We inspected this service on the 20 and 21 September 2018 and it was unannounced.

Leonora Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Leonora Home accommodates 20 people in one adapted building. At the time of our inspection there were 12 people living at the service.

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.

At our last inspection in May 2017, we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because medicines that were prescribed ‘as required’ (PRN) were not managed safely. We asked the provider to complete an action plan to show what they would do and by when to meet the Regulations. At this inspection, we found the service had made the required improvements.

Medicines were managed safely. We observed staff administering medicines and saw their practice was safe. The medicines administration records were completed in full with no unexplained gaps. Protocols for ‘as required’(PRN) medicines were in place with good detail for staff to know when to administer particular medicines.

Risks had been identified, assessed and there were detailed risk assessments in place to keep people safe. There were environmental risk assessments, which identified generic risks, safety measures were detailed and reviewed regularly.

There were sufficient staff available to meet people’s needs. Staff understood their role in keeping people safe and had received training on safeguarding people from harm. The registered manager had carried out the required pre-employment checks before staff started work.

Staff were trained and had opportunity for regular supervision. New members of staff had an induction period where they could learn about the job role. There was a clear staff structure and everyone was aware of their responsibilities.

People had sufficient food and drinks. Feedback from people about the food was very positive, they appreciated the choice and quality on offer.

The premises were kept clean and well maintained. At our last inspection we observed staff wearing gloves in corridors. At this inspection staff did not apply gloves until they were in people’s rooms or bathrooms. The service was a small home that felt very homely.

People were supported by a staff team that knew their needs well. We observed kind and positive interactions. People are 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 support this practice.

Care plans were comprehensive and regularly reviewed. There was a ‘key-worker’ system in place, which meant people were allocated a member of staff to work more closely with.

People had been given the opportunity to record their end of life wishes. The service had supported people at the end of their lives with assistance from healthcare professionals.

Activities were varied and provided daily. People had the option to be involved but could also choose to spend time doing their own activity. Visitors were welcomed without restriction.

There were regular meetings for people, relatives and staff and minutes were kept. Surveys were completed so that feedback about the service could be sought. Complaints were managed, recorded and investigated in full.

Leonora Home is one of the services provided by Pilgrims’ Friend Society, a Protestant Christian organisation. It provides care and accommodation for up to 20 older people some who are living with a diagnosis of dementia. At the time of our inspection 14 people were living in the home. This inspection was unannounced and took place on 15 and 16 May 2017.

A registered manager was in post when we inspected the service but was not available at this inspection due to planned leave. 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. In the registered manager’s absence a business manager, regional operations manager and senior staff members were available to support our inspection. We spoke with the registered manager on her return so they had the opportunity to add anything further to this inspection.

The provider changed their legal entity in December 2016 from Pilgrim Homes to Pilgrims' Friend Society and this was the home’s first rated inspection under this provider. Previously the home had been inspected in December 2013 and was found to be meeting the requirements we looked at.

We found that medicines were not always managed safely. This was evident around the recording of ‘As required’ medicines where protocols were not always in place to guide staff. One person was not receiving their medicine in line with the directed pharmacy instructions.

We saw that equipment and assistive aids were stored in communal bathrooms around the home which reduced the accessibility of these spaces for people. We observed staff wearing gloves in the corridor before they went in to people’s bedrooms to offer personal care which could potentially result in an infection control concern.

The building and décor of the home needed a lot of renovation and was having an impact on the type of care the service could continue to support. The garden was not a secure environment for people who lacked capacity to spend time without the support or supervision of staff. The provider had recognised areas needing improvement and plans were in place to address this.

Although quality monitoring was in place issues around medicine management and recording had not been identified in order for action to be taken prior to our inspection.

People we spoke with told us they felt safe. Staff had the knowledge to identify and act on any safeguarding concerns to keep people safe. One relative told us "My mother has lived here for a number of years now. I'm convinced that had she still been at home, she would not have been alive by now and I'm convinced that, because of the care she gets, she will still be around for a good many years yet.”

People enjoyed the choices of food and drink available and food provided met their specific dietary needs. Staff provided good support to those who needed help with eating and drinking. Mealtimes were enjoyable occasions and staff were attentive to people’s requests.

People told us they were happy with the care they received and staff were kind and knew them well. People’s care was provided in an unrushed manner by staff that treated them respectfully. Comments from people and their relatives included “They make me feel nice and comfortable when I'm in bed and not feeling very well", “If I need a cuddle, someone will put their arm around me”, “They always take their time with mum and she's never said to me that she feels as if she's been rushed at all. Everything gets done in her own time these days.”

There was mixed reviews on the levels of activities provided by the home. An activity co-ordinator was employed but only worked eight hours a week. The home followed a Christian ethos and some people living in the home practiced a strict regime where