Keneydon House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Keneydon House is located in the town of Whittlesey. The service can accommodate and support up to 21 people with their personal care.

This unannounced inspection took place on 12 and 19 November 2018. On the first day,17 people were receiving the service. On the second day of our inspection, 18 people received the service.

The service did not have a registered manager. The last registered manager left the service in August 2018. 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 a senior care worker was managing the day-to-day running of the service.

The provider lacked oversight of the service and there was a lack of robust systems and controls in place to protect people and keep them safe. Governance systems, audits and checks were ineffective and failed to identify shortfalls in the service and bring about improvement.

There were significant risks associated with fire safety, assisting people to move, people choking, people’s food and fluid intake, and the use of equipment that had not been managed adequately and mitigated. People’s prescribed medicines were not always managed safely. The internal environment of the building did not help people to find their way around or engage in everyday life.

There were not enough staff with the right skills to meet people’s assessed needs at all times. The provider did not have robust checks in place to ensure they recruited suitable staff. Staff had not received effective training to enable them to meet the needs of the people using the service. Staff lacked understanding on how and when to report incidents that occurred.

People with short term memory loss were not supported adequately to make choices about the meals they would like to eat. People were not always provided with appropriate equipment to help them eat independently. Staff were not all aware of people’s dietary needs.

Staff lacked understanding in relation to gaining people’s valid consent. Staff did not involve people in decisions about their care. Staff did not always respect people’s personal preferences about the way they wanted to be supported. Staff did not always support people to maintain their dignity and respect their privacy. People had access to healthcare professionals when needed.

People did not receive personalised care that was responsive to their needs. Staff did not always support people in a consistent and planned way. Care plans lacked detail to inform staff on the type and level of care people needed to meet their individual and diverse needs. Staff did not have enough information on how to meet people’s end of life care needs. Staff did not encouraged people to take part in meaningful activities and they were left unsupervised, unoccupied and unstimulated.

The provider did not demonstrate that complaints received were investigated and resolved to the complainants’ satisfaction. Records were not always up to date and accurate.

The provider did not have systems in place to ensure they were up to date with best practice. The provider had not notified the CQC of all incidents that it was legally obliged to let us know about.

Following this inspection, we sent an urgent action letter to the provider telling them about our findings and the seriousness of our concerns. We requested an urgent action plan from them telling us what they were going to do at once to address them. An action plan was returned the next day. We also shared

Keneydon House is registered to provide accommodation and personal care for up to 21 older people, some of whom were living with dementia. It is not registered to provide nursing care.

Our last inspection took place on 16 January 2017 and as a result of our findings we asked the provider to make improvements. These included making improvements to staff members' understanding of the Mental Capacity Act 2005 (MCA), the management of medicines, record keeping and quality assurance. We received an action plan detailing how and when the required improvements would be made by.

This unannounced inspection took place on 23 August 2017. There were 12 people receiving care at that time. We found the provider had made the necessary improvements to the service.

The last registered manager left the service in February 2017. The current manager had been in post since April 2017. They were experienced at managing care services and had applied to register with the CQC. 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 quality of people’s care was monitored and kept under review. Records were accurate and up to date. People and stakeholders were encouraged to provide feedback on the service. People were supported to manage their prescribed medicines safely.

People’s rights to make decisions about their care were respected. Where people did not have the mental capacity to make decisions, they had been supported in the decision making process.

There were systems in place to ensure people’s safety was managed effectively. Staff were only employed after satisfactory pre-employment checks had been obtained. There were sufficient staff to ensure people’s needs were met safely.

People received care from staff who were trained and well supported. Staff were aware of the actions to take to report any concerns. People’s health and nutritional needs were effectively met and monitored.

People received care and support from staff who were kind, caring and respectful. People were treated with dignity and respect. People were involved in every day decisions about their care.

People’s care and support needs were planned for and evaluated to ensure their current needs were met. There were opportunities for people access the community and engage in various activities.

There was a system in place to receive and manage people’s compliments, suggestions or complaints.

Keneydon House provides accommodation and personal care for up to 21 people, some of whom live with dementia. The provider is not registered to provide nursing care. The home is located over two floors. Bedrooms are sited on both floors and accessed via stairs or a stair lift. There are external and internal communal areas on the ground floor for people and their visitors to use.

Our last inspection took place on 11 March 2016. As a result of our findings we asked the provider to make improvements to their staff recruitment procedure and to display our ratings on their website and in the service. We received an action plan detailing how and when the required improvements would be made by and these actions have been completed.

This unannounced inspection took place on 16 January 2017. There were 13 people receiving care at that time.

The service had a registered manager in place. 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 provider had made improvements in the service’s recruitment procedures and staff were only employed after the provider had obtained satisfactory pre-employment checks. There were sufficient staff to meet people’s assessed needs. Staff were well trained, and well supported by senior staff.

There were systems in place to ensure people’s safety was managed effectively. However, these were not always updated to reflect people’s current needs.

People were not always supported to manage their prescribed medicines effectively. Medicines were stored safely. Staff were aware of the procedures for reporting concerns and of how to reduce the risk of harm.

People’s health, care and nutritional needs were effectively met. People were provided with a balanced diet and staff were aware of people’s dietary needs.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found that there were formal systems in place to assess people’s capacity for decision making and applications had been made to the authorising agencies for people who needed these safeguards.

People received care from staff who did not always have a good understanding of the MCA and DoLS. This meant that people’s decisions may not always be respected.

People received care and support from staff who were kind, patient and caring towards the people who lived at the service. People felt they were treated with respect. However, people’s dignity was not always upheld. People and their relatives had opportunities to comment on the service provided and people were involved in every day decisions about their care.

Staff understood and met people’s care needs. However, people’s care plans were not always up to date and reflective of people’s current needs. This meant that up to date information may not always have been available for staff to refer to.

There was a varied programme of entertainment for people to join in with. However, not all people were supported to spend their time in meaningful ways.

People knew who the registered manager and senior staff were, and were happy to speak with them regarding any issues. People had access to information on how to make a complaint and were confident their concerns would be acted on.

Records were not always up to date or accurate and could not be relied on to demonstrate the care that staff provided.

The service did not have an effective quality assurance system. Systems were not in place to ensure sufficient food was delivered to the service regularly and supplies were supplemented by staff.

We found three breaches of the Health and Social Care Act (Regulated Activities) R

Keneydon House is registered to provide accommodation and personal care for up to 21 people. The provider is not registered to provide nursing care. The home is located over two floors. At the time of our inspection there were 19 people living at the home.

This comprehensive inspection took place on 11 March 2016 and was unannounced. A registered manager was in post at the time of the inspection, they had been registered since February 2016. 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 2008 and associated Regulations about how the service is run.

The registered manager and the provider had failed to display their ratings within the home and on their website.

Staff were knowledgeable about reporting any incident of harm. People were looked after by enough staff to support them with their individual needs. However, full pre-employment checks had not been completed on staff to make certain they were suitable to look after people who lived at the home. People were supported to take their medicines as prescribed and medicines were safely managed.

Risk assessment were not personalised and did not give the information on how to reduce the risk and ensure that people were kept safe.

People were supported to eat and drink sufficient amounts of food and drink. They were also supported to access a range of health care services and their individual health needs were met.

People’s rights in making decisions and suggestions in relation to their support and care were valued and acted on. People were looked after by staff who were trained and supported to do their job.

The CQC monitors the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. At the time of our inspection people who lived at the home who did not have capacity to make decisions about their support and care. The provider was aware of the procedure to follow and DoLS applications had been made. People were treated by respectful staff who encouraged and enabled people to maintain their independence.

People’s needs were met and although peoples care records did not provide full detail of the support that is required, especially for those people who behaviour can challenge others. There was a process in place so that people’s concerns and complaints would be listened to and acted on.

The registered manager was supported by a senior management team and care staff. Staff were supported and managed to look after people in a safe way. Staff, people and their relatives were enabled to make suggestions about the running of the home. Quality monitoring procedures were in place and action had been taken where improvements were identified.

We found two breaches of Regulations 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.

We carried out an unannounced comprehensive inspection of this service on 21 January 2015 at which a breach of legal requirements was found. This was because people did not always receive the support with their care and support needs that they required as staffing levels were not appropriate.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook a focused inspection on 07 July 2015 to check that they had followed their plan and to confirm that they now met the legal requirements.

This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Keneydon House on our website at www.cqc.org.uk

Keneydon House provides accommodation and personal care for up to 21 people who require support with their personal care. The home provides support to older people and people living with dementia. There were 15 people living in the home when we inspected.

A registered manager was in post at the time of the inspection. 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 our focused inspection on the 7 July 2015, we found that the provider had followed their plan which they had told us would be completed by the 31 March 2015 and legal requirements had been met.

People told us that they were having their needs met and staff had a little more time to talk to them. Our observations on the day also confirmed that staff were able to meet people’s needs in a timely way The staff on duty knew the people they were supporting and demonstrated their knowledge about supporting people with their personal care and support. Additional staff had been employed to prepare, cook and serve the lunchtime meal.

Keneydon House provides accommodation and personal care for up to 21 older people including those living with dementia. Accommodation is located over two floors. There were 17 people living in the home when we visited.

This inspection was undertaken on 21 January 2015 and was unannounced. Our previous inspection took place on 7 May 2014, and during this inspection we found that all of the regulations we looked at were being met.

The home had a registered manager in post. 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 CQC monitors the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. We saw that there were policies and procedures in relation to the MCA and DoLS to ensure that people who could not make decisions for themselves were protected. We saw that the registered manager had followed guidance and had submitted an application for one person who liberty was being deprived. Staff we spoke with were unclear about the process to follow if people were being deprived of their liberty or where they had not got the capacity to make decisions. This put people at risk of having their liberty being deprived or a decision not being made in their best interests

There was a process in place to ensure that people’s health care needs were assessed. This helped ensure that care was planned and delivered to meet people’s needs safely and effectively. Staff knew people’s needs well and how to meet these. People were provided with sufficient quantities to eat and drink.

People’s privacy and dignity was respected at all times. Staff were seen to knock on people’s bedroom doors and wait for a response before entering. They also ensured that people’s dignity was protected when they were providing personal care. Care records we reviewed showed us that, wherever possible, people were offered a variety of chosen social activities and interests. People told us that the staff were very kind and knocked on their door before entering.

The provider had an effective complaints process in place which was accessible to people, relatives and others who used or visited the service.

The provider had a robust recruitment process in place. Staff were only employed within the home after all essential recruitment safety checks had been satisfactorily completed. Staffing levels were not appropriate to meet people’s needs at all times.

The provider had effective quality assurance systems in place to identify areas for improvement and appropriate action was taken to address any identified concerns. Audits, completed by the provider and registered manager and subsequent actions taken, helped drive improvements in the home.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.You can see what action we have told the provider to take at the back of the full version of the report.

During this inspection we spoke with nine people who used the service, one visitor, three staff and the manager.

We considered our inspection findings to answer 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 the summary of what we found:-

Is the service safe?

We found that there were enough staff on duty to meet the basic needs of the 18 people who were residing at Keneydon House. Assessments of potential risks to people had been identified and actions had been put in place to minimise them .

Staff we spoke with were clear about their responsibilities in relation to safeguarding vulnerable adults and information about how to report their concerns was clearly accessible around the home.

Is the service effective?

People we spoke with were all very happy with their care and support provided by staff. Care records gave staff detailed guidance in how people liked their needs to be met and how to maintain people’s independence.

Is the service caring?

We observed that there was a good rapport between people who live at Keneydon House and the staff. We heard lots of gentle banter and laughter during our inspection. People told us, and we observed, that people were treated with respect, were supported to be as independent as possible and their dignity was preserved.

Is the service responsive?

We saw that people’s care and support needs had been regularly reviewed to ensure that the service was still able to meet people’s needs. Staff we spoke with were knowledgeable about how people liked their care and support needs to be met.

We were told and we observed that people’s needs were attended to and met in a timely way by staff

Is the service well led?

The manager was registered with the Care Quality Commission in December 2013. We saw that a number of systems were in place to assess and monitor the quality of service provided to people. Staff we spoke with felt well supported by the manager and were able to approach her at any time.

We found the provider was compliant with the regulations in all areas that we assessed. If you wish to see evidence supporting our summary please read the full report.

All of the five people with whom we spoke gave us positive feedback about the service. One of them said, “The staff are very hard working and are always more than willing to help us. You’re never made to feel like you’re being a nuisance if you ask for something.” A relative said, “I have complete confidence in the staff because they’re so kind and attentive.”

We saw that staff had consulted with people who used the service (and their representatives) about what assistance was to be provided.

People said that they received all of the health and personal care they needed. Records confirmed that assistance had been provided in a safe, reliable and responsive way.

Most areas of the accommodation were decorated and furnished to make them into comfortable spaces. However, in some parts there were shortfalls that detracted from the overall standard achieved.

We noted that staff had the knowledge and skills they needed to provide care for people in ways that were right for them.

Documents showed that there was a reliable system for receiving and resolving complaints.

People said that staff members were polite, kind and respectful. They confirmed that their privacy and dignity was respected. Care records indicated people were involved with their care records when they first moved to the home. They stated that as they were supported to make decisions regarding their immediate care needs and wishes, they were less concerned about the written care records.

People received the care and support they required to improve their health and well-being. Care records were written in enough detail to provide guidance to staff members. People we spoke with said staff always supported them with their care needs.

There was information available for people if they wanted to contact the local authority regarding safeguarding. Staff members were able to explain their role in reporting any allegations of abuse and the person we spoke with stated they would be able to tell one of the staff members if they were not happy or had any concerns.

People living at the home and staff members said there were enough staff available to ensure people were cared for properly and received the support they wanted.

There were systems in place to regularly check and monitor the way the service was run.

People told us that they were satisfied with their care, including how they were supported with taking their prescribed medication. They said that they felt that their care was provided in a way that they chose and when they asked for it.

We received a mix of positive and less than positive views from those people with whom we spoke.

People told us that they were satisfied with their care, saying it was "alright" and considered that the staff treated them with respect. They said their care needs were "usually" met in a timely manner, including when they received their medication.

People indicated that they enjoyed going out into the garden when they had their guests visiting.

The majority of the people said they liked their food although one person said that they had not enjoyed their lunch.

One person said that they did not know who to speak with if they were unhappy about something and they had not been asked for their views about the running of the service. However, they felt "safe" whilst living at the home.

One of the people who use the service said that the staff treated them well and considered that they ‘were not so bad’.

One of the people who use the service said that the cleaning of their room was ‘much better.’ They were expecting a new carpet, to be installed within their bedroom, ‘very soon’.

One person, who we spoke with, seemed happy with the way their medication was given to them.