The inspection visit took place on 3 May 2017 and it was unannounced.

Kenilworth Grange Care Home is a nursing home which provides care over three floors to younger and older people including people who are living with dementia and those who have a physical or mental disability.

Kenilworth Grange is registered to provide care for 60 people, of which 14 beds are part of the ‘Discharge to assess’ (D2A) scheme (funded by Clinical Commissioning Groups and South Warwickshire Foundation Trust). The D2A scheme aims to ensure people are moved out of hospital (when medically stable) to receive a period of rehabilitation/re-ablement in a community setting prior to assessment of their long term care needs. Some people on D2A may have complex health care needs and may not be able to return to their own home. At the time of our inspection visit there were 54 people living at the home, 12 of whom were on the D2A scheme.

At the last inspection, the service was rated Good overall, however responsive was rated as Requires Improvement. At this inspection we found the service remained Good.

There was a registered manager 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.

People and relatives were complimentary and satisfied with the quality of care they received. People received care that enabled them to live their lives as they wanted and people were able to provide choices about what they wanted to do for themselves. People were encouraged to make their own decisions about the care they received and care was given in line with their expressed wishes. People were supported to maintain important relationships and to keep in touch with those people.

Care plans contained accurate and detailed relevant information for staff to help them provide the individual care people required. People and relatives were involved in making care decisions and reviewing their care to ensure it continued to meet their needs.

For people assessed as being at risk, care records included information for staff so risks to people’s health and welfare were minimised. Staff had a good knowledge of people’s needs and abilities which meant they provided safe and effective care. Staff received essential training to meet people’s individual needs, and effectively used their skills, knowledge and experience to support people and develop trusting relationships. Staff told us the training they received equipped them to meet and support people’s needs.

People’s care and support was provided by a caring staff team and there were enough trained and experienced staff to be responsive to meet their needs. People told us they felt safe living at Kenilworth Grange and relatives supported this. Staff knew how to keep people safe from the risk of abuse. Staff and the registered manager understood what actions they needed to take if they had any concerns for people's wellbeing or safety.

The registered manager and care staff understood their responsibilities in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, staff’s knowledge and people’s records ensured people received consistent support when they were involved in making complex decisions, such as decisions around their personal safety or where they wanted to live. Staff gained people’s consent before they provided care and supported people to retain as much independence as possible.

People were supported to pursue various hobbies and leisure activities but this was an area the registered manager planned to improve to ensure people had a variety of activities that personally interested them.

People received meals and drinks that met their individ

The inspection took place on 4 November 2014. It was an unannounced inspection.

Kenilworth Grange Care Home provides residential and nursing care to older people with dementia. It is registered to provide care for 60 people. The home has three floors and nursing care is provided on all floors. People who live at the home have limited mobility. At the time of our inspection there were 55 people living at Kenilworth Grange Care Home.

Kenilworth Grange Care Home is required to have a registered manager 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 and associated Regulations about how the service is run. At the time of this inspection, there was a registered manager in post.

People who lived at the home, relatives and staff told us people were safe. There were systems and processes in place to protect people from the risk of harm. These included robust staff recruitment, staff training and systems for protecting people against risks of abuse. Risks to people were minimised because people received their care and support from suitably qualified staff in a safe environment that met their needs.

People told us staff were respectful towards them and we saw staff were caring to people throughout our visit. We saw staff protected people’s privacy and dignity when they provided care.

People told us there were enough suitably trained staff to meet their individual care needs. We saw staff spent time with people and provided assistance to people who needed it.

Staff understood they needed to respect people’s choice and decisions if they had the capacity to do so. Assessments had been made and reviewed about people’s individual capacity to make certain care decisions. Where people did not have capacity, decisions were taken in ‘their best interest’ with the involvement of family and appropriate health care professionals. This meant the provider was adhering to the Mental Capacity Act 2005.

The provider was meeting their requirements set out in the Deprivation of Liberty Safeguards (DoLS). At the time of this inspection, no applications had been authorised under DoLS for people’s freedoms and liberties to be restricted. The registered manager was aware of recent changes and was in the process of reviewing the support people received, in line with the authorisations now required.

People’s health and social care needs had been appropriately assessed. Care plans provided detailed information for staff to help them provide the individual care people required. However, staff’s knowledge about certain people did not always support the details held in people’s care records. Appropriate risks associated with people’s care needs had been assessed and plans were in place to minimise the potential risks to people.

There was a procedure in place for managing people’s medications safely.

Systems were in place to monitor and improve the quality of service people received. The registered manager had plans in place to ensure the effectiveness of regular checks would be maintained. Staff told us they felt supported by colleagues and managers and if they had any concerns, these would be listened to and acted upon.

We met with six people who lived at Kenilworth Grange. Due to the complex needs of people, some were unable to verbally share their experiences of what it was like to live at the home.

We spoke with three relatives and one visiting professional to obtain their views about the home. We also spoke with the manager, deputy manager, two nurses and one member of the care staff.

We observed staff interaction and talked with care staff about how they met the needs of people they supported.

Staff demonstrated a clear understanding of people's needs and engaged with people in a positive manner. People appeared relaxed and happy in the company of the staff and were not hesitant when they approached them.

We saw consent to care had been obtained for people who lived at the home.

The relatives we spoke with told us they were happy with the care at Kenilworth Grange.

We looked at the care planning documentation and we found that care plans were very detailed and demonstrated that staff treated each person as an individual based upon their needs.

We saw that people were provided with a good choice of food and they told us they were happy with the choices available to them.

Staff told us they were supported by the manager and had access to regular training.

We saw that systems were in place to monitor the quality of the service.

We asked people about their care and the care they had received. We asked whether they had been involved in making decisions about their care and had been kept informed. Two people told us they had been happy with the care and support they had received. Other people's responses relating to experiences were: ‘’It's alright living here’’ and ‘’I’m very pleased with the home''.

We found that the home was compliant against the five outcomes we inspected. Although; we have asked the provider to take note of some findings.

The electronic records system did not confirm when people's care had been explained or when people's care had been reviewed. We saw only one review date and a future review date identified.

The home's training statistics showed that only 59% of staff had attended adult safeguarding training since January 2012.

Discussions with staff and one person using the service identified some concerns relating to staffing levels at the home. Staff said there had been occasions when there had been insufficient staff to meet people's needs. Although, these concerns had been raised we found no written evidence stating people's care had been compromised.

We observed the home had limited storage facilities and as such some equipment was seen stored in some bathrooms. This limited access to bathrooms and presented risks to people should they need to use the bathrooms.