Archived: The Leys

The Leys is a residential care home that can provide care and support for older people and people living with dementia. The service is registered to provide accommodation and personal care to a maximum of 33 people. At the time of inspection 12 people were using the service.

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

Risks to people had not always been mitigated. We found risks associated with water temperature, food temperatures, environment and equipment.

Risks associated with people’s health conditions were not always thoroughly assessed and mitigated. People with risks from known health conditions did not always have details recorded and factors to reduce the risks were not always identified or followed.

Effective systems were not in place to protect people from the risk of potential abuse. Safeguarding procedures had not always been followed. Records of injuries were not detailed and follow up checks were not recorded.

Records of injuries and accidents were not always reviewed by the manager, to identify concerns and improve practice when needed.

Records did not evidence that staff supported people with all of their individual needs, such as continence tasks or personal hygiene tasks.

Medicine management required improvement. Records were not always clear regarding which medicines were currently prescribed. Reasons for administering as required medicines were not completed.

Systems and processes to provide oversight of the service were ineffective in identifying improvements needed. Concerns found on this inspection had not been previously identified or mitigated by the provider.

The provider had not always followed the requirements under the duty of candour. The duty of candour requires registered providers and registered managers to act in an open and transparent way with people receiving care or treatment from them. The regulation also defines ‘notifiable safety incidents’ and specifies how registered persons must apply the duty of candour if these incidents occur.

People and relatives told us they were supported by staff who knew them well and had been trained to meet their needs. People and relatives were positive about staff.

People were supported to have maximum choice and control of their lives but staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

People, relatives and staff all knew how to complain and felt their concerns would be dealt with appropriately. Feedback was requested from stakeholders.

The service had received a five-star food hygiene rating on 12 April 2022 from the food stand agency.

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 1 February 2022) and there were two breaches of regulation. 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 not been made and the provider was still in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. 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 has not changed from inadequate based on the findings of 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.

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 risk mitigation, records, medicines and oversight at this inspection.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service remains 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.

The Leys is a residential care home that can provide care and support for older people and people living with dementia. The service is registered to provide accommodation and personal care to a maximum of 33 people. At the time of inspection 13 people were using the service.

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

The judgement of this service takes into account the previous breaches and ratings in each domain.

Risks to people had not consistently been identified and mitigated. At this inspection people were at risk from fire and unsafe food storage. Records evidenced risks associated with scalding.

Medicine management required improving. Staff did not also have the required information needed to administer medicines as prescribed. For example, as required medicines did not always have protocols in place.

Unexplained injuries had not consistently been investigated or a cause identified.

Care plans had not been consistently reviewed to ensure all the information was reflective of people's needs. Some care plans held conflicting information within them and not all were person centred.

Recording of care tasks was not consistent. Staff had not always recorded the reason a task had not been completed. For example, if a person refused or if staff had just not completed the task.

People told us activities were limited and they did not have much to do. People and their loved ones were supported to stay in contact throughout the COVID -19 pandemic.

Referrals were made to health professionals and staff supported people to access appointments as required.

People were supported by staff who knew them well, had sufficient training and who had been safely recruited. People were complimentary about staff, people told us they felt safe and staff were kind.

Staff wore the appropriate personal protective equipment (PPE) and the cleaning schedules evidenced people’s bedrooms and communal rooms were cleaned regularly.

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 10 February 2021) and there were two breaches of regulation. 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/sustained, and the provider was still in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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.

We have found evidence the provider needs to make improvements. Please see the safe and well led sections of this full report.

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

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 fire safety, food safety, medicines and governance at this inspection.

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 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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains 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 six months to check for significant improvements.

This service has been in Special Measures since 28 January 2020. During this inspection the provider had not demonstrated that improvements have been made.

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.

The Leys is a residential care home that can provide care and support for older people and people living with dementia. The service is registered to provide personal care to a maximum of 33 people. At the time of inspection 14 people were using the service.

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

We found continued issues with management oversight. Audits had not identified the concerns raised during the inspection.

Information documented on people’s needs required improvement. We found missing information within care plans, and not all risk assessments had been completed. Care plans required reviewing and information logged consistently. Some risk assessments needed implementing.

Documentation of care tasks was inconsistent. We found gaps in the recording of safety checks, repositioning checks and the recording of peoples nutritional and hydration needs.

Medicine management required improvement. We found not all information had been documented. People received their medicines by trained staff.

People were supported by staff who had been safely recruited, appropriately trained and who knew them well.

People were protected from abuse by the systems and processes implemented. Staff understood how to recognise abuse and how to report it.

Complaints, suggestions and feedback had been appropriately managed and actions implemented to improve the service.

People were protected from infections. Staff wore appropriate personal protective equipment (PPE) and cleaning schedules were in place to ensure the service was clean and hygienic.

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 24 March 2020) and there were multiple breaches of regulation.

The provider completed an action plan and had conditions put on their registration following the last inspection.

At this inspection enough improvement had not been made and the provider was still in breach of regulations 12 and 17. Other areas had improved and the provider was no longer in breach of regulations 13 and 18.

This service has been in Special Measures since 19 March 2020.

Why we inspected

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 contain those requirements.

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 coronavirus and other infection outbreaks effectively.

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

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.

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

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 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 safe care and oversight of the service 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 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.

The overall rating for this service is ‘Requires improvement’. However, we are keeping the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.

The Leys is a residential care home that can provide care and support for older people and people living with dementia. The service is registered to provide personal care to a maximum of 33 people. At the time of inspection 18 people were using the service.

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

There was a continued lack of understanding, oversight and governance systems to ensure people received a safe service. Systems that were in place were not implemented effectively and audits did not identify ongoing concerns with the service.

Records of care had not been consistently completed. Audits had not identified the gaps in recording found during inspection.

The provider was not complying with a condition of their registration. There was insufficient staff adequately deployed at night time.

People’s hydration needs were not always monitored, and timely action was not taken to address concerns where people’s fluid intake was low. People were at increased risk of pressure sores because they were not always repositioned in line with the care plan. Injuries or bruising people had sustained had not always been investigated or reviewed.

Infection control procedures required strengthening to manage the risk of cross contamination.

The environment continued to require improvements to decoration and maintenance.

Medicines were safely managed, staff had been safety recruited and completed an induction. People told us they felt safe and the staff supporting them were kind.

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 inadequate (published 29 January 2020) the provider was in breach of regulations 9, 12, 14, 17 and 18.

This service has been in Special Measures since 29 January 2020.

At this inspection enough improvement had not been made/ sustained, and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 10, 11 and 12 December 2019. Breaches of legal requirements were found in relation to person-centred care, meeting peoples nutritional and hydration needs, safe care and treatment, staffing and governance.

Before this inspection we received concerns in relation to documentation recording management of risk. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed following this focused inspection and remains inadequate.

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

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 safe care and treatment, staffing and good governance at this inspection.

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

The overall rating for this service is ‘Inadequate’ and the service remains 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.

The Leys is a residential home providing care and support for older people and people with dementia. The service is registered to provide personal care to up to 33 people. At the time of inspection, they were supporting 26 people.

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

The leadership and the management of the service had not made enough improvements to the safety and governance of the service since the last inspection.

There was a continued lack of understanding, oversight and governance systems to ensure people received a safe service. Systems that were in place were not implemented effectively and audits did not identify ongoing concerns with the service.

Records relating to people's risks and care needs were incomplete and contained misleading information. As a result, staff did not receive all the information and guidance they required to provide care that met people's needs. People’s care needs were not regularly reviewed.

Some aspects of environmental safety were not effectively managed. Insufficient fire safety measures were in place and some areas of the home were not clean or maintained in a way to mitigate infection risks.

We found there to be insufficient numbers of staff working at the service to keep people safe. People were at risk of experiencing unsafe care and treatment as a result. Staff were safely recruited.

People’s nutritional needs were not properly assessed, and people did not receive the support they needed with eating and drinking. This put people at risk of malnutrition.

Improvements were required to staff training. Staff had not received all the training they required, and reliable records were not kept of staff training.

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. However, the policies and systems in the service did not support this practice.

A complaints procedure was in place and written complaints had been investigated by the registered manager. However, problems raised verbally were not always recorded as complaints, and therefore weren’t dealt with in accordance with the provider’s policy.

People did not always receive timely support to meet their ongoing health needs and health monitoring. People were supported to access relevant health and social care professionals when they were unwell.

We found individual staff to be caring and compassionate towards people. However, due to staffing levels at the service they lacked opportunities to spend time with people. Care being delivered was often task focussed.

People received their medicines as prescribed and staff understood their roles and responsibilities to safeguard people from the risk of harm.

We have identified breaches in relation to the management of risks to people, meeting people’s eating and drinking needs, staffing levels, staff training and the governance of the service at this inspection.

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 (29 December 2018) and the provider was in breach of one regulation. 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

This was a planned inspection.

Enforcement

We have imposed conditions on the provider's registration, for more information please see the end of the report.

We will meet with the provider 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

'The Leys' accommodates and provides personal care, without nursing, for up to 33 older people, some of whom have dementia care needs. The home is owned and managed by 'St Martins Residential Homes'. The premises had been adapted and consisted of two floors which included bedrooms, a main lounge and dining room, and a new dementia unit. At the time of our visit there were 28 people using the service.

The Leys is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At our last inspection we rated the service as ‘good’. At this inspection we found the evidence failed to support the rating of good and the service has been given a rating of requires Improvement.

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.

During this inspection we found that risks to people had not always been identified and managed safely. For example, where people were using thickener in their drinks because of a risk of choking, there were no risk management plans in place to cover the risk of choking or dehydration.

Although there were quality assurance audits in place, there was a lack of managerial oversight to ensure quality checks were used effectively to bring about improvements to people’s care and support. For example, records management was not always accurate and organised so records could be accessed easily. Falls and nutrition records were inconsistent and unreliable. People did not always receive their medicines as prescribed. Systems in place to ensure lessons were learnt from accidents and incidents needed to be strengthened. Significant incidents had not always been reported to the relevant authorities so they could be investigated and actions taken to reduce the risk of such incidents happening again. Confidential information was not always stored securely.

Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse and incidents of concern. The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. Staffing levels were sufficient to meet people’s needs. Systems were in place to ensure that people were protected by the prevention and control of infection. Systems in place to ensure lessons were learnt from accidents and incidents needed to be strengthened.

People’s needs and choices were assessed and their care provided in line with their preferences. Staff received an induction process when they first commenced work at the service and received on-going training to ensure they could provide care based on current practice when supporting people. People enjoyed the meals and told us they had a choice of meals every day. People were supported to access health appointments when required, including opticians and doctors, to make sure they received continuing healthcare to meet their needs.

There were no records of any best interest meetings specific to people or the support that they needed to ensure decisions were made in their best interests. This did not ensure the principles of the Mental Capacity Act (MCA) were always followed.

People received care from staff who were kind and caring. People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. People had developed positive relationships with staff who had a good understanding of their needs and preferences.

People’s needs were assessed and planned for with the involvement of the person and or their relative where required. Care plans were personalised and provided staff with guidance about how to support people and respect their wishes. Information was made available in accessible formats to help people understand the care and support agreed. People were supported to take part in meaningful activities and there was a varied programme of activities available for people to take part in. There was a complaints procedure in place to enable people to raise complaints about the service. People were supported to plan and make choices about their care at their end of life.

Staff felt well-supported and received supervision that gave them an opportunity to share ideas, and exchange information so they had the knowledge and support they needed to perform their roles. Specialist training was provided to make sure that people's needs were met and they were supported effectively. The staff we spoke with were all positive about the registered manager and were happy with the support they received.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

The Leys accommodates and cares for up to 23 older persons with a range of mainly age related dependencies, including people with dementia care needs. There were 21 people in residence when we inspected.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 safe. People’s needs were assessed before they were admitted to the home and regularly reviewed to ensure they received appropriate and timely care. They had an agreed care plan that reflected their individual needs. Their care plans were regularly reviewed and provided care staff with the information and guidance they needed to do their job.

People benefited from being cared for by sufficient numbers of experienced care staff that had received the training they needed to do their job safely. Care staff knew what was expected of them when caring for older people, including those with dementia care needs, and they carried out their duties effectively and with compassion.

People’s healthcare needs were met and they received treatment from other community based healthcare professionals when this was necessary. People’s medicines were appropriately and safely managed. Medicines were securely stored and there were suitable arrangements in place for their timely administration.

People had enough to eat and drink and enjoyed their meals. People that needed support with eating and drinking received the timely practical help they required. People’s individual nutritional needs were assessed, monitored and met with appropriate guidance from healthcare professionals that was acted upon when required.

People’s individual preferences for the way they liked to receive their care and support were respected. People were enabled to do things for themselves by care staff that were attentive to each person’s individual needs and understood their capabilities. They received support from care staff that demonstrated that they understood what was required of them to provide people with the care they needed.

People were treated with dignity and their right to make choices was upheld. There were imaginative activities to keep people entertained and constructively occupied if they chose to participate in them.

People’s views about the quality of their service were sought and acted upon. The quality of the service provided was regularly audited so that people benefitted from any improvements that were made. People and their relatives or significant others were assured that if they were dissatisfied with the quality of the service they would be listened to and that appropriate action would be taken to resolve matters to their satisfaction.

People were safeguarded from abuse and poor practice by care staff that knew what action they needed to take if they suspected this was happening. There were recruitment procedures in place that protected people from receiving care from care staff that were unsuited to the job.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive to people's needs?

' Is the service well-led?

Is the service safe?

People were cared for in an environment that was clean and hygienic but some minor repairs to worn carpets in some corridors had not been made. This posed a potential trip hazard to both staff and people in residence. Prompt action was taken to rectify this when we identified the hazard.

When we inspected there were sufficient numbers of experienced and competent staff on duty to meet people's care needs. We saw that the equipment in place for staff to use was appropriately maintained. This meant that people were protected from the risk of neglect or unsafe care.

There were suitable arrangements in place to respond to emergencies, with the manager or provider's representative always being available 'on call' to support staff to manage the situation safely and effectively.

People's needs had been assessed before they were admitted to 'The Leys'. This meant that staff had the information they needed to minimise identified risks to people.

Is the service effective?

People said they received all the support they needed to enable them to do what they could for themselves. Staff had received the information, training and managerial support they needed to do their job effectively. We spoke with staff and observed them going about their duties and we concluded that they had a comprehensive knowledge of each person's care needs and preferences.

One person commented, 'All the staff are conscientious. They make me feel good about myself and that is really important to me.'

Is the service caring?

We saw that staff were purposeful and unhurried so they had not 'rushed' people. When we saw staff interact with people their manner of approach was patient, kind, and good humoured. They encouraged people who struggled to do things for themselves.

Is the service responsive to people's needs?

We saw that there were enough staff on duty to meet people's needs. This was confirmed by both the staff and people in residence we spoke with. One person said, 'I only have to push my buzzer if I need help. There is always a smile on their face, no matter how busy they are. They always say I should use my buzzer to call them if I want anything. It's reassuring.' We heard and saw that when someone used the call buzzer staff attended to them with minimal delay.

Is the service well-led?

Staff received a good level of practical day-to-day managerial support. The provider had ensured there were quality assurance processes in place but we identified some shortfalls in ensuring these were always effective, but there was not a breach of the Health and Social Care Act regulations.

There was not a registered manager in post when we inspected. The current manager is in the process of submitting an application for registration.

When we published our last inspection report in June 2013 we had identified a minor concern with staffing levels in the afternoon.

When we again visited 'The Leys' unannounced on the afternoon of 2 August 2013 we found that the home had been appropriately staffed in accordance with the provider's action plan to ensure compliance.

We spoke with a visiting relative who has visited the home regularly and they commented that, 'In my experience there are enough staff around. I have had no worries about the home being short staffed when I visit in the afternoon. The carers always seem attentive and never appear to be rushing around.'

We were informed by the provider that improvements were being made to the layout of the premises and that this building work had started since our last published report.

We found when we visited on 2 August 2013 that this work had been safely and sensitively managed with minimal disruption to the people in residence. The staff said that the builders had taken care not to upset anyone by creating noise and there had been no problems with dust or access to any of the rooms currently in use within the home. We also saw that people were relaxed in the communal lounge.

All the people we spoke with said they were comfortable. They all said they had enjoyed their lunch and had enough to eat and drink.

The staff we spoke with were friendly, helpful and knew about people's individual needs and preferences.

We found, however, that there were only two care staff on duty for several hours that afternoon. This was because the manager was on holiday and was not available as a third person to assist the care staff on duty if they needed additional help with people's personal care needs. On this occasion we found there had been no arrangements made to bring in extra staff to cover for the manager's absence. This meant that on several occasions when two staff were temporarily required to assist a person with their needs there were no other available staff to attend to people. We spoke with the provider who gave assurances that this will not happen again.

We saw that the communal areas of the home, such as the lounge, dining room and access corridors, were clean and free from odour.

We observed staff engage people in a quiz activity in the communal lounge. We saw that people enjoyed the activity and chatted with staff and were relaxed in their presence. We heard staff talk with people and their tone of voice was friendly, they explained what they were doing and they used words of encouragement when, for example, they physically assisted several of the more frail people to move from the lounge to the dining room for their lunch.

We found 'The Leys' homely, clean, comfortably furnished and well maintained throughout. Communal areas and bedrooms were free from odour. We saw evidence that people's rooms were personalised with their belongings, such as photographs and other personal items they valued.