The inspection took place on 19 July 2018. The inspection was unannounced.

Carnalea Residential Home is a ‘care home’. People in care homes receive accommodation and nursing 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. Carnalea Residential Home provides accommodation and support for up to 55 older people. There were 48 people living at the service at the time of our inspection. People had varying care needs. Some people were living with dementia, some people had diabetes or had suffered a stroke, some people required support with their mobility around the home and others were able to walk around independently.

A registered manager was employed at the service by the provider. 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 on 17 May 2016, the service was rated as ‘Good’. At this inspection, we found that there were now areas that required improvement. This is the first time the service has been rated Requires Improvement.

Restricted visiting hours and areas where people could receive their visitors meant people’s rights and choices within their home were neglected.

Mealtimes were not organised to ensure a good experience for people eating their meal. People were not always satisfied with the food and choices available.

The verbal and informal complaints of people and their relatives had not been listened to. People were not happy with all aspects of the service provided. Complaints were not seen as an opportunity to make improvements to the service provided.

The provider and registered manager missed opportunities to make improvements as their monitoring systems did not identify all the areas that required further development to enhance the lives of people. An open and listening culture had not been created to ensure people’s basic rights were at the forefront of the service provided.

Risk assessments around people’s personal care needs were in place. However, these did not always reflect individual or changing needs. Fire evacuation drills were not carried out regularly as advised by the Kent Fire and Rescue service.

The design and decoration of the premises did not support a dementia friendly environment. We have made a recommendation about this.

People’s care plans did not always address all their individual needs or their personal histories. Care plan reviews were carried out but did not always take into account people’s changing needs.

Staff knew their responsibilities in keeping people safe from abuse. Procedures were in place for staff to follow and staff were able to describe these.

Accidents and incidents were appropriately recorded by staff, action was taken and followed up by the registered manager.

The procedures for the administration of people’s prescribed medicines was still managed and recorded appropriately so people received their medicines as intended. Regular audits of medicines were undertaken to ensure safe procedures continued to be followed and action was taken when errors were made.

The registered manager carried out an initial assessment with people before they moved in to the service. People were involved in the assessment, together with their relatives where appropriate.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. Some improvements were required to ensure people’s basic rights were understood by the registered manager and staff.

People had access to a range of activities to choose from. Some people preferred their own company and pursued interests such as reading o

This inspection took place on 17 and 19 May 2016. The inspection was unannounced.

Carnalea residential home is registered to provide accommodation and personal care services to up to 55 people. There were 43 people living at the home on the day of our inspection.

Many people living at the home required full support with their personal care and others could lead a more independent life with minimal support. The home had been extended to provide more space and larger rooms. The newer, extended part of the home was well planned, bright and airy where all rooms had en-suite facilities. The older, original side had character with well kept original features. Doors led out to beautiful gardens with comfortable garden furniture, well used by people. It was a lovely sunny day on the day of our inspection and people were sitting outside enjoying the sunshine. The gardens included a well maintained functioning vegetable patch for the benefit of people living at the home.

Although a manager was employed, they had not yet registered with the Care Quality Commission. They had however started the application process. 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 and their relatives told us they felt safe living at Carnalea. They knew who to speak to if they had any concerns and were confident they would be listened to. Staff were clear of their responsibilities in keeping people safe from abuse and knew how to report concerns and who to. Individual risk assessments were carried out with people to ensure their safety was maintained when receiving care and support. These were reviewed regularly so any changes in people’s needs were identified and managed appropriately.

People’s care and support needs were assessed before moving into the home so the manager could be sure they were able to cater for the needs of the individual. Following this, care plans were developed with the involvement of people, and their relatives where appropriate. Care plans recorded the step by step guidance for staff in how to provide individual care to each person. These were reviewed regularly to make sure they were up to date in order to provide the right care at all times.

There were suitable numbers of staff to be able to provide the personal care people had been assessed as needing. Care staff were not expected to undertake cleaning or cooking duties as experienced cooks and domestic staff were employed. This meant care staff could concentrate on providing the care people required. Safe recruitment methods had been used when employing new staff to make sure only suitable staff were employed.

A training plan was in place and all staff received the training they required to carry out their role well. Staff told us how they had been encouraged and supported to progress up the career ladder within the home. Staff were supported through one to one supervision sessions and regular staff meetings, giving them the opportunity to raise concerns or to make suggestions for improvement.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. The manager had taken steps to comply with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. People were not being restricted and their rights were being protected.

People and their relatives said the staff had a caring approach and looked after them well. There was a good atmosphere in the home where people and staff appeared happy and relaxed. Digni

The atmosphere in the home was calm and relaxed. All the interactions we saw between staff, management and people who lived in the home were positive. We saw that people felt free to express their opinions and were listened to and provided with all the support they needed.

We observed that staff treated people with dignity and respect. Staff were polite and interacted well with people. Staff understood the needs of the people who lived in the home.

People who lived in the home told us they felt well cared for and comments included, "I am very lucky here. You can always have a laugh and joke with the staff”. “They always knock on my door before they come in”. “I feel I am well cared for”. Relatives spoke positively about the care their loved ones received.

Staff understood the importance about giving people choices and listening to what they had to say.

The service had effective systems in place for minimising risks associated with infection control. All areas of the home were clean, there were no unpleasant odours, and staff received regular training updates to refresh their knowledge.

There were appropriate recruitment procedures in place. Staff had received induction and training appropriate to their role.

People knew who to talk to if they had any concerns about the service and were confident they would be dealt with.

There was an effective system to regularly assess and monitor the quality of service that people received.

We spoke with five people who lived in the home, six relatives and four members of staff. We also spoke with the manager and the registered provider.

People we spoke with all told us that they were happy in the home and that they felt that they were well looked after. Comments included "I am well cared for and glad I moved in here" and "I get lots of care".

Relatives we spoke with told us they were happy with the care provided to their loved ones. They said, "I am happy I found this home, they are very supportive" and, "You have to give credit where credit is due, they really look after everyone here".

People who lived in the home were treated with dignity and respect. People were offered choices in their daily lives, although care plans did not always formally record the decision making process.

People's needs were assessed before moving into the home. We observed that staff read and understood care plans which meant that they knew what care and support to provide to people.

People told us that they felt safe in the home and staff understood their roles in relation to protecting people.

We saw that people were provided with a range and choice of meals.

People were supported by a stable staff group in sufficient numbers, who understood the different needs of the people they cared for.

People we spoke with did not have any complaints about the service and were confident that if they had any concerns they would be dealt with immediately.