The inspection took place on 22 and 24 August 2017 and the first day was unannounced. This meant the provider or staff did not know about our inspection visit.

We previously inspected Lenore Care Home in April 2015, and the service was rated Good.

Lenore care home is based in Whitley Bay and provides accommodation for people with learning disabilities and/or mental health issues, who require assistance with personal care and support. At the time of our inspection 22 people were using the service

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like directors, 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 storage, administration and disposal of medicines were safe. However, the temperature of the room the medicines were stored in was not checked each day. We saw by the second day this was in place. At the last inspection it was noted that protocols for medicines to be taken when required (PRN) were not available. We saw every person who received PRN medicines now had a protocol in place.

The service was in the middle of a full refurbishment programme. People who used the service had chosen the colours to paint the walls.

Risks to people arising from their health and the premises were in place. However, some risk assessments needed further information to inform staff how to mitigate the risks.

There were sufficient numbers of staff on duty in order to keep people safe, meet their needs and ensure the premises were well maintained.

Safeguarding principles were well embedded and staff displayed a good understanding of what to do should they have any concerns.

There were effective pre-employment checks in place to reduce the risk of employing unsuitable members of staff. People who used the service were involved in the interview and selection process.

There was prompt and regular liaison with GPs, nurses and specialists to ensure people received the treatment they needed.

Staff completed a range of training, such as safeguarding, health and safety and first aid. Staff had a good knowledge of people’s likes, dislikes and life histories.

Staff had built positive, trusting relationships with the people they cared for. Staff were supported through regular supervision and appraisal. Staff told us the manger was supportive and willing to talk at any time.

People enjoyed the food they had and confirmed they had an input into the menus. People had access to the kitchen to make drinks, snacks throughout the day. However, staff observed to remind people washed their hands and to minimise the risk of infection.

People were supported to access activities of their choice. In house activities took place such as arts and crafts and cinema clubs.

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

The atmosphere at the home was relaxed, homely and welcoming. We saw numerous instances of caring and supportive interactions between staff and people during our inspection.

The manager completed a number of audits to ensure the quality of the service. The manager and senior support worker were devising a new medicine audit.

Staff, people who used the service, relatives and visitors we spoke with was positive about the registered manager’s impact on the service. We found the culture to be one where people received a good standard of care in a setting they found homely, safe and secure and were happy to live in.

People told us they were happy with the care and support they received. One person said, "I love living here me, its great and the staff are great too." Another person said, "It's okay here." A friend of a person living at the home who visited regularly told us, "You feel at home here. The staff are great. I would say that it is probably the best care home in the North East."

People told us their consent was gained prior to care being delivered and we found that staff acted in accordance with their wishes.

We found that people's care and support needs were appropriately assessed and their care was planned. They received care safely, and to an appropriate standard.

People were cared for in a clean and hygienic environment and we found the provider had appropriate measures in place to monitor and manage infection control.

There were enough suitably skilled and qualified staff on duty to meet people's needs safely and appropriately.

We saw the provider had a complaints policy and procedure in place, which people had access to.

People told us they were very happy living at Lenore Care Home. They said they had a lot of choice and made their own decisions about their lives. People said they felt safe in the home and liked the staff. One person told us, "we get spoilt all the time, this is the best home I have been in." Another person said "If you need something you ask the staff and they get it."

This inspection took place on 13 and 14 April 2015 and was unannounced. A previous inspection undertaken in December 2013 found there were no breaches of legal requirements.

Lenore Care Home is the only location owned and run by Mr and Mrs Duchett and is based in Whitley Bay. It provides accommodation for up to 23 people with learning disabilities and/or mental health issues, who require assistance with personal care and support. There were 21 people living at the home at the time of our inspection.

The home had a registered manager who had been registered since October 2010. 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.

People told us they felt safe living at the home and said staff treated them very well. There were effective security measures in place to ensure people were safe at the home. Staff had a good understanding of safeguarding issues and said they would report any concerns to the manager or the local authority safeguarding team. The premises were maintained and safety checks undertaken on a regular basis. However, we found two windows where the appropriateness of window restrictors needed reviewing.

The registered manager told us staffing levels were regularly reviewed to support the individual needs of people living at the home. Additional staff were rostered to support activities or individual appointments, such as hospital visits. Proper recruitment procedures and checks were in place to ensure staff employed at the home had the correct skills and experience. People living at the home were able to input into the recruitment of new staff. We found some minor issues with medicines records, but saw they were administered safely.

Staff told us they were able to access a range of training and were supported to undertake additional training, if they requested it. Staff employed recently confirmed they had undertaken an induction process and shadowed experienced staff before fully taking on care duties. Staff told us they had access to regular supervision sessions and had an annual appraisal. The registered manager showed us new documentation designed to update and improve the staff development process.

People told us they enjoyed the food provided at the home and were able to request items to be included on the monthly menus. We observed fresh fruit was readily available around the home and people had access to adequate supplies of both hot and cold drinks.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005. These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. The registered manager told us that no one at the home was subject to any restriction under the DoLS guidelines. Staff had a good understanding of how to support people to make choices. The registered manager told us there had been no recent best interest decision meetings.

Elements of the home had been adapted to promote people’s independence, with ground floor rooms for people who could not climb stairs. We noted that the decoration of the home was in need of refreshing in some areas. The registered manager confirmed a programme of refurbishment was in progress and some painting of rooms had already taken place and new carpets had been laid in rooms and on landings and stairs.

People told us they were happy with the care provided. We observed staff treated people with consideration and there were good relationships between staff and people living at the home. Staff had a good understanding of people’s individual needs, likes and dislikes. People had access to general practitioners, dentists and a range of other health professionals to help maintain their wellbeing. Specialist advice was sought, where necessary, and acted upon. People said they were treated with dignity and staff respected people’s individual preferences and decisions.

People had individualised care plans that were detailed and addressed their identified needs. Staff told us that people preferred to manage their own time rather than participate in organised activities, although people told us about a recent trip to Seahouses which they had enjoyed. Professionals we spoke with thought individual time and pursuits were more important in helping people develop life skills. People told us they would tell the staff or the registered manager if they had a complaint, but were happy with the care at the home. We noted that complaints were not always recorded in detail and that actions taken were not necessarily documented. The registered manager said she would address this.

The registered manager showed us records confirming regular checks and audits were carried out at the home. Questionnaires completed by people living at the home, and by staff, indicated a high level of satisfaction. Staff were positive about the leadership of the registered manager and felt well supported in their roles. Regular staff meetings took place to discuss the running of the service and the care needs of people. People told us they were also involved in meetings and could make suggestions and requests about activities, menus and the running of the service. People and staff all talked about the family atmosphere at the home.