people received care that met their needs. One person said, 'I am quite happy here. They call a doctor when you need one, there is always someone around.'

Arrangements were in place for the safe handling of medicines. One person said, 'I get my medicine on time.'

We found that there were positive interactions between staff and people. We saw that there were sufficient staffing levels to meet people's assessed care needs. One staff said, 'There is definitely enough staff.'

Systems to monitor the quality of the service were not robust and efficient.

Improvements were required in records relating to people's care and for the management of the home.