We inspected this service on 14 November 2018. St Luke’s Nursing Home is a ‘care home’ situated in the village of Scothern, five miles north of Lincoln. It provides accommodation for up to 32 older people or people living with dementia. 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.

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.

A registered manager was in place. 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 continued to feel safe and staff ensured that risks to their health and safety were reduced. We found that sufficient staff were deployed to safely meet people’s needs and that staff had received training to ensure they had the knowledge to protect people whilst providing care.

People were protected from the risks of infection as the service employed dedicated cleaning staff to ensure the environment was clean and had appropriate policies and procedures to monitor and reduce the risk

Systems were in place to support people to take their medicines safely. Staff received relevant training and felt well supported. People were asked for their consent and appropriate steps were taken to support people who lacked capacity to make decisions.

People were supported to eat and drink enough to maintain good health.

There were positive and caring relationships between people using the service and the staff who cared for them. Staff promoted people's right to make their own decisions where possible and respected the choices they made. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were treated with dignity and respect by staff who understood the importance of this.

People received person-centred and responsive care from staff who had a clear understanding of their current support needs. Care plans were in place, which provided information about the care people required.

People knew how to make a complaint and there was a clear complaints procedure in place.

When people were at the end of their life the service had effective measures in place to support them and ensure their wishes and needs were met.

An open and transparent culture enabled people and staff to speak up if they wished to. The management team provided strong leadership and a clear direction to staff.

There were robust quality monitoring procedures in place. The management structure of the service was clear.

Further information is in the detailed findings below

The inspection took place on 6 January 2016 and was unannounced.

St Luke’s Nursing Home is registered to provide accommodation for nursing and personal care for up to 32 older people or people living with dementia. There were 29 people living at the service on the day of our inspection. There was also a day centre in the same premises.

There was a registered manager in post at the time of our inspection. 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 the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act, 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is to protect them. The management and staff understood their responsibility and made appropriate referrals for assessment. No one at the time of our inspection had their freedom restricted under a DoLS authorisation. However, the registered provider had made applications to the local authority and was waiting on assessments.

People felt safe and were cared for by kind, caring and compassionate staff. People were kept safe because staff undertook appropriate risk assessments for all aspects of their care and care plans were developed to support people’s individual needs. Staff knew what action to take and who to report to if they were concerned about the safety and welfare of the people in their care. People received their prescribed medicine safely from staff that had the skills to do so.

People were cared for by staff that were supported to undertake training to improve their knowledge and skills to perform their roles and responsibilities. People were given a choice of nutritious and home cooked meals. There were plenty of hot and cold drinks and snacks available between meals. People had their healthcare needs identified and were able to access healthcare professionals such as their GP or dentist. Staff knew how to access specialist professional help when needed.

People and their relatives told us that staff were kind and caring and we saw examples of good care practice. People were always treated with dignity and respect and enabled to make decisions about their care and treatment and maintain their independence. People were at the centre of the caring process and staff acknowledged them as unique individuals.

There were systems in place to support people and their relatives to make comments about the service or raise concerns about the care they received. People and their families told us that the registered manager and staff were approachable.

The registered provider had robust systems in place to monitor the quality of the service and make improvements. Staff had access to professional development, supervision and feedback on their performance. The service received recognition from other agencies for areas of good practice.

The service provided care to 32 older people or people living with dementia. The service was well provided with two lounges, a dining room, conservatory, toilets, shower rooms and bathrooms. People had access to a contained courtyard and garden.

At lunchtime we undertook a Short Observational Framework for Inspection (SOFI) in the dining room. SOFI helps us to understand people’s perceptions of the care and treatment they receive when they are unable to tell us themselves. We have used this to find out about the lunchtime experience of people living with dementia.

We considered the findings of our inspection 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, discussions with people using the service, their relatives, the staff supporting them, a visiting health professional and a health and social care student on placement. We also looked at four care records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

The service had policies and procedures in relation to the Mental Capacity Act (2005) MCA and Deprivation of Liberty Safeguards (DoLS). The MCA states that every adult has the right to make their own decisions about their care and treatment and must be assumed to have capacity to make them unless it is proved otherwise. The Deprivation of Liberty Safeguards are part of the MCA. DoLS supports people in care homes and hospitals to be looked after in a way that does not unlawfully restrict their right to freedom.

The service had policies and procedures in relation to safeguarding vulnerable adults and whistle blowing. We spoke with care staff who understood what was meant by abuse and knew how to report their concerns.

We saw the home had a programme of regular audit and risk assessments to ensure people were cared for in a safe environment.

The service was safe, clean and hygienic. We saw regular checks were made on the cleanliness of the building. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk. A visiting health professional told us they had no safety concerns about the care people received.

Is the service effective?

Our observations found that members of staff knew people's individual health and wellbeing needs. There was a process in place to ensure staff were aware of people's changing needs and what to do if a person became unwell. Staff told us that they shared information at handover between each shift and updated peoples care records at least twice a day.

We found staff attended training courses to meet the individual needs of people in their care such as the care of a person living with dementia.

We spoke with one person’s relatives who told us, “At first XX couldn’t walk, they’re really good, slowly got XX back on their feet.”

Is the service caring?

We observed staff speak with people in a kind and caring way and give them time to answer questions. We saw no one was rushed and staff helped people to do things in their own time. We saw all staff had a very good rapport with people and there was a lot of chat and laughter.

We observed lunchtime and saw people were treated as individuals and staff promoted and encouraged people to be independent.

The people who were able to communicate with us told us they well were cared for.

Is the service responsive?

A visiting health professional told us staff were responsive to people’s needs and made appropriate and timely referrals to them.

A member of bank staff told us, “I think the home is very responsive to people’s needs. One person was dying and we called their family. The staff sat with XX and their family. It was a peaceful death.”

We saw when care workers raised concerns about people's health and social care needs, that the provider had contacted appropriate health and social care professionals. The individual care files identified this and a record of each referral, professional visit and outcome were recorded.

We saw the provider had contingency plans in place in event of an emergency situation.

Is the service well led?

We found there was no registered manager in post. During our visit we spoke with the provider who assured us the acting manager who had been in post since November 2013 would be submitting their application to the Care Quality Commission to be registered as the manager of the service.

We spoke with visiting relatives who told us that they could approach the manager at any time. One relative said, “XX is very busy but we can go to them in the office at any time, can do that with most of them - the nurses.”

Nursing and care staff told us leadership in the service was very good. One staff member said, “XX is very good, very knowledgeable, organised and excellent with residents.”

We spoke to two people who use the service about the support with medicines they received from the staff. One person said “Pretty reasonable. It’s alright practically it is working alright. Everybody makes you welcome”. Another person said “It is very good, everybody is so lovely”, they mentioned especially one member of permanent nursing staff. “They are like my family". The day care manager said “Since your last visit a lot has been done. You can see a better standard on everything”.

We saw care files were reviewed regularly. People were involved in their review and had signed their care plan agreement.

We saw a programme of monthly, quarterly and bi-annually audits had been introduced for medication, record keeping, health and safety training and staffing levels. We saw actions plans had been completed and evaluated for each audit undertaken.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

We visited the service to follow up improvements since our last scheduled visit in September 2012.

People told us they had seen their care plans and staff gave them information and explanations about the care they received. Comments included, "The staff listen to me and do what I ask” and “I’m very happy with my care, the care staff know what help I need.”

People spoken with told us they were well looked after, they saw their GP and nurse when required and their health needs were met. Comments included, "I am looked after well.”

People told us they received their medicines on time but we found problems with the handling and auditing of medicines.

People spoken with told us they liked their home. They said it was comfortable and homely. Some people told us how they had been consulted about redecoration and they were pleased with the results.

Records and discussions showed staff had received more training, which enabled them to be skilled and confident when supporting people.

We found aspects of the home's management systems such as checks; audit and review programmes were not effective in protecting people’s safety. We identified concerns in relation to areas such as care records and the environment.

We visited the home to follow up improvements since our last visit in September 2012. As this inspection was specifically to look at improvements with Outcomes 16 and 21, quality monitoring and records, we will be completing a further unannounced inspection at the home to check the compliance with the remaining outcomes identified in the scheduled inspection report from the inspection visit in September 2012.

Since the last inspection the provider had employed a consultant to work with the manager to ensure the necessary improvements were made to meet these outcomes. The provider was also visiting the service on a regular basis to monitor the improvements needed.

People spoken with told us they were consulted about their care. They said they were happy with their home and environment. Comments included, "We are asked what we think of things" and “Feel listened to, the manager is very open.”

We found improvements had been made to the quality and accuracy of the care records. New care records had been put in place for all people who lived in the home. We spoke with people about their care records. One person told us their key worker had involved them with writing the new care plans.

We visited the service to look at the management of medicines. During the visit we checked records and storage, observed the administration of medicines and spoke with two people and relatives.

We found concerns with arrangements for the recording, handling, using, safe keeping and safe administration of medicines.

We spoke with two people who use the service about the support with medicines they received from the staff. One person said, “We have a good arrangement now. My pain built up into a crescendo yesterday. It was getting late yesterday morning I preferred my pain killer earlier. They brought pain relief at 7 a.m. and by the time I got up, it started to help me”.

Another person said, “I feel not so good. I want to go home, it’s my back". We saw this person had refused to take medicines. They said, "I didn't want it then because I had a job to take them, I get so thirsty."

People felt that their rights to privacy, dignity, independence and to make choices about their daily living arrangements were respected. All said that activities were organised which they could choose to join. Comments included, "I like the food, they come round and tell me what’s on the menu, always a good choice,” "I enjoy the activities we do, not many people join in really but that’s their choice” and "If I'm asleep, they don't wake me up."

When we asked people about the standards of care we received mixed comments from people using the service and from relatives. Positive comments from people using the service included, "I’m happy with the care, the staff know me well and know how I like to be helped, it works very well” and “ I’m very satisfied with all the care.”

We received some negative comments from people who used the service such as, "Care can be a bit hit and miss, mainly due to the staffing levels, the carers try their best but things get missed" and "We don't always get a bath when we want one."

People living at the home were complimentary about the staff team, telling us they felt confident in their care workers and they were generally supported in the way they wanted to be. People using the service told us, “Staff are very kind and helpful”, “Very grateful to them for everything” and “Lovely group of staff, very caring, couldn’t wish for better.”

However, people who used the service generally felt staffing levels were not good enough. Comments included, "It gets very hectic round here, like today, they haven’t stopped, don’t have time to sit and talk, the staff are very busy”, “Staff are very kind and helpful, but you regularly have to wait for assistance” and “They do seem a bit short handed, when you need help in the evenings to go to bed it’s a case of join the queue.”

The people we spoke with said they were happy with the care and support they received and felt the home was a safe place to live. They told us staff were always respectful and helpful. Generally people felt there were enough staff on duty to meet peoples needs. A relative told us some staff were more caring than others, but overall they were happy with how care was provided.

People said they would like more to do as there was no programme of activities they could take part in. One person commented, “It’s a long day” and a relative said “nothing really takes place”.

People confirmed they had been asked about their care needs and preferences, but could not recall seeing their care plan, or discussing what it contained with staff.

We asked if there were any other areas people felt could be improved and most people said there was nothing they could think of. However a relative said they felt the dining room should be made more homely looking and another told us that laundry arrangements could be better.

People we spoke with said they felt comfortable raising any concerns they might have with the manager. No one raised any areas of concern with us during our visit.

People who live at the home told us that they were happy with their rooms and had no complaints about the general facilities the home provided. The relatives we spoke with told us the home was always fresh and clean. One said, “It (the fresh clean smell of the home) was the first impression I got and that has been maintained for over a year”. Visitors said they felt the environment was “okay”, but one area they agreed could be improved was the general “plainness” of places like the corridors and dining room.