This focused inspection took place on 06 July 2018 and was unannounced.

We carried out an unannounced comprehensive inspection of this service on 14 March 2017. Since that inspection we received concerns in relation to how people were supported when their health deteriorated and in relation to the handling of complaints. As a result, we undertook an unannounced focused inspection of Keele House on 06 July 2018. We inspected the service against two of the five questions we ask about services: Is the service responsive and is the service well-led. At this inspection the service was rated as requires improvement in responsive and well-led, therefore the overall rating for the service is now requires improvement. This report only covers our findings in relation to these two domains. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Keele House on our website at www.cqc.org.uk.

Keele House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Keele House is a large detached house in a quiet residential area of Ramsgate. It provides care and support for up to 31 older people some of whom are living with dementia. At the time of the inspection there were 27 people living at the service.

There was a registered manager working at the service. A registered manager is a person who has registered with 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.

People’s concerns and complaints were not consistently recorded in line with the provider’s policy. Informal complaints had not been consistently recorded. Formal complaints were investigated, responded to and recorded. Complaints were used as an opportunity to improve the service and learn lessons. The provider agreed this was an area for improvement.

Services are required to prominently display their CQC performance rating. The provider had displayed the rating in the entrance to the service but it was not displayed on their website.

People’s needs were assessed and monitored. Each person had a care plan which gave staff guidance about their preferred routines.

People were encouraged and supported to keep their body and mind active with a variety of activities to choose from.

People’s choices and preferences for their end of life care were recorded to make sure staff could follow their wishes. Staff worked with health care professionals to promote joined-up care.

The registered manager had an open-door policy. They completed checks and audits regularly to monitor the safety and quality of the service.

Staff understood their roles and understood the provider’s whistle-blowing process. Staff told us they felt supported and valued. The staff team promoted individualised care.

Accidents and incident were monitored and lessons were learned when things went wrong to reduce the risk of it happening again.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The inspection took place on 14 March 2017 and was unannounced.

Keele House is a large detached house in a quiet residential area. It provides care and support for up to 31 older people some of whom are living with dementia. There were 28 people living at the service when we visited.

The service had a registered manager who had been at service for a number of years. 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. This was the first inspection since a change of provider in February 2016.

People told us they felt safe at the service. Staff recognised different types of abuse and knew who they would report any concerns to, they were confident that the registered manager would address any issues. Risks to people were identified, assessed and plans were put in place which gave staff the guidance needed to manage and minimise the risks. People’s medicines were managed safely and in the way they preferred.

The registered manager had completed audits to identify environmental risks. Fire drills were completed and people had a personal emergency evacuation plan (PEEP) in case of a fire. Additional audits had been completed to monitor the quality of care given to people and checks were carried out on the records completed by staff to make sure they were accurate and up to date.

There were enough staff to meet people’s needs and they were recruited safely. Staff told us they were well supported, they had regular one to one meetings with their line manager and had the training required to meet people’s needs. People, staff and relatives told us that the provider and registered manager were approachable and accessible. The provider and registered manager spent time with people on a regular basis, including people who chose to stay in their rooms. Everyone working at the service shared the same visions and values, which were to keep people safe, independent and provide quality care.

People were involved in developing and updating their care plans, the service had a new online system for care plans and recording the care people received. People’s care plans were person centred and showed what people could do for themselves and how they preferred to be supported. Staff knew people well, interactions between people and staff were affectionate and relaxed. Staff offered people reassurance and encouragement. People were laughing with staff throughout the day. People could have visitors whenever they liked and were supported to maintain relationships with family and friends.

There was a picture board in the dining room letting people know what activities were happening each day, some people said these could be more varied. The registered manager and provider agreed this was an area for development.

People had a choice of food and drinks each day. There was a menu board in the dining room with photographs of the meals on offer. People were encouraged to eat a balanced diet to stay healthy. People’s had a target for the amount of fluids they had each day to prevent dehydration. When people were at risk of choking speech and language professionals had been consulted and their guidance was followed. People had access to healthcare professionals when required and any concerns about people’s health were responded to quickly.

The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these h