We undertook an unannounced inspection on 27 and 28 July 2016. This was the first inspection of this service under this provider. We undertook a comprehensive inspection of the service on 9 and 19 June 2015 under the previous provider when we rated the service as ‘Requires Improvement’. We imposed a warning notice for safe care and treatment and a requirement notice for good governance. We undertook a focussed inspection on 14 September 2015 to check compliance with the warning notice. We found the provider was meeting the regulation we looked at, but we did not amend our rating as we wanted to see consistent improvements at the service.

Hallmark Care Homes (SW19) Limited, also known as Kew House, provides accommodation and personal and nursing care for up to 81 older people. The service operates over three communities. Each community occupies a floor of the home. Oak community on the ground floor provides personal care and support. Cedar community on the first floor provides support to people living with dementia, and Maple community on the second floor provides nursing care. At the time of our inspection 70 people were using the service.

A registered manager was in post. They had been at the service since December 2015 and were registered when the service was re-registered in July 2016. 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.

On the whole there were sufficient staff on duty to meet people’s needs. Staff were aware of the support people required and provided them with this promptly. Staff were aware of their responsibilities to care for people, including to safeguard them from harm and to work in accordance with the Mental Capacity Act 2005. Staff received the training they required to undertake their role. Staff reported that they felt well supported by their management team, however, we found that staff had not received supervision at the frequency stipulated in the provider’s policy.

People’s care and support needs were assessed, and on the whole detailed care plans were produced informing staff how to meet these needs. We saw that this considered a range of support needs including in relation to people’s physical health, psychological health and social needs. The majority of people had care plans in place outlining their wishes in regards to end of life care. However, we identified that this was not in place for all people and did not always take into account pain management. People were able to access healthcare professionals when needed, and staff liaised with specialists for advice when needed.

Staff were aware of the risks to people’s safety, and management plans were in place to minimise and manage those risks. The risks were reviewed regularly to identify if they had changed and if people needed additional support. We saw that appropriate action had been taken to reduce the risks of people falling and developing pressure ulcers at the service. Staff also monitored people’s food and fluid intake for those at risk of becoming malnourished or dehydrated.

There were positive and caring interactions between staff and people using the service. Many of the people at the service considered the staff as “friends”. We observed staff engaging people in conversations and a number of different activities. There was a comprehensive lifestyle (activities) programme in place and people were able to choose what activities they participated in and how they spent their time. The staff had organised for people to interact with the local community through links with local schools and via the ‘pre med’ project. This involved students prior to starting their medical degrees undertaking work experience at the service.

People’s privacy