The inspection took place on 23 September 2016 and 27 September 2016 and was unannounced.

Ernest Luff Homes provides accommodation and personal care for up to 28 older people and people who may be living with dementia. The service does not provide nursing care. At the time of our inspection there were 22 people using the service and one person was in hospital.

There was a registered manager in post at the service. 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 day-to-day running of the service was carried out by a management team that consisted of the registered manager and the business manager.

People were safe because the management team and staff understood their responsibilities to recognise abuse and. keep people safe. People received safe care that met their assessed needs and staff knew how to manage risk effectively.

There were sufficient staff who had been recruited safely and who had the correct skills and knowledge to provide care and support in ways that people preferred.

The provider had clear systems in place to manage medicines and people were supported to take their prescribed medicines safely.

People’s health needs were managed effectively with input from relevant health professionals and people had sufficient food and drink that met their individual needs.

The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We found the provider was following the MCA code of practice.

The management team supported staff to provide care that was centred on the person and staff understood their responsibility to treat people as individuals.

People were treated with kindness and respect by staff who understood their needs and preferences. Staff respected people’s choices and took their preferences into account when providing support. People were encouraged to enjoy pastimes and interests of their choice and were supported to maintain relationships with friends and family so that they were not socially isolated. People’s spiritual needs were met in ways that they preferred.

Staff had good relationships with people who used the service and were attentive to their needs. People’s privacy and dignity was respected.

There was an open culture and the management team encouraged staff to provide care that met people’s needs.

The provider had systems in place to check the quality of the service and take the views of people and their relatives into account to make improvements to the service.

The provider had systems in place so that people could raise concerns and there were opportunities available for people or their representatives to give their feedback about the service.

The registered manager and the business manager were visible and actively involved in supporting people and staff. Staff were positive about their roles and their views were valued by the management team.

The purpose of this inspection was to check that improvements had been made following our last inspection on 6 May 2014. At the time we had concerns that people’s individual needs were not always being met because there was a lack of consistency in the care plan evaluations. This meant that the provider was not meeting essential standards of quality and safety. We asked the provider to take action to address the concerns identified. The provider sent us an action plan and they told us the actions they would be taking to address the concerns identified within a reasonable timeframe.

During this inspection we reviewed the care and treatment records of five people who used the service to see if the required improvements had been made. We saw that the required improvements had been made to ensure people's needs were assessed and care was planned and delivered in line with their individual care plan. The plans were now regularly updated following any changes in their assessed care needs.

During this inspection we reviewed the accident and incidents records and looked at how the service managed the behaviour of people. This was to review if the required changes had been made. We saw that the provider had taken action to update people’s care plans and risk assessments. These now contained sufficient detailed guidelines for staff on how to effectively manage people’s behaviours. We saw documentation had been put in place to record clear details of the accident or incident which was then analysed by the manager. The information was used by the manager to update people’s mental health care plans where required. Records demonstrated that the mental health team responded promptly to requests for a review of people's mental health. This meant that staff had consulted with health professionals and had up to date mental health care plans in place to ensure people’s safety and well-being.

Records seen confirmed that the manager had reviewed and analysed the accident and incident forms on a monthly basis to identify any patterns or areas of concern. The analysis was then used to review what lessons could be learnt and what action was to be taken.

The Ernest Luff Home had two separate buildings. The Ernest Luff House was for people who needed personal care and the Olive Luff House was mainly for people who were living with dementia. At our last inspection on 13 January 2014 we found that standards were not being met in relation to respecting and involving people, health and welfare, nutrition, staffing levels, training and support for staff and quality assurance. At this inspection we found that the provider had made considerable improvements in all these areas. However, they still needed more consistency in the assessment and recording of care needs and care management.

During our inspection we spoke with five people who were living in the service and two relatives. We also spoke with the manager, the care team leaders and some of the staff.

During our inspection we gathered evidence to help us answer our five questions; 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 detailed evidence supporting our summary can be read in our full report.

Is the service safe?

People told us that they felt safe in the service. A relative we spoke with said: “The home is much safer now that there are more staff.” People told us that they felt their rights and dignity were respected and they felt in control of decisions about their care and support. There were systems in place to protect people from poor practices or abuse.

There were systems in place to ensure that managers and staff learnt from events such as accidents and incidents, complaints, whistleblowing and investigations. This helped to reduce the risks to people and encouraged the service to continually improve.

The service was starting to review people in the service who might need an application made under the Deprivation of Liberty Safeguards (DoLS). This was to ensure that when a decision was made, for example, when a person was not able to leave the service unsupervised, this decision was made in their best interests.

Is the service effective?

People told us that staff were effective in meeting their needs. One relative told us: “Staff treat each resident as an individual and meet their individual needs.” Another relative said: “Staff are very good and look after residents very well.” One person told us that there was a very good laundry service. They said: “My washing was collected this morning and was back this afternoon.”

Is the service caring?

People were supported by kind and attentive staff. People we spoke with were all complementary about the staff and told us that they were “very caring” and “friendly”. One person told us: “My key worker is an absolute gem, a born carer, there’s nothing they won’t do.” Both the relatives and a health professional we spoke with described the staff as very caring.

Is the service responsive?

All the people we spoke with told us that the staff were responsive to their needs and answered their call bell promptly. One person said: “If I’m not feeling well staff get the doctor straight away.” The service worked well with other agencies to ensure that people had continuity in their care.

A relative who had previously been concerned about staffing levels confirmed that levels had improved since the last inspection. They said that staff now had more time to respond to people’s individual needs. They told us: “Standards of care are much better. I wouldn’t want my relative to be anywhere else.”

Is the service well led?

One person told us: “It’s a lovely home. It’s well run”. A relative told us: “If I have any problems I can talk to the senior staff or manager and they sort it out.” One of the health professionals who visited the home on a regular basis considered that both the units were well managed. Staff told us that they felt well supported by the management team.

The systems for monitoring standards within the service had improved since the last inspection. Prompt actions were being taken to address any identified shortfalls.

The Ernest Luff Home had two separate buildings. Ernest Luff House was for people who needed personal care and Olive Luff House was mainly for people who were living with dementia.

In the month prior to our inspection we received complaints about staffing levels on Olive Luff from three relatives and from one member of staff. We spoke with two of the relatives to discuss their concerns before we carried out this inspection. During our inspection we spoke with two people living in Ernest Luff. We also spoke with four relatives and six people in Olive Luff. The three relatives who visited on a regular basis all said that Olive Luff was understaffed. Relatives told us that there was a lack of response when they raised concerns over low staffing levels and falling standards of care in Olive Luff.

People told us that they felt safe in the home. We found that people were treated respectfully but were not always involved in decisions about their support and care when staff were rushed. The care records were not always up to date, this meant people could not be assured of the right care. Staff were not always taking appropriate action when people had unplanned weight loss. The staffing levels did not always match the dependencies of people living in the home, particularly on Olive Luff. This meant that individual needs were not consistently being met. The staffing levels were also impacting on the ability of the senior staff to provide sufficient training, supervision and auditing of quality within the service.

We were unable to inspect the Olive Luff wing of the home due to infection control measures that were in place during our visit. However we gathered evidence of people’s experiences of the service in the Ernest Luff wing during our inspection on 31 January 2013. We spoke with four people who lived at the home, relatives who were visiting, the manager and four staff. People we spoke with told us they were happy living at Ernest Luff. They felt that staff treated them respectfully and in a way that they liked.

We saw that people in Ernest Luff were given opportunities to make decisions about their care and support, including a choice of what to eat and whether to join in planned activities. One relative of a person who lived at the home told us, “The new manager comes and talks to them all, [residents of the home and families]. She [the manager] has introduced a lot more quizzes and fun things for people to do.”

People in Ernest Luff told us that they were able to choose how to spend their day, which included the times they got up and went to bed. Staff we spoke with told us about the training they had received to enable them to carry out their roles in supporting people. We saw records that evidenced a training plan for staff.

We found that the provider had systems in place to assess and monitor the quality of the service provided to people.

At the time of our inspection the registered manager was Mrs Lynne Durrant.

We carried out an unannounced inspection at Ernest Luff Home on 15 November 2011. At our last inspection on 28 July 2011 people who were more independent were all extremely positive and complimentary about the staff, the care they received and the Christian ethos of the home. However, we had concerns about the support and care provided to people with dementia and those who were more dependent on staff to meet their needs.

During this inspection we therefore had conversations of varying lengths with one relative and with four people who needed considerable staff support. They all told us that they were happy with the staff and the care provided. The relative told us “I couldn’t ask for a nicer place for X to be. I can’t speak too highly of the staff, they’re so caring to me as well.” One person told us “I’m very happy here, the staff are very good.” However, another person told us that they were not always given a genuine choice about when they were assisted to get up. They said “I need to fit in with the jobs they have to do; they have to get me up before they go off duty.” The manager told us that they would be meeting with staff and reinforcing the fact that people’s choices must always take priority over staff convenience.

Two people on the residential unit who were independent were extremely complimentary about the care and support provided and said that they very much appreciated the Christian ethos of the home. They told us that staff provided the support they needed in the way that they wanted. One of them told us “They respect my modesty.” However, a person who required more staff support told us that they did not get a choice about the time they were assisted to get up in the morning, nor were they always given a choice about where they spend their day. They told us “I asked to go to my room for a rest on my bed as I was feeling tired but staff said you have to stay down here. There really wasn’t a choice.”

We observed some very caring staff interaction with people on the dementia care unit. The activity coordinator was also providing stimulation and activities on both a group and one to one basis that were obviously appreciated by the people who participated. Relatives praised the standard of the activities but were concerned that the activity staff had to carry out care duties due to reductions in care staff numbers. They considered that at times there were insufficient care staff to meet people’s needs.

People were very positive about the standard of the meals and the choices available. One person commented “The food is wonderful, it’s like home cooking.” Another told us “The cook is very good and the food is presented well.” Relatives told us that the home was always kept clean and fresh.

Two people told us that they could not think of anything that could be better at the home. One of them said “It’s just like home, it’s very relaxed here. I don’t have anything bad to say about the home.” Two relatives were very complimentary about the staff on the dementia unit. One told us “Staff treat residents well, the interaction is very good.” Another said “There’s such a loving and supportive atmosphere here. I wouldn’t want X anywhere else.”