This inspection took place on 17 July 2018 and was unannounced.

At our last inspection of 13 and 14 June 2017 we found breaches of regulation in relation to safe care and treatment and good governance.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions ‘Safe’, ‘Effective and ‘Well-led’ to at least ‘Good’. At this inspection we found that the provider had made improvements to ensure they were now compliant with the regulations.

Kelstone Court Nursing Home is a ‘care home’. 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.

Kelstone Court Nursing Home accommodates up to 30 people in one adapted building. At the time of our inspection 26 people were residing at the home.

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 the time of our inspection the manager was in the process of registering with the CQC.

People that lived at the home were kept safe, and staff knew how to report any concerns in relation to people’s safety. Any safeguarding incidents were thoroughly investigated and reported to the appropriate authorities. Staff were vetted to ensure that they were safe to work with people, and staffing levels were assessed to ensure they met the needs of people at the home.

Risks to people were adequately assessed and suitable guidance was in place to ensure that risks to people were mitigated. Health and safety checks were in place to ensure the premises were well maintained, and checks in place to prevent and control the spread of infection. People’s medicines were managed and administered safely and in line with appropriate guidance.

Staff received training, supervision and appraisal to support them with the requirements of their role. People’s consent was sought in line with the relevant guidance and staff knew how to support people to express their wishes.

The environment had improved to ensure that people were supported in a dementia friendly environment. People had access to healthcare professionals in a timely manner and were supported to maintain a balanced diet.

People felt that staff were caring and kind. People’s privacy and dignity was respected, and they were encouraged to express their views.

The home was responsive to people’s needs and suitable activities were available for people to participate in. People were consulted on their wishes and supported to discuss their end of life care needs. Complaints were handled thoroughly and responded to in a timely manner.

People and staff felt that the home was well-led. The manager had implemented positive changes to support the development of the home and improve quality assurance processes.

We undertook an unannounced inspection on 13 and 14 June 2017. This was the first inspection of the service under this provider. The provider registered this service with the Care Quality Commission on 5 May 2017. The service was previously registered under a different provider. You can read our inspection reports for the service under the previous provider by selecting the 'all reports' link for ‘Kelstone Court Nursing Home’ on our website at www.cqc.org.uk.

Kelstone Court Nursing Home provides accommodation, personal and nursing care to up to 30 older people. At the time of our inspection 25 people were using the service, some of whom were living with dementia.

A registered manager was 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 2008 and associated Regulations about how the service is run. The registered manager had previously managed the service under the old provider.

The registered manager had not adequately assessed, identified and managed risks to people’s health and safety. Risk management plans were not always updated in line with changes in people’s needs and did not always provide clear information regarding the support people required to manage those risks.

Clear, detailed and specific care plans were not always maintained. Care records were standardised and had not been tailored to people’s individual needs. Information was not always clear about the level of support people received or how this was to be delivered.

The provider had organised for an external consultant to review the quality of service delivery and had developed an improvement plan in response to the findings of this review. The registered manager had undertaken some audits on areas of service provision, however, at the time of our inspection a robust quality assurance process was not in place.

A suitable environment was not in place throughout the building that met people’s needs. The environment was looking tired with areas requiring redecoration due to worn carpets, damaged and stained paintwork. The provider had a complete refurbishment planned which was starting the day after our inspection. We recommend the provider consults national guidance on how to provide a dementia friendly environment to help people with dementia navigate around the service.

There were sufficient staff to meet people’s needs and the provider followed robust recruitment processes. Staff were knowledgeable about safeguarding adults procedures and escalated any concerns to their management team. Safe medicines management processes were in place and people received their medicines as prescribed.

Staff had the knowledge and skills to undertake their duties, and the provider had plans to further strengthen and develop a training programme for staff. Staff adhered to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) authorisations. People’s nutritional, hydration and healthcare needs were met. Staff supported people to access healthcare services and followed advice provided by healthcare specialists.

People were encouraged and empowered to make choices about their care and how they spent their day. The majority of staff were knowledgeable about the people they were supporting and what was important to them. Staff respected people’s privacy and dignity.

Staff provided people with the support they required and at a pace they were comfortable with. Staff were aware of what support people required and provided them with this. Staff encouraged people to be as independent as possible. A wide range of activities were delivered by staff to ensure people had opportunities to be stimulated and engaged. This included a weekly trip to the pub for lunch which was very popular.

Staff felt well supported by t