Gloucester House is a nursing home that was purpose built in 1990, situated in Sevenoaks, providing en-suite accommodation for up to 54 people some of whom live with dementia.

The service is split in to four units known as villages over two floors connected by a lift and each village accommodates up to 12 to 14 people. The individual villages are named after villages in Kent. There were 45 people in Gloucester House at the time of our inspection.

A registered manager is 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 and associated Regulations about how the service is run.

We carried out an unannounced comprehensive inspection at Gloucester House in March 2016. Breaches of Regulation were found and Gloucester House was rated as requires improvement overall. This was because there were not a sufficient number of suitably trained staff deployed to ensure that people's needs were consistently met to keep them safe. Appropriate assessments of people's mental capacity and best interest meetings were not carried out and documented when necessary. The quality assurance systems needed to be developed to ensure that they identified areas for improvement. We received an action plan from the provider that told us that they were taking action to ensure the health and safety of people who lived at Gloucester House.

This unannounced comprehensive inspection was carried out on the 21 and 24 February 2017 to see if the breaches of regulation had been met. This inspection found that improvements had been made and the breaches of regulation met.

People spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, registered manager and staff had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. The provider was actively seeking new staff, nurses and care staff, to ensure there was a sufficient number with the right skills when people moved into the home. The provider had made training and updates mandatory for all staff, including safeguarding people, moving and handling, management of challenging behaviour, pressure area care, falls prevention and dementia care. Staff said the training was very good and helped them to understand people's needs.

All staff had attended safeguarding training. They demonstrated a clear understanding of abuse; they said they would talk to the management or external bodies immediately if they had any concerns, and they had a clear understanding of making referrals to the local authority and CQC. Pre-employment checks for staff were completed, which meant only suitable staff were working in the home. People said they felt comfortable and at ease with staff and relatives felt people were safe.

Care plans reflected people’s assessed level of care needs and care delivery was based on people's preferences. Risk assessments included falls, skin damage, behaviours that distress, nutritional risks including swallowing problems and risk of choking and moving and handling. For example, cushions were in place for those that were susceptible to skin damage and pressure ulcers. The care plans also highlighted health risks such as diabetes and Parkinson’s. Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people's

Gloucester House is a nursing home that was built in 1990, situated in Sevenoaks, providing en-suite accommodation for up to 57 people some of whom live with dementia. There had been a change of ownership by a new provider in June 2015.

The service is split in four wings (‘villages’) across two floors connected by a lift and each village accommodates up to 12 to 14 people each. There were 49 people in Gloucester House at the time of our inspection, 43 of whom had nursing needs and 27 of whom lived with dementia. Not all of the people living in the service were able to express themselves verbally and communicate with us.

This inspection was carried out on 03, 04 and 07 March 2016 by three inspectors and an expert by experience. It was an unannounced inspection.

There was a new manager in post who was registered with the Care Quality Commission (CQC) since June 2015. A registered manager is a person who has registered with the CQC 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.

Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.

People, relatives and staff told us there were insufficient staff deployed to consistently meet people’s needs. Staffing levels had not been calculated taking into account the dependency and complexity of needs for people living with dementia and who may have nursing requirements or behaviours that challenge.

There were thorough recruitment procedures in place which included the checking of references.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

Staff knew each person well and understood how to meet their support and communication needs. Staff communicated effectively with people and treated them with kindness and respect. People were able to spend private time in quiet areas when they chose to.

The premises needed re-decorating and this was planned to take place following the conversion and renovation works planned over the next 12 months.

Staff had not yet received all essential training although this training was in process and monitored to ensure its completion by all staff within a set time frame. All members of care staff received regular one to one supervision sessions. Nursing staff had not yet received this support; however a newly appointed deputy manager had scheduled this to take place.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options had been considered. Staff sought and obtained people’s consent before they helped them. However people’s mental capacity was not assessed nor documented appropriately when necessary about particular decisions; meetings with appropriate parties were not held or recorded to make decisions in people’s best interest, as per the requirements of the Mental Capacity Act 2005.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. People praised the food they received and they enjoyed their meal times. Staff knew about and provided for people’s dietary preferences and restrictions.

People’s individual assessments and care plans were reviewed monthly or when their needs changed, although not all people’s care files were up