This inspection was unannounced and took place on the 13 and 14 December 2016.

Kenton Road, is a care home which provides residential and nursing care for up to 23 older adults. People receiving the service lived with profound learning and physical disabilities. Some people living at the service also had additional health conditions such as epilepsy and conditions which meant they were unable to move independently. The home comprises of two floors with its own secure rear garden and is situated in Headley Down. At the time of the inspection seventeen people were using the service.

Kenton House has 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 2008 and associated Regulations about how the service is run.

Relatives of those using the service told us their family members were kept safe. Staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people.

People’s safety was promoted because risks that may cause them harm had been identified and guidance provided to manage these appropriately. People were assisted by staff who encouraged them to remain independent. Appropriate risk assessments were in place to keep people safe.

The provider used robust recruitment processes to ensure people were protected from the employment of unsuitable staff. Recruitment checks were in place to ensure people were of suitable character and experience to enable them to complete their role.

People were kept safe as the provider ensured sufficient numbers of staff were deployed in order to meet people’s needs in a timely fashion. In the event of unplanned staff sickness the provider sought to use existing staff including the registered manager to deliver care to ensure familiarity to those receiving the service.

Contingency plans were in place to ensure the safe delivery of people’s care in the event of adverse situations such as large scale staff sickness or accommodation loss due to fire or floods.

People were protected from the unsafe administration of medicines. Nurses were responsible for administering medicines and had received additional training to ensure people’s medicines were administered, stored and disposed of correctly. Nurse skills in medicines management were regularly reviewed by managerial staff to ensure they remained competent to administer people’s medicines safely.

New staff induction training was followed by a period of time working with experienced colleagues to ensure they had the skills and confidence required to support people safely.

People were supported by staff who had up the most relevant up to date training available which was regularly reviewed to ensure staff had the skills to proactively meet people’s individual needs.

Documentation was not always available to show people had been appropriately assessed to ensure they were able to make decisions regarding where they lived and all aspects of the care they received. However best interest meetings were used with family, health and social care professionals involved with people to ensure consent was provided prior to the delivery of all aspects of people’s care. People where possible, were supported by staff to make their own decisions. Staff were able to demonstrate that they complied with the requirements of the Mental Capacity Act 2005 when supporting people during their daily interactions.

This involved making decisions on behalf of people who lacked the capacity to make a specific decision for themselves. The home promoted the use of advocates where people were unable to make key decisions in their life. This is a legal right for people who lack mental capacity and who do not have an appropriate family member of friend to

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

The 17 people using the service on the day of the inspection were unable to communicate their views to us. Therefore we observed staff interactions with people and spoke with four people’s relatives. The registered manager was unavailable on the day of the inspection so we spoke with the deputy manager, the operations manager and three staff. We also reviewed records relating to the management of the home which included, three care plans and daily care records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We found the service to be safe because staff had received training in safeguarding people and had access to relevant guidance.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. One application had been submitted to date. We found that there were proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

There was evidence that staff had undergone appropriate checks on their suitability as part of the recruitment process. The professional registration of nurses had been checked. The service employed nurses, care staff, an activities co-ordinator and an assistant physiotherapist to meet people’s needs.

Is the service effective?

The service was effective because people had been supported to give their consent to decisions about their care where they were able to do so. Guidance had been provided for staff about people’s individual communication methods and how best to facilitate their decision making. People’s relatives confirmed to us that staff supported people to make their own decisions where they were could do so. One person’s relative told us “X can make basic decisions. Staff support X to make decisions.” We observed that staff sought people’s consent through sound, facial expression and eye contact during our inspection.

Where people could not give their consent to an aspect of their care, there was evidence that people’s capacity to make the specific decision had been assessed and best interests decisions had been made with the involvement of others relevant to the decision or person, such as family or health professionals. One person’s relative told us “Yes, I am always consulted about every aspect of X’s care when X cannot consent.”

People had care plans in place to meet their individual care needs and to manage risks to them. This demonstrated that the service effectively promoted people’s health and welfare

The service had provided opportunities for people to live active lives both at the service and in the wider community. There were two minibuses and these were used regularly to enable people to access the local community.

Is the service caring?

We spoke with people’s relatives who told us that the staff were caring. One person’s relative told us “Staff are totally caring.” Staff were observed to be interact warmly with people. They spoke with people constantly about what was going on.

Is the service responsive?

The service was responsive to changes in people’s needs. We saw evidence that people had been referred to a range of health services to meet their needs. These included speech and language therapy (SALT), incontinence services, epilepsy and wheelchair services. The provider had a physiotherapy assistant on site. This enabled them to respond promptly to any changes in people’s needs in relation to physiotherapy.

Although the service had not received any written complaints, people’s relatives told us that they felt able to speak freely with the staff if they wanted to raise any issues. One relative told us “If I want to speak with the manager I just knock on the door.” The service had sent out a quality survey in 2013 and arrangements were in hand to send out the 2014 survey. This ensured that the provider had sought people’s views of the service provided.

Is the service well-led?

The service had a permanent registered manager in place. People’s relatives whom we spoke with told us that they found the manager to be effective and approachable.

There were systems in place to enable the provider to have oversight of the quality of the service provided and to assess the quality of the service provided.