This inspection took place on 12 December 2018. The inspection was unannounced.

At our last comprehensive inspection of the service in September 2017 we found the service had improved sufficiently to be removed from special measures. It had been rated in January 2017 as being overall inadequate. At the inspection in September 2017 we rated the service as still requiring improvement because there was not sufficient evidence to demonstrate the sustainability of the improvements we found and we made two recommendations.

Since the last inspection in September 2017 the service had engaged with commissioners and their quality teams in ensuring the improvements that had been achieved were sustained. At this inspection we found that the service was compliant with all the fundamental standards of safety and quality and these had been consistently maintained. We also recognised there was a commitment for continually developing the quality of the service provision.

Kendal Care 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. It provides nursing and residential care for up to 120 older people, some of whom are living with dementia.

The home is arranged over three floors and has a passenger lift for access to these. There are three units in the home, one designated to residential care, one for nursing and one for dementia care. All bedrooms are single occupancy with ensuite facilities. Each of the three units has its own communal dining and lounge and recreational areas. The home is set back from the main road, with level access to garden and outdoor areas. At the time of the inspection there were 83 people living in the home.

There was a registered manager in post who had been appointed since the last inspection in September 2017. 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.

There were sufficient numbers of suitably trained staff to meet people’s needs. Staff training was ongoing and staff had received a variety of training that enabled them to safely support and care for people. Staff were also supported through regular staff meetings, supervision and appraisals.

We saw that the service worked with a variety of external agencies and health professionals to provide appropriate care and support to meet people’s physical and emotional health needs.

Where safeguarding concerns or incidents had occurred, these had been reported by the registered manager to the appropriate authorities and we could see records of the actions that had been taken by the service to protect people.

When employing fit and proper persons the recruitment process had included all the required checks of suitability.

People’s rights were protected. The registered and deputy managers were knowledgeable about their responsibilities under the Mental Capacity Act 2005. People were only deprived of their liberty if this had been authorised by the appropriate body or where applications had been made to do so.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Hazards to people’s safety had been identified and managed. People were supported to access a wide variety of activities that were made available to them and pastimes of their choice.

People were treated with respect and their dignity and privacy were actively promoted by the staff supporting them.

Auditing and quality monitoring systems were in place that allowed the servi

This unannounced comprehensive inspection took place on 7and 8 September 2017. The last comprehensive inspection of Kendal Care Home was in January 2017 when we rated the service as inadequate and the home was placed in special measures. At that inspection, we found a number of breaches of regulation that affected the safety of people living in the home and the quality of the service provided.

During this inspection, we saw that the provider had taken action to improve the safety and quality of the service. However, we did find some areas still needed to improve and demonstrate they could be sustained.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection, the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Kendal Care Home provides nursing and residential care for up to 120 older people, some of whom are living with dementia. The home is over three floors and has a passenger lift for access to these. There are three units in the home, one designated to residential care, one for nursing and one for dementia care. All bedrooms are single occupancy with ensuite facilities. Each of the three units has its own communal dining and lounge areas. There is a cinema room for all people living in the home to use. The home is set back from the main road, with level access to garden and outdoor areas. There is ample car parking for visitors. At the time of the inspection there were 58 people living in the home.

There was a manager in post who had commenced their application to become registered at the time of the inspection. 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.

People told us they were very happy with the improved care and treatment at Kendal Care Home.

The management of medications had improved and was seen to be much safer. We saw that the service had worked hard to improve in this area since the last inspection. Medicines were being stored, administered and recorded appropriately.

While there were significant improvements we have made a recommendation about the management of some medicines.

There had been a number of new staff appointed since the last inspection and we found that one of the checks of suitability, before commencing employment, had not been completed.

We have made a recommendation that the service ensures that all the checks of suitability for fit and proper persons being employed are completed.

Since the last inspection, the provider has been responsive and proactive in implementing and improving the systems used in the recording of information about people’s needs and the planning of their care. We saw that risks related to peoples care and treatment were being better recorded and managed. Records had been improved to ensure accurate details about the changing needs of people were available to the staff looking after them.

We saw that all staff had completed a revised programme of induction training and had received specific training to ensure they had the right skills to meet people’s needs. We saw that improvements to how the ongoing training of staff was managed had been made. Staff told us how they felt supported through supervision and training to fulfil their roles.

The level of staffing on the day of the inspection was sufficient to ensure that the current number of people living in the home had their needs met. The numbers of staff on shift during the day and night were consistent with the depend

This comprehensive inspection of Kendal Care Home took place between 6 and 24 January 2017 January. The pharmacist visited unannounced on 6 January and we began the inspection unannounced on 20 January 2017. We returned to the home to continue the inspection on the 23 and 24 January 2017 when the registered manager was aware we would be returning. This was a planned comprehensive inspection to follow up on requirement notices made at the previous inspection and to monitor the improvements made at the last inspection. We had also received some concerns from relatives of people living in the home and professionals coming into contact with the service.

Kendal Care Home provides nursing and residential care for up to 120 older people, some of whom are living with dementia. The home is over three floors and has a passenger lift for access to these. There are three units in the home and all the bedrooms are single occupancy with ensuite facilities. Each of the three units has communal dining and lounge areas. There is a cinema room for people to use. The home is set back from the main road, with level access grounds. There is car parking for visitors. At the time of the first day of the inspection there were 81 people living in the home.

The service had a registered manager in post at the time of this inspection. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run.

We had inspected the service on 30 September and 06 October 2015. At that inspection, the registered provider had not met with all of the requirements of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. We found significant concerns in relation to person centred care, the safe management of medicines, safeguarding people, the correct application of the Mental Capacity Act (2005), meeting people’s nutritional and hydration needs, maintaining accurate records and good governance, staffing levels, training and recruitment procedures for fit and proper persons. As a result, the service was rated as ‘inadequate’ and placed in ‘special measures’ by the Care Quality Commission (CQC). The special measures framework is used to help make sure that registered providers found to be providing inadequate care significantly improve.

We last carried out a full comprehensive inspection of this service on 3 May 2016. At that inspection, we found that improvements had been made and the service was meeting the fundamental standards with the exception of two regulations. There was a breach of Regulation 12, safe care and treatment, of the Health and Social Care Act 2008 (Regulated Activities) 2014. This was because the registered provider had not demonstrated that clear monitoring and analysis was being done to make sure that avoidable risks were prevented. There was also a breach of Regulation 17 regarding good governance because the registered provider had not made sure systems were in place to ensure an effective governance structure to monitor the safety and quality of the service provision. As a result of the improvements that had been made, the service was rated overall as ‘requires improvement’ and the service was taken out of the ‘special measures’ it had been placed in following an inspection in September and October 2015.

At this inspection in January 2017, we reviewed actions the provider had taken against the breaches in regulations identified at the previous inspection in May 2016 and how they had maintained the improvements that had been seen at that inspection. We found that the registered provider had not met the requirements from our previous inspection. There was a continued breach of Regulation 12, safe care and treatment and Regulation 17, Good gover

This unannounced comprehensive inspection of Kendal Care Home took place on 3 May 2016.

We last carried out a full comprehensive of this service on 30 September and 06 October 2015. The registered provider did not meet the requirements of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 and was rated as ‘Inadequate’. The service was placed in ‘special measures’ by the Care Quality Commission (CQC). The special measures framework is used to help make sure that registered providers found to be providing inadequate care significantly improve. It requires there is a timely and coordinated response from a provider where CQC has judged the standard of care to be inadequate. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Kendal Care Home on our website at www.cqc.org.uk.

We further carried out four other visits to the service between 20 December 2015 to 01 February 2016 to follow up on two warning notices issued.

During this inspection in May 2016, we found the provider had made improvements and was meeting the fundamental standards inspected with the exception of Regulation 12 (Safe care and Treatment) and Regulation 17 (Good Governance) 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.

As a result of the improvements made, the service has been taken out of special measures. The service will be expected to sustain the improvements and this will be considered in future inspections.

Kendal Care Home provides nursing and residential care for up to 120 older people, some of whom are living with dementia. The home is over three floors and has a passenger lift for access to these. There are three units in the home and all the bedrooms are single occupancy with ensuite facilities. Each of the three units have communal dining and lounge areas. There is a cinema room for people to use. The home is set back from the main road, with level access grounds. There is ample car parking for visitors. At the time of the inspection there were 58 people living there.

The service did not have a registered manager in post at the time of this inspection . A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run. The registered provider had recruited a suitable person for this post and they were working in the home when we inspected. They were in the process of applying to register with CQC as the registered manager.

We found that the registered provider had been making improvements as outlined in their action plans . We found that medicines were now being handled safely and the management of training had improved with a programme of planned training in progress. The service was also using a dependency tool assessment to help ascertain the numbers of staff they needed based upon people’s dependency and individual needs.

At this inspection we saw that improvements had been made in applying the principles of MCA and training was being given to help staff deal with situations where restraint might be needed. At this inspection the monitoring of nutrition and hydration had significantly improved and was being addressed through monitoring by management. At this inspection we found that improvements had been made in reviewing and monitoring all care plans and assessments.

The two new breaches of regulations were in relation to making sure there were appropriate governance structures in place for all aspects of care being provided and to continuously improve the welfare of people. The registered provider had not demonstrated to us they had done everything

This focused inspection took place over the period of time from 20 December 2015 to1 February 2016 and all the visits made during that period were unannounced. We last inspected this service on 30 September and 6 October 2015 where there was a breach of regulation 17 (Good Governance) when we found that there were not effective operating systems in operation to protect people against the risks of inappropriate or unsafe care. There had not been regular assessment and monitoring of the quality of the services provided to people including in medication management where found the service to be in breach of Regulation 12(2) (g) the proper and safe management of medicines; We carried out two visits to the home on 7 January and 11 January 2016 to follow up on the warning notice issued as a result.

We found during this focused inspection that the home had made improvements since the inspection in September 2015 in some aspects of quality monitoring and had introduced and maintained more quality assurance audits, including regular medication audits since the last visit. There were now daily walk rounds by a member of the management team covering the home to monitor staff practices on each floor and check staffing deployment. Care plans had been subject to reviews and had been updated to reflect any changes in people’s needs or preferences. Risk assessments had been carried out for people living there to help identify risks and audits had been carried out to monitor that nutrition and weights were being reviewed. The registered provider had improved the overall systems in place to monitor and report back on quality monitoring issues and assurance monthly. The acting manager had carried out audits, including for medication procedures and medication training for staff and had also completed. However there was still room for improvement in the consistency of monitoring of medication management and adherence to clear procedures.

There continued to be a breach of Regulation 17 (Good Governance). This was in relation to the lack of accessible and known procedures being in place for staff to refer to regarding the scheme of delegation within the home in the event of an emergency situation that could impact upon the service provision to people living at Kendal Care Home. As a result staff did not follow a recognised procedure they knew and understood when they encountered difficulties such as the adverse weather affecting travel and staff. The rotas and logging in systems within the home were not always clear and accurate records of the staffing situation. As a result there was not a clear audit trail of the process to show what staff were on which unit and in what capacity they were working. During the course of this inspection we found that operating systems were not being effective in ensuring the safe running of the home in the event of emergency situations. There were not clear and detailed contingency plans and escalation systems in place for responding to emergencies and untoward events. We issued a warning notice in relation to the continued breach that required the registered provider to make improvements to ensure operating systems were being effective in ensuring the safe running of the home in the event of emergency situations.

We had visited on 20 December 2015 out of normal working hours and again on 1 February 2016 as part of the inspection to monitor the service after CQC had received concerns from other agencies, health care professionals and individuals in relation to the levels of suitably qualified nursing and care staff and the levels of management staff being deployed in the home to make sure meet people's needs were being safely met. We visited to make sure there was effective management oversight in the home at all times and to check that there would be sufficient staff on duty period over the Christmas holidays. Rotas showed that sufficient staff would be on duty and that there would be management on call. Sta

We carried out an unannounced comprehensive inspection of this service on 8, 9 and 12 February 2015 at which breaches of legal requirements were found that had an impact on people living in the home. This was because the registered provider had not always made sure there was the right mixture of staff skills and experience on all shifts or that training and staff support was monitored so people could be sure staff had the right skills and experience to support them.

Following the comprehensive inspection in February 2015 the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. They sent us an action plan setting out what they would do to improve the service and meet the requirements in relation to the breaches and when this would be completed by.

After the inspection in February 2015 we received concerns from other agencies and individuals in relation to the levels of suitably qualified staff being deployed in the home to meet people’s needs and to provide individual support where it was needed. As a result we undertook a focused inspection on 2 June 2015 to look into those concerns. This report only covers our findings in relation to staffing. We have not revised the rating for this key question as it would require a longer term track record of consistent good practice across all aspects of the safe domain. We will review our rating for safe at the next comprehensive inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Kendal Care Home on our website at www.cqc.org.uk

Kendal Care Home provides nursing and residential care for up to 120 older people, some of whom are living with dementia. On the day of the inspection there were 82 people living there.

The home is on three floors and has a passenger lift for access to these. There are three suites in the home for people needing nursing care, residential care and for people living with dementia. All of the bedrooms in the home are for single occupancy with ensuite shower and toilet facilities. All the three suites had communal dining and lounge areas for people to use. There is a cinema room for people to use. The home is set back from the main road, with level access grounds. There is ample car parking for visitors.

The service did not have a registered manager in post at the time of this inspection. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run. The registered manager had resigned their post in March 2015. The registered provider had since recruited a suitable person who was in post and in the process of registering as the manager with CQC.

We found on the day of our visit, 2 June 2015, that there was an adequate level of staff on duty to meet minimum requirements and provide the personal and nursing care and support people needed. However at times the nursing support available to people did not reflect an emphasis on person centred nursing care but more on completing nursing care tasks.

We found that staff and the new manager were working hard to try to maintain a safe service and to recruit and retain suitable staff. We could see that the use of agency staffing was decreasing.

Our inspection team was made up of an adult social care inspector and an inspection manager. We visited Kendal Care Home following concerns that had been raised with the Care Quality Commission (CQC) about the levels of staff on duty affecting care. We arrived at 8am and made a tour of the home and all the three floors where people lived.

We spoke with the manager and deputy manager, nursing and care staff and ancillary staff working in the home and observed staff deployment and interactions with the people living there. Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with the management and staff and looking at records and duty rotas.

We considered our inspection findings to answer the questions we always ask:

• is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Agency staff were still working in the home because there had been a shortage of care and nursing staff at times. However the same agency staff had been working in the home for several months and so had got to know the service. The levels of staff we found during our visit and the rotas we looked at indicated that nursing and care staff levels and skill mix were being maintained. Staff told us they found the staffing improved and raised no concerns with us about this.

There were sufficient domestic and catering staff available to provide the support needed in these areas and maintenance staff to maintain the environment. Additional staff were being recruited on an on going basis for nursing and care roles, activities coordination and maintenance to provide support across the home.

Is the service effective?

The steps the registered provider and manager had taken to review and alter procedures around admission had improved the process for the people coming into the home. Admissions were better planned and organised taking into account staffing levels.

Is the service caring?

We observed that there were sufficient staff available to care and support people.Staff were respectful and gave encouragement and prompting when supporting people, for example with their meals and drinks.

Is the service responsive?

Changes had been made to the way admissions were organised so that staff could follow up any issues and get the medicines and equipment people needed before they came in to help ensure their needs could be met on arrival.

Is the service well-led?

The staffing levels in the home had been affected by shortages and sickness. In response to this the registered provider had put interim contingency plans in place using agency staff to maintain better staffing. Management was more stable in the home and staff said this had been an improvement. The registered manager was actively recruiting staff to provide care and support.

Our inspection team was made up of a pharmacist. During this inspection we checked if compliance actions we made at the last inspection in July 2014 had been completed. We considered our inspection findings to answer the questions we always ask:

• is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We looked at how medicines were being managed in the home. We found that people had been prescribed medicines to be taken when required and we found that medicines prescribed in this way did not have any information available to guide staff as to how to give them. We found there was no information recorded to guide staff which dose to give when a variable dose was prescribed. It was important that this information be recorded to ensure people were given their medicines safely and consistently at all times.

Is the service effective?

We also saw that some medicines were unavailable for administration and a third one ran out on the day of our visit. It was important that arrangements were in place to ensure that all medicines were available for administration when people were living in the home to meet their medication needs

Is the service caring?

We saw that the nurse administered medication to people in a kind and respectful manner.

Is the service responsive?

We found that one person was prescribed Insulin, however there was no information recorded as to how often to monitor their blood sugars which are taken in order to check it is safe to administer the prescribed dose of insulin.

Is the service well-led?

Record keeping was not consistent with regard to medicines. We saw that the provider did regular audits of medication to identify concerns in order to protect people from harm. However, the audits had not noted and addressed the concerns we found during the inspection.

We carried out this visit, unannounced and out of hours, as we had received some concerning information about the home. We had been informed that staffing levels within the home, in particular at weekends, were inadequate to meet people’s needs.

We found sufficient numbers of staff on duty to meet people's needs and keep them safe. We saw that there were arrangements in place to maintain staffing levels, which allowed the manager to respond to unexpected changes through sickness or sudden absence.

Our inspection team was made up of inspector and a pharmacist. During this inspection we checked if compliance actions we made at the last inspection in April 2014 had been completed. We also looked at outcomes in response to concerns raised with us that one or more of the essential standards of quality and safety were not being met.

We considered our inspection findings to answer the questions we always ask:

• is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We looked at the records of applications that had been correctly submitted and these were in order. The service had appropriate policies and procedures in place in relation to this and also regarding the Mental Capacity Act 2005.

We found that the appropriate processes had been followed with records of people’s best interests, mental health and mental capacity assessments by appropriate medical, health and social care professionals. This was to help make sure that people’s human rights were respected and taken into account.

We checked the personnel record files for recently recruited staff and the information held on agency staff. We found that appropriate checks were made as part of the recruitment process. These included a check to ensure each of those who applied for a position was suitable to work with vulnerable people before they started working at the home.

We found that there had been staff shortages and the service had used agency staff to maintain staffing levels as an interim measure. A longer term recruitment and retention strategy had been implemented as well.

We found that appropriate arrangements were not in place in relation to the recording of medicines. We saw that medicines were not always kept or administered safely. We saw medicines that were left unattended and insecure on a number of occasions during the medicines round with risk to people from unauthorised access. We found a large quantity of medicines that were no longer required that had not been disposed of in a timely manner. This increased the risk of medicines being put back into use inappropriately or being mishandled and diverted.

The service did not have a registered manager in post. However a new manager had been recruited and was in the process of registering with the CQC.

Is the service effective?

We found that the provider had procedures in place for obtaining valid consent and what people’s wishes were if their health deteriorated. Attention was being paid to making sure that people were being supported to give consent or make decisions about their care and treatment.

We found that a review was underway in regard to decisions made around resuscitation. The review being carried out was to improve the recording and accuracy of information and make sure that where people lacked capacity to make a decision their rights were upheld.

Is the service caring?

We saw that care and nursing staff gave encouragement when supporting people. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

We observed that staff interacted with people in a positive and supportive way.

Is the service responsive?

Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes.

We saw people were able to follow their own faiths and attend religious services if they wanted to.

Is the service well led?

Quality assurance processes were in place. The provider did regular audits of medicines handling to identify concerns in order to protect people from harm. However, these assessments and audits had not identified the medication shortfalls found at this inspection.

The service did not have a registered manager in post when we visited. However the new manager had been recruited, was in post and applying for registration with CQC. They demonstrated a good understanding of procedures regarding deprivation of liberty.

The inspection team who carried out this inspection consisted of two inspectors a pharmacist and an expert by experience. During the inspection, the team worked together to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary is based upon our observations, discussions with people using the service, their relatives and the staff supporting them and from looking at the records held in the home. We also observed the interactions between people living there and the staff supporting and caring for them. We used the 'Short Observational Framework for Inspection' (SOFI) to help us do this. SOFI is a specific way of observing care to help us understand the experiences of people who could not easily talk with us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

At a previous inspection we found concerns with the home’s arrangements for managing medicines. We found that improvements had been made to make sure that people living in the home were given their medicines safely. We spoke with two people living in the home about their medicines. They both said that they received their medicines at the times they needed them and said staff were supportive and caring.

The provider had contingency plans in place for dealing with foreseeable emergencies. A member of the management team was available on call in case of emergencies. There were enough staff on duty to meet the needs of the people living at the home and we saw that staff treated the people living there with respect and promoted their dignity.

Staff personnel records did not contain all the information required by the Health and Social Care Act 2008. This meant the provider could not demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home. A compliance action has been set for this and the provider must tell us how they plan to improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. Staff had received training to meet the needs of the people living at the home.

People’s health and care needs had been assessed with them and/or their families. Risks to their health and wellbeing had been assessed and plans put in place to manage them. Specialist dietary, mobility and equipment needs had been identified in care plans and action taken to meet them.

We found that the provider had procedures in place for obtaining valid consent and evidence of power of attorney and assessing mental capacity however this important information was not evident in practice within people's care files. This meant that staff did not have prompt access to accurate information on who had legal authority to make decisions on people’s behalf. It also meant capacity was not always assessed according to legislation. We found that the information on file for decisions made around resuscitation were not of a consistently good standard.

People’s different needs were taken into account with the layout of the home and the signage used to promote their understanding and independence.

Relatives we spoke with confirmed there were a range of activities for people to take part in and that the visiting times were flexible.

Is the service caring?

People were supported by suitably trained and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. A visitor told us they had moved their relative from another home and said "It has been a good move, the care has been good and the staff have really helped her to settle in”. They also told us that their relative had more activities to choose from and “more mental stimulation here”.

From our observations and what people told us we found that people’s preferences, interests and personal wishes were discussed with them and recorded. We were told that staff were “polite” and “cheerful” and listened to what they had to say.

Is the service responsive?

People’s needs had been appropriately assessed before they moved into the home. People told us they had key workers and also about the ‘service user of the day’. This programme focused upon a different person each day and ensured that all care files, and risk assessments were reviewed.

Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

Quality assurance processes were in place and people told us they were asked for their feedback on the service they received and that they had also filled in a customer satisfaction survey. The staff said the management team was supportive and held regular meetings to promote good communication. Staff told us they were given regular supervision and the opportunities to train and develop professionally.

The service worked well with other key organisations, including the local authority and safeguarding teams. This approach helped to support care provision and service development.

We spoke with four people about their medicines. One person told us “it was a bit hit and miss at first but it is ok now” when referring to administration of their medicines after first being admitted to the service. Another person told us that staff said “let me know when you have swallowed them [tablets]” and that staff stayed with them until they were taken. None of the people we spoke with had any concerns about the way medicines were handled.

Overall, we found that medicines were not managed in a safe way. Whilst people who we spoke with were mostly happy with the way their medicines were managed, we saw that medicines were not handled properly.

People living at Kendal Care Home we spoke with during our visit told us that “I feel very happy here" and “I feel safe and well looked after”. People we spoke with living there and visiting relatives were positive about the cleanliness and comfort of the home.

From our observations and conversations with people living there we found they were able to follow their own interests and take part in social activities. We saw that people were comfortable with the staff on duty. We were told that staff were "Very kind” and also “patient”. We found that staff knew the people who lived there well and were familiar with their conditions and needs.

People told us they “liked” and “enjoyed” the food provided and that they had a choice. We saw that the menu was varied and that people had their weights monitored.

There were systems in place to recruit and train staff. Some staff still needed some important training and this was being organised to make sure they were fully prepared for their roles. Staff levels and the way staff were used was also being reviewed by the new manager. This was because there were times when there were not enough of the right staff available to meet people's needs promptly. People told us that they often had to wait for help when they rang their call bells, but that staff did "eventually" come. This meant people may not get the right help they needed and in a timely way and that could affect their care and welfare.

Everyone living in the home had a care plan in place that had information about them and what help and support they needed. However some assessments of risk in care plans, for example, the risk of falling had not always been completed and instructions had not always been followed in practice by staff. If care plans did not give and accurate reflection of the care people needed they might be at risk of getting inappropriate care and treatment.

The provider had systems for getting people's views and monitoring the quality of the services provided but these had not been followed fully in practice. We saw that people had not had any meetings to allow them to give their views and affect the running of their home. We also saw that the systems to check or 'audit' the quality of care in the home had not been carried out as they should be. This can affect the safety and quality of care provision. There was a new manager in post and they were working to find the problems and address them.

This unannounced inspection of Kendal Care Home took place over two days on 30 September and 6 October 2015. During our previous inspections on 8, 9 and 12 February 2015 we found the service was not meeting all the regulations.

This was because at our inspection on 8, 9 and 12 February 2015 there was not verifiable evidence that all staff in the home had received induction training and appropriate training for their roles. Care plan assessments did not always reflect a person-centred strategy and changes were not always reflected in care plans. The registered provider had not made sure that all aspects of service provision and record keeping were being regularly monitored for effectiveness.

We also carried out a focussed inspection on 2 June 2015 following concerns raised by other agencies and individuals in relation to the levels of suitably qualified staff being deployed in the home to meet people’s needs. We found on the day of our visit, 2 June 2015, that there was an adequate level of staff on duty to provide basic personal and nursing care. However the nursing support available to people did not reflect an emphasis on person centred nursing care but more on completing nursing care tasks.

Following the inspection on 2 June 2015 the registered provider wrote to us and gave us an action plan saying how and by what date they intended to improve training provision and recording, care planning and person centred care. At the inspection on 30 September 2015 we found that the care plan assessments and reviews of assessments to help ensure that people received care that met their needs were still not satisfactory. We also found that the registered provider had not made sure that all aspects of service provision and record keeping were being regularly monitored for effectiveness. Staff training was being better organised and monitored but some staff still lacked appropriate training and support for their roles. Whilst we could see changes had begun to improve service provision in these areas they had yet to be fully effective.

At this inspection we also found that there were others breaches of regulations that had an impact on people living in the home. These were in medicine management, recruitment of staff, making sure that care planning was person centred and that all needs had been assessed and risks well managed. We found that systems had not always been effective in making sure people’s nutrition and hydration needs were well monitored and not all records required by regulation were up to date. We found that a systematic approach to determining the range of skills needed and gender mix of staff on duty to meet people’s preferences and needs not always being used. Agency staff were being brought in to try to maintain staff numbers. Some agency staff had not been well supported in their roles and responsibilities in the home

Kendal Care Home provides nursing and residential care for up to 120 older people, some of whom are living with dementia. The home is over three floors and has a passenger lift for access to these. There are three suites in the home and all the bedrooms are single occupancy with ensuite facilities. Each of the three units has communal dining and lounge areas. There is a cinema room for people to use. The home is set back from the main road, with level access grounds. There is ample car parking for visitors. During our inspection there were 75 people living there.

The service did not have a registered manager in post at the time of this inspection or at the time of our inspection in February 2015. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run. The registered manager had resigned from their post in March 2015 and their replacement left in August 2015 before registering with CQC. The registered provider is currently trying to recruit a suitable person for this post.

We found that on the residential unit people has some very positive things to say about the way the unit was run, the unit manager and their care and support. The two other units where there was nursing care provided for people, some of whom were living with dementia, were perceived less positively by relatives. They told us about the lack of leadership and management on the units and the frequent use of agency staff who did not know people well.

We found that the registered provider had started to make improvements in providing a consistent training programme for staff and providing mandatory training. However we found that training for specific roles and responsibilities was not consistent for all care and nursing staff to support them to safely effectively fulfil the requirements of their roles. This was evident because staff had not worked within the requirements of the Mental Capacity Act 2005.

We found that the management of medicines in the home did not always follow policies and procedures and current best practice and medicines were not always given as prescribed by the doctor. Most of the people we looked at had photographs and their allergies recorded on their medicines records which reduces the risk of medicines being given to the wrong person or to someone with an allergy and is in line with current guidance.

The systems used to assess the quality of the service had not identified all the issues that we found during the inspection. Whilst we found that some aspects of the quality monitoring processes were being done well others were less well monitored. The standard of some clinical record keeping was not adequate. The registered provider had not ensured that an effective system was in place to make sure the nutritional and hydration needs of people were accurately recorded and monitored. We also found that care and risk assessments had not always been reviewed and updated.

We found that people living at Kendal Care Home were able to see their friends and families as they wanted and go out when they wanted with them. There were no restrictions on when people could visit them. We could see that people who were able to made day to day choices about their lives in the home and were able to follow their own faiths. People living there and visiting relatives told us that staff were polite and caring and “Work extremely hard”.

We have made a recommendation about making sure confidential health checks were carried out with people before they started work. Confidential health questionnaires help the registered provider to support physical or mental health conditions which are relevant to a person’s capability for the role.

You can see what action we told the provider to take at the back of the full version of the report.

This unannounced inspection of Kendal Care Home took place over two days on 30 September and 6 October 2015. During our previous inspections on 8, 9 and 12 February 2015 we found the service was not meeting all the regulations.

This was because at our inspection on 8, 9 and 12 February 2015 there was not verifiable evidence that all staff in the home had received induction training and appropriate training for their roles. Care plan assessments did not always reflect a person-centred strategy and changes were not always reflected in care plans. The registered provider had not made sure that all aspects of service provision and record keeping were being regularly monitored for effectiveness.

We also carried out a focussed inspection on 2 June 2015 following concerns raised by other agencies and individuals in relation to the levels of suitably qualified staff being deployed in the home to meet people’s needs. We found on the day of our visit, 2 June 2015, that there was an adequate level of staff on duty to provide basic personal and nursing care. However the nursing support available to people did not reflect an emphasis on person centred nursing care but more on completing nursing care tasks.

Following the inspection on 2 June 2015 the registered provider wrote to us and gave us an action plan saying how and by what date they intended to improve training provision and recording, care planning and person centred care. At the inspection on 30 September 2015 we found that the care plan assessments and reviews of assessments to help ensure that people received care that met their needs were still not satisfactory. We also found that the registered provider had not made sure that all aspects of service provision and record keeping were being regularly monitored for effectiveness. Staff training was being better organised and monitored but some staff still lacked appropriate training and support for their roles. Whilst we could see changes had begun to improve service provision in these areas they had yet to be fully effective.

At this inspection we also found that there were others breaches of regulations that had an impact on people living in the home. These were in medicine management, recruitment of staff, making sure that care planning was person centred and that all needs had been assessed and risks well managed. We found that systems had not always been effective in making sure people’s nutrition and hydration needs were well monitored and not all records required by regulation were up to date. We found that a systematic approach to determining the range of skills needed and gender mix of staff on duty to meet people’s preferences and needs not always being used. Agency staff were being brought in to try to maintain staff numbers. Some agency staff had not been well supported in their roles and responsibilities in the home

Kendal Care Home provides nursing and residential care for up to 120 older people, some of whom are living with dementia. The home is over three floors and has a passenger lift for access to these. There are three suites in the home and all the bedrooms are single occupancy with ensuite facilities. Each of the three units has communal dining and lounge areas. There is a cinema room for people to use. The home is set back from the main road, with level access grounds. There is ample car parking for visitors. During our inspection there were 75 people living there.

The service did not have a registered manager in post at the time of this inspection or at the time of our inspection in February 2015. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run. The registered manager had resigned from their post in March 2015 and their replacement left in August 2015 before registering with CQC. The registered provider is currently trying to recruit a suitable person for this post.

We found that on the residential unit people has some very positive things to say about the way the unit was run, the unit manager and their care and support. The two other units where there was nursing care provided for people, some of whom were living with dementia, were perceived less positively by relatives. They told us about the lack of leadership and management on the units and the frequent use of agency staff who did not know people well.

We found that the registered provider had started to make improvements in providing a consistent training programme for staff and providing mandatory training. However we found that training for specific roles and responsibilities was not consistent for all care and nursing staff to support them to safely effectively fulfil the requirements of their roles. This was evident because staff had not worked within the requirements of the Mental Capacity Act 2005.

We found that the management of medicines in the home did not always follow policies and procedures and current best practice and medicines were not always given as prescribed by the doctor. Most of the people we looked at had photographs and their allergies recorded on their medicines records which reduces the risk of medicines being given to the wrong person or to someone with an allergy and is in line with current guidance.

The systems used to assess the quality of the service had not identified all the issues that we found during the inspection. Whilst we found that some aspects of the quality monitoring processes were being done well others were less well monitored. The standard of some clinical record keeping was not adequate. The registered provider had not ensured that an effective system was in place to make sure the nutritional and hydration needs of people were accurately recorded and monitored. We also found that care and risk assessments had not always been reviewed and updated.

We found that people living at Kendal Care Home were able to see their friends and families as they wanted and go out when they wanted with them. There were no restrictions on when people could visit them. We could see that people who were able to made day to day choices about their lives in the home and were able to follow their own faiths. People living there and visiting relatives told us that staff were polite and caring and “Work extremely hard”.

We have made a recommendation about making sure confidential health checks were carried out with people before they started work. Confidential health questionnaires help the registered provider to support physical or mental health conditions which are relevant to a person’s capability for the role.

You can see what action we told the provider to take at the back of the full version of the report.