This inspection took place on 19 September 2018 and was unannounced.

We inspected the service to follow up on the breaches and to carry out a comprehensive inspection.

At the last inspection in September 2017 the service was not meeting all of the legal requirements with regard to regulations 9, person-centred care and regulation 12, safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found some improvements had been made but there were continued breaches of regulations 12, safe care and treatment and regulation 9, person-centred care as further improvements were required with regard to aspects of people’s care. At this inspection we found two other breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to regulation 18, staffing levels and regulation17, good governance.

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

Kenton Manor is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Kenton Manor accommodates a maximum of 65 older people, including people who live with dementia or a dementia related condition, in one adapted building. At the time of inspection 64 people were using the service.

A registered manager was 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 a quality assurance programme to check the quality of care provided. However, the systems used to assess the quality of the service had not identified some of the issues that we found during the inspection and those that had been identified were not actioned in a timely way.

People said they felt safe and they could speak to staff as they were approachable. However, we had concerns that staffing levels were not sufficient or that staff were appropriately deployed to ensure people received person-centred care. People said staff were kind and caring. However, we saw staff did not always interact and talk with people. Limited activities and entertainment were available to keep people engaged on the middle and top floor of the home. In some parts of the home there was an emphasis from staff on task-centred care.

Improvements were required to the management of medicines. People were not always supported to have maximum choice and control of their lives with staff supporting them in the least restrictive way possible, the policies and systems in the service did not always support this practice. We have made a recommendation about the management of medicines.

Record keeping was inconsistent. Detailed guidance was not available for staff to minimise or appropriately manage risks to all people. Written information was not available to ensure all people were supported safely and in a person-centred way. There were some opportunities for staff to receive training to meet people's care needs. A system was in place for staff to receive supervision and appraisal. However, we have made a recommendation about staff training

Changes had been made to the environment. Some areas had been refurbished. However, not all areas of the home were clean and well-maintained for the comfort of people who used the service. Further improvements were required to ensure the environment was designed to promote the orientation and independence of people who lived with dementia. We have made a recommendation that the environment should be designed according to best practice guidelines for people w

This inspection took place on 18 September and 2 October 2017. We last inspected the service on 6 October 2016 and found the provider had breached the regulations in relation to infection control and meeting people’s nutritional needs. We did not receive an action plan from the provider following the last inspection. We found during this inspection there were no concerns identified with infection control or nutrition.

The home provides accommodation, nursing and personal care for up to 65 people, including people living with dementia. There were 63 people living at the home when we inspected.

The home had a registered manager. 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.

During this inspection we found the provider had breached the regulations relating to safe management of medicines and person-centred care. People did not have care plans to guide staff as to when to administer when required medicines or covert medicines. Other records were available to confirm regular medicines were administered and stored appropriately. We found people’s care was often rushed and there was a lack of stimulation and engagement for people in communal areas.

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

People and relatives said the home was safe.

Staff had a good understanding of safeguarding and the provider’s whistle blowing procedure. They knew how to report concerns. Safeguarding concerns had been referred to the local authority safeguarding team and fully investigated by the provider.

People, relatives and staff said there were enough staff deployed to meet people’s needs in a timely way.

Regular health and safety related checks were carried out, such as checks of fire safety, gas and electrical safety and specialist equipment. The provider had a business continuity plan to deal with unforeseen emergencies. People had personal emergency evacuation plans (PEEPs) which described their support needs in an emergency.

Accidents and incidents at the home had been recorded and investigated. These were monitored to look for trends and patterns.

There were effective recruitment procedures and protocols to ensure staff were recruited safely. This included taking up references and completing Disclosure and Barring Service (DBS) checks.

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.

Although people were supported with eating and drinking as needed, we noted some people were brought to the dining room a long time before their meal arrived.

Staff told us they were well supported and had access to training to enable them to carry out their role effectively.

Staff supported people to access healthcare services when required.

People’s needs had been assessed which included identifying their care preferences. Although medicines care plans were not available for most people, other care plans we viewed were personalised. These had been reviewed regularly to help ensure they reflected people’s current needs.

There were some opportunities for people to participate in group activities if they wished. This included a coffee morning and arts and crafts sessions.

People and relatives knew how to raise concerns. Previous complaints had been investigated and action taken to resolve the complaint.

Staff had opportunities to give their views and suggestions about the home. For example by attending staff meetings or speaking with the registered manager.

There were regular quality assurance checks. Where improvements had been i

We carried out an unannounced comprehensive inspection of this service on 4 and 11 May 2016. One breach of legal requirements was found at that time. This related to a breach of regulation regarding safe care and treatment, specifically in relation to the safe management of medicines. We also made a recommendation about staffing levels.

We undertook this focused inspection on 6 October 2016 to confirm that they now met legal requirements. We also examined staffing levels as a recommendation had been made previously, and personal care, as this was raised as an area of concern by a relative and dealt with by the local safeguarding adult’s team. This report only covers our findings in relation to the legal requirement, the recommendation and areas raised as being of potential concern. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Kenton Manor on our website at www.cqc.org.uk.

Kenton Manor provides accommodation, nursing and personal care for up to 65 people, including people living with dementia. There were 64 people accommodated there on the day of our inspection.

The service had 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 2008 and associated Regulations about how the service is run.

We found the provider had complied with the legal requirement in relation to the safe management of medicines. We found the provider was in breach with the regulation relating to the safe use of the premises.

The registered manager and staff had taken steps to ensure that medicines required on a weekly basis and before food were administered as prescribed.

People and staff said staffing levels were sufficient to ensure people’s needs were met safely. Staff were busy but not rushed. We found some people could not use their call bells, so required staff to monitor their wellbeing. Guidance to staff to ensure those individuals were kept safe was not clear.

The home was mostly clean and hazardous areas controlled. However kitchenette areas required refurbishment or replacement to ensure they could be kept clean and corrosive dish washer liquid stored securely. A large number of cartons containing dietary supplements were out of date.

Risks in relation to poor nutrition and hydration were assessed and monitored. We highlighted the need for nursing staff to more consistently guide care workers on target fluid intakes and on what to do should these not be achieved.

Staff helped people with their hygiene and personal care. People were well groomed and appropriately dressed in clean clothing. Some records relating to the support staff provided were inconsistently completed.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to the safe care and treatment and ensuring good hydration. You can see what action we told the provider to take at the back of the full version of this report.

We carried out an inspection of Kenton Manor on 4 and 11 May 2016. The first day of the inspection was unannounced. We last inspected Kenton Manor in July 2014 and found the service was meeting the relevant regulations in force at that time.

Kenton Manor provides accommodation, nursing and personal care for up to 65 people, including people living with dementia. There were 65 people accommodated there on the day of our inspection.

The service had a registered manager in post. 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 felt safe and were well cared for. Staff took steps to safeguard vulnerable adults and promoted their human rights. Incidents were dealt with appropriately, which helped to keep people safe.

The building was generally safe and well maintained. Chemical feeds for the kitchenette dish washers were accessible and had to be secured to limit unintended access. This was resolved at the time of the inspection. Many easy chairs were low and difficult for some people to get out of. We were told new chairs were on order. Other risks associated with the building and working practices were assessed and steps taken to reduce the likelihood of harm occurring. The home was clean.

We made recommendations regarding the way staffing levels were assessed and determined and the suitability of the furnishings available for people.

We observed staff acted in a courteous, professional and safe manner when supporting people. We received mixed comments about whether the levels of staff on duty were sufficient to safely meet people’s needs. The provider had a robust system to ensure new staff were subject to thorough recruitment checks.

Improvements were required to the way certain medicines were managed. Systems to ensure medicines requiring administration on a weekly basis needed strengthening. Other medicines were safely managed.

As Kenton Manor is registered as a care home, CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found appropriate policies and procedures were in place and the registered manager was familiar with the processes involved in the application for a DoLS. Arrangements were in place to assess people’s mental capacity and to identify if decisions needed to be taken on behalf of a person in their best interests. Where necessary, DoLS had been applied for. Staff obtained people’s consent before providing care.

Staff had completed safety and care related training relevant to their role and the needs of people using the service. Further training was planned to ensure their skills and knowledge were up to date. Staff were well supported by the registered manager.

Staff were aware of people’s nutritional needs and where people were at risk of malnutrition, appropriate support was provided. People’s health needs were identified and external professionals involved if necessary. This ensured people’s general medical needs were met promptly. People were provided with assistance to access healthcare services.

Activities were offered within the home and people also had occasional trips out. We observed staff interacted positively with people. We saw staff treated people with respect and explained clearly to us how people’s privacy, dignity and confidentiality were maintained. Staff understood the needs of people and we saw care plans and associated documentation were clear and person centred.

People using the service and staff spoke well of the registered manager and felt the service had good leadership. We found there were effective systems to assess and monitor the quality of the service, which included feedback from people receiving care and over

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 a summary of what we found -

Is the service safe?

We saw that risks to personal safety were assessed and steps were taken to protect people from avoidable harm.

Staff closely observed and supervised people to ensure their safety. People's mental frailty was taken into account to identify their vulnerabilities and prevent them from being harmed.

Staff who worked at the home were properly checked and vetted to make sure they were suitable to be employed to care for vulnerable people.

Is the service effective?

People living at the home were given care and support that was appropriately planned to meet their needs. They told us, “I’m very happy here, I get all the help I could possibly need”, and, “It’s all good, we get well looked after”.

The service supported people to have adequate nutrition and hydration. People were given choices of suitable food and drinks and told us they liked the meals. One relative told us their family member had gained weight since living at the home and another said their relative had made progress in eating independently. They said, “He couldn’t even use a spoon to feed himself when he came here from hospital. Now he can use a knife and fork again”.

Is the service caring?

People’s care was focused on meeting their individual needs and was provided by staff who we observed were patient and encouraging. Relatives confirmed this and told us, “I’ve never heard the staff be anything other than kind and polite”, and, “Some of the staff transferred here from the previous home my mother was in. They already knew her needs, they’re fabulous with her”.

Is the service responsive?

People’s needs were assessed before they moved into the home. Care was planned according to individuals’ preferences, interests and diverse needs. When people’s needs changed, staff adapted their care to ensure their welfare and safety was protected.

People had access to activities that were important to them and were supported to maintain relationships with their family and friends.

Is the service well-led?

The manager and staff had good understanding of the ethos of the service and their roles and responsibilities. Quality assurance systems were in place to keep checks on standards and get people’s views about the home.

There was a clear complaints procedure and comments and complaints were acted on to make improvements to the service that people received.

People living at the home and relatives told us they were satisfied with the care and treatment provided. We found care needs were properly assessed and planned. Our observations confirmed that people experienced personalised support. Their care was provided by staff who were trained and supported to meet their needs.

Staff understood their roles in protecting vulnerable people. Any concerns that people were not being safeguarded from harm were responded to appropriately.

Systems were in place to check the quality of the service provided, and to make any necessary improvements.

Care and other records in the home were held securely and were accurate and informative.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

People living at the home, and their representatives, were consulted about, and agreed to their care and treatment. We found that care was appropriately planned and centred on the individual’s welfare and safety. There was a skilled staff team and staffing was organised to make sure people’s nursing and personal care needs were met.

People and their relatives spoke positively about the service and expressed no complaints. Their comments included: “In my opinion the care is excellent”; “We’re treated very well here”; and, “The staff keep me up to date. They’re very good and will do whatever you ask”.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

Those able to express an opinion told us that they were very happy living in the home. They told us the care was “very good”, and that the staff and manager were “nice people”.

People told us that felt safe in the home and that would tell the staff if they were unhappy. They said that they were well looked after, and that their privacy and dignity were protected by the staff.

Two visiting relatives told us that they were very happy with the care their family members were receiving in the home, and said that they had no complaints at all about the service.

One told us that the home was “Excellent!”, and told us that they have “every confidence in the manager and staff”. When asked what could be improved, this relative said, “Nothing - the care is unbelievable”.

A second relative told us the food was good and plentiful, that the laundry was reliable, and that there were never any odour problems in the home. This person also said that the people living in the home always looked clean and well groomed. Our observations confirmed this.

A visiting health professional said that they had only recently started coming to the home, but that the care in the home appeared to be good, and that staff followed the advice given to them.