This unannounced inspection was undertaken on 24 July 2018 and was carried out by one inspector and an inspection assistant. At our last inspection we rated the service ‘good’. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Ernest Dene is a ‘care home’ for older people, some of whom are living with dementia. People in care homes receive accommodation and 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.

The service is registered to accommodate a maximum of 33 people. This originally included nine double rooms which are now single occupancy. The service currently accommodates 24 people. Most of the people using the service had been living at the home for many years. Most of the staff team had also been working at the home for some time and everyone knew each other well.

People using the service were relaxed with staff and the way staff interacted with people had a positive effect on their well-being.

Staff understood their responsibilities to protect people from abuse and knew how to raise any concerns with the appropriate safeguarding authorities.

Risks to people’s safety had been identified and the management had thought about and recorded ways to mitigate these risks.

Staff understood their roles and responsibilities in relation to maintaining high standards of cleanliness and hygiene in the premises.

There were systems in place to ensure medicines were administered to people safely and appropriately.

There were enough staff on duty to support people safely.

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

Staff understood the principles of the Mental Capacity Act (MCA 2005) and knew that they must offer as much choice to people as possible in making day to day decisions about their care.

People were included in making choices about what they wanted to eat and staff understood and followed people’s nutritional plans in respect of any cultural requirements or specific healthcare needs people had.

Both people who used the service and the staff who supported them had regular opportunities to comment on service provision and made suggestions regarding quality improvements.

People had regular access to healthcare professionals such as doctors, dentists, chiropodists and opticians.

Staff treated people as unique individuals who had different likes, dislikes, needs and preferences. Staff and management made sure no one was disadvantaged because of their age, gender, sexual orientation, disability or culture. Staff understood the importance of upholding and respecting people’s diversity. Staff challenged discriminatory practice.

Everyone had an individual plan of care which was reviewed on a regular basis.

People were supported to raise any concerns or complaints and staff understood the different ways people expressed their views about the service and if they were happy with their care.

This inspection took place on 23 December 2015 and was unannounced. This was a comprehensive inspection of the service at which we also checked that breaches of legal requirements identified at the last inspection on 18 December 2014 had been addressed. We found significant improvements at the service since the previous inspection showing that these requirements were now met.

Ernest Dene Residential Care Home is registered to provide accommodation and personal care for up to 33 older people. At the time of the inspection 22 people were living in the home. A registered manager was in place for the home. 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.

Risks to people’s safety were identified and managed effectively, and we found improvements in care practices to ensure that people’s dignity was protected appropriately. There were improvements in the cleanliness within the home and the support for people with their meals to ensure that people had choices available to them, and their dietary needs were met.

Staff recruitment procedures were sufficiently rigorous to ensure their fitness to work with people in the home. People’s medicines were managed safely, and staff knew what to do if people could not make decisions about their care needs. People were supported to make decisions about their care and how their needs would be met. Staff were available to meet people's care needs, and supported people to attend appointments with health and social care professionals.

Staff had relevant training and supervision, and understood people’s preferences, likes and dislikes regarding their care and support needs. They recorded current information about people’s care, and monitoring information when needed to ensure that action could be taken swiftly if they were at risk.

People using the service said the manager was approachable and supportive. Systems were in place to monitor the quality of the service, and a number of improvements had been made as a result including improvements to the home environment.

People had formed good relationships with staff, and were supported to maintain their independence skills. Staff were kind, patient and encouraging with people, including those who could challenge the service. People felt confident to express any concerns or make a complaint to bring about improvements.

This inspection took place on 18 December 2014 and was unannounced which meant that nobody at the home knew about the visit in advance.

Ernest Dene Residential Care Home is registered to provide accommodation and personal care for up to 33 older people. At the time of this inspection the home did not have a registered manager in place, however the acting manager was in the process of applying for registration. 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.

Some risks to people’s safety were not identified and managed effectively, and we found some examples of people’s dignity not being protected at all times. There were also shortfalls in the standard of cleanliness within the home, and in the support provided to people with their meals.

People were involved in decisions about their care and how their needs would be met. Staff were available to meet people's health and social care needs. People’s medicines were managed safely, and staff knew what to do if people could not make decisions about their care needs.

Staff understood people’s preferences, likes and dislikes regarding their care and support needs.

People using the service, relatives and staff said the manager was approachable and supportive. Systems were in place to monitor the quality of the service, although there were some gaps in identifying areas for improvement. People and their relatives felt confident to express any concerns, so these could be addressed.

At this inspection there were four breaches of regulations relating to cleanliness, risk management, support with food, and dignity. You can see what action we told the provider to take at the back of the full version of the report.

We considered our inspection findings to answer questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with twelve people using the service, three staff supporting them and from looking at records. If you want to see the evidence supporting

our summary please read the full report.

Is the service safe?

We carried out this inspection in response to concerns reported to us from two sources about the management and staffing in the home. We did not find any evidence to suggest that people were not safe in the home.

Is the service effective?

This was a short inspection focused on looking at staffing levels. On the day of the inspection people had all received personal care and were helped to have their lunch. There was no evidence that the service was not effective.

Is the service caring?

We spent an hour observing interaction between staff and people living in the home. Most people told us that staff were caring. Comments included, " they are good. I can find no fault with them," and "If they're busy you have to wait, they normally deal with you as soon as they can. No improvements are needed." We observed three staff showing patience and empathy when supporting people. One person told us they thought staff were "rigid" and did not listen to people.

Is the service responsive?

We spoke with a senior care worker, the acting manager and a representative from the company who run the home. We also spoke with 12 of the 28 people living at Ernest Dene and spent some time observing the daily routine in the home.We found that the number of staff on duty were able to meet people's needs at the time of the inspection which was on a Sunday.

Is the service well-led?

The manager of the home had stopped working at the home full time in April 2014 though still visited the home and provided staff training. People living in the home did not know who the current manager was and this had caused some confusion.

People's care plans outlined their decision making abilities and known preferences. We saw that people's needs were regularly reviewed. People told us there were activities available within the home and we saw evidence of trips to local events and facilities. They also said they were given the opportunity to make choices about day to day matters that affected them.

There were systems in place to deal with foreseeable emergencies. The home had appropriate training, policies and procedures in place to minimise the risk of people being abused.

Staff were inducted into all aspects of their role and then had the opportunity to attend other training days or courses to further develop their skills.

Accidents and incidents were recorded and the Care Quality Commission was notified of significant events in line with the regulations. NHS statistics indicated that people from the home had a higher level of admissions than expected to Accident and Emergency Departments, but we found no evidence of this being the case.

At the time of the inspection there were thirty people living at the home. We spoke to eighteen of them and one relative visiting the home. We also spoke to four staff members, and looked at five people's care records and four staff records.

People were very positive about the home. People told us “Its very nice,” and “Its good as far as I’m concerned.” They told us that they felt safe at the home.

They told us that staff were attentive and gave them the support that they needed. One person noted “They are very caring.” We observed many examples of staff supporting people in a supportive manner that respected their dignity.

We observed two mealtimes in the home, and people told us that they enjoyed the food served. One person noted “If I don’t like something they’ll get me something else.”

People said that they were happy with the home environment. One person told us “It has a homely feel.”

A variety of activities were available for people at the home, and some people went out regularly. One person told us “I go out in the local area.” However some people told us that they would enjoy a greater variety of activities.

We talked to people living in the home and spent time observing the care and lifestyle that people experience. Overall the feedback was that people are provided with the care that they need, and are well settled in the home. They are given choices and have generally formed good and supportive relationships with staff.

People spoke highly about the support provided by staff at the home, with comments including ‘nice staff,’ ‘they are very helpful,’ and ‘it’s grand.’ One person noted ‘it’s grand, it’s comfortable and the food is smashing.’ Most people liked the food, however some people were unhappy with the menu options currently available.

People said that staff asked them what their needs and wishes were, and tried to meet these as far as possible. They confirmed that they received their medication at the prescribed times, and that they saw healthcare professionals when needed.

A variety of activities were available, and many people were satisfied with these, but a number of people felt that they were often bored and that one day was often very like another, indicating that they would like more varied activities within and outside of the home. People were clear about who they could speak to if they had a complaint or felt at risk of harm. Appropriate quality control procedures are in place for the home, but without updated action plans, people cannot always be sure of when improvements are made as a result of these.