The inspection was carried out on the 31 May 2018. The inspection was unannounced.

Staff provided nursing care for up to 32 older people. Kentwood House is a family run ‘care home.' People in care home services receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The accommodation spanned two floors and some rooms had on-suite facilities. A lift was available for people to travel between floors. There were 16 people living in the service when we inspected. People had longer-term health issues associated with ageing or illness requiring nursing care.

We carried out our last comprehensive inspection of this service on 28 March and 07 April 2017 and we gave the service an overall rating of ‘Requires Improvement.’ At that inspection we found two breaches of the legal requirements of the Health and Social Care Act Regulated Activities Regulations 2014 and one breach of the legal requirements of the Health and Social Care Act Registration Regulations 2009. The breaches related to Regulation 12, Safe Care and Treatment and Regulation 18 Notifications of incidents. We also made five recommendations. The recommendations related to the management of Legionella risks, planning for foreseeable emergencies, the presentation of policies, the management of the Mental Capacity Act 2005, specialist staff training and the legal requirements placed on the provider to send notifications to CQC.

The registered provider sent us an improvement action plan telling us how they intended to meet the legal requirements of the Health and Social Care Act Regulated Activities Regulations 2014 and the Health and Social Care Act Registration Regulations 2009. They told us they would meet the regulations by 31 August 2017. At this inspection we found improvements had been made. The regulations had been met and the recommendations had been acted on.

There was a registered manager employed at the service. A registered manager is a person who has registered with 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 registered provider both worked at the service.

Since our last inspection the system for managing incidents and accidents had been improved. These were recorded and checked by the provider to see what steps could be taken to prevent incidents or accidents happening again. The risk was assessed and the steps to be taken to minimise them were understood by staff. The improvements included a protocol for notifying CQC and/or the Local Authority Safeguarding Team when required.

General and individual risks were assessed and management plans implemented by staff to protect people from harm. Infection risks were assessed and control protocols were in place and understood by staff to ensure that infections were contained if they occurred.

The registered manager and care staff used their experience and knowledge of people’s needs to assess how they planned people’s care to maintain their safety, health and wellbeing. The risk from infection from waterborne illness [Legionella] had been minimised.

All staff had now received training about the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

The provider had reviewed key policies including those that covered the planning of foreseeable emergencies.

Staff had received specialised training in relation to the management of challenging behaviours. Staff received training that related to the needs of the people they were c

The inspection was carried out on 28 March 2017 and was unannounced. We returned on 7 April 2017 to complete the inspection.

The home provides accommodation, nursing and personal care for up to 32 older people, some of whom may be living with dementia. The nursing and care was provided in an environment designed to meet people’s longer term needs. Accommodation was provided over two floors with a passenger lift available for moving between floors. There were 20 people living at the home at the time of our inspection.

A registered manager was employed at this 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.

At our last inspection 27 May 2016, we gave the home an overall rating of, ‘requires improvement’ and ratings of requires improvement in the responsive and well led domains. Although we did not find any breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, we found that the registered manager needed to make improvements. Complaints had not been formally recorded and regular audits of the quality of the home were not taking place.

At this inspection, there had been some improvements, but we found other areas that breached the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Health and Social Care Act 2008 (Registration) Regulations 2009. The fire risk assessment did not identify any additional protections needed for people who may not be able to evacuate the premises quickly. For example, personal emergency evacuation plans and horizontal evacuations. We have referred this to the fire service. Incidents and accidents were recorded and checked by the registered manager, but the actions that could be taken to prevent the incidents reoccurring had not been recorded. The registered manager and provider had not reported incidents of potential harm to the local authority or CQC.

Staff had received training about protecting people from abuse and showed a good understanding of what their roles and responsibilities were in preventing abuse. Nursing staff understood their professional responsibility to safeguard people. However, reportable incidents had not been appropriately reported and investigated and the potential risk from legionella had not been fully assessed. We have made a recommendation about this.

There were a range of policies in place governing how the home should be run, but these were not kept updated. We have made a recommendation about this.

The provider and registered manager ensured that they had planned for foreseeable emergencies, so that should emergencies happen, people’s care needs would continue to be met. Equipment in the home had been tested and well maintained. However, the emergency policy was not specific to the home. We have made a recommendation about this.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The registered manager understood when an application should be made. Decisions people made about their care were generic and did not cover individual elements of their care. We have made a recommendation about this.

Staff received support and supervision and a range of training that related to the needs of the people they were caring for. Nurses were supported to develop their professional skills maintaining their registration with the Nursing and Midwifery Council (NMC). However, the registered manager had not ensured that additional training had been provided for c

This inspection took place on 27 May 2016 and was unannounced. At the last inspection of the service we found the provider was meeting the regulations we looked at.

Kentwood House is registered to provide accommodation for up to 32 people who require nursing or personal care. At the time of our inspection there were 23 people using the service. There was 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At this inspection we found that improvement was required because complaints were not formally recorded and investigated within the timeframes set in the provider’s complaints procedure. Regular audits had also not been carried out to monitor the quality of the service and the care provided to ensure it was of high quality.

People using the service said they felt safe and were well cared for. Safeguarding adults procedures were in place and staff understood how to safeguard the people they supported. Risks to people were assessed and monitored, and guidance was available to staff on how to safely manage these risks.

Medicines were safely stored and administered within the service and there were arrangements in place to deal with foreseeable emergencies. There were enough staff on duty to safely meet people’s needs and recruitment checks had been made on staff before they started work for the service.

Staff had undergone an induction when starting work and had received appropriate training to ensure they had the skill required for their roles. Staff were also supported in their roles through regular supervision.

Staff sought consent from people when offering them support and the registered manager and staff demonstrated a clear understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People had enough to eat and drink and enjoyed the meals on offer. They had access to a range of healthcare professionals when needed and were involved in making decisions about their care and support.

Staff treated people with dignity, kindness and consideration. People's privacy was respected.

People were provided with information about the service when they joined in the form of a 'service user guide' which included details of the provider’s complaints policy.

People were involved in their care planning. The care and support they received was personalised and staff respected their wishes and met their needs. Care plans provided clear information for staff on how to support people using the service. They were reflective of people's individual care needs and preferences and were reviewed on a regular basis. People were supported to be independent where possible, for example by attending to some aspects of their own personal care.

Staff were knowledgeable about people’s individual needs. They were committed to offering people a good service that improved the quality of their lives There were a variety of activities on offer that met people’s needs. People’s cultural needs and religious beliefs were recorded to ensure that staff took account of these areas when offering support.

People knew about the service’s complaints procedure and said they believed their complaints would be investigated and action taken if necessary. They spoke positively about the management of the service and staff told us the management team were available to support them when needed. People and their relatives were provided with opportunities to provide feedback about the service. However improvement was required to demonstrate that people’s feedback was used to drive improvements within the service.

We visited Kentwood House to look at the safety, care and welfare of people using the service.

We spoke with five people using the service about their experience of life at the home. Also a visitor. People were positive about staff, comments included, “Staff are good" and " I like the home and am happy with my care".

We observed staff consulting people, gaining their consent before carrying out personal care or treatments. They were professional and friendly in their interactions with people, demonstrating skill and empathy in their approach. Two activities coordinators were employed to provide daily social activities. The activities coordinator on duty at the time of the visit was engaging people in one to one and group activities. Records showed staff were suitably trained and supported, ensuring delivery of safe and appropriate care.

Emergency procedures were in place. These minimised the risk of peoples’ care needs not being met in the event of emergencies, for example a fire or power failure. Risk assessment and risk management activities ensured the safety and security of the environment.

People told us that they had no complaints and were happy with the home and their care. They told us that if they had a concern or complaint they would inform a member of staff or the manager. Systems were in place to respond to comments and complaints.

During the visit registration issues were discussed and will be dealt with separately with the provider.

People we spoke to told us that they were happy living in the home. Comments included “I am happy here” and ‘the staff are lovely”.

People spoke about the activities they liked doing and said that there was a good choice of activities on offer.

People we spoke to said that they were happy living in the home and that they enjoyed activities such as bingo and doing puzzles. Comments included “I am happy” and “I like playing cards”.

People we spoke to told us that they liked the meals provided, comments included “the food is beautiful” and “there is plenty to eat”.

Staff we spoke to told us that they could speak to the manager at any time if they were unhappy about anything at the home.

Staff we spoke to said that they enjoyed working at the home and received the training and support they needed to do their jobs. Comments included “We all work as a team” and “I can go and speak to the manager at any time”.

During the visit we talked with six people living in the home and met others briefly. We also talked with two relatives, five staff, and a visiting health professional.

People living in the home said:

“It’s nice here; the staff are good.”

“I’m settled here and quite comfortable. The staff are all very kind.”

“I like it here. It’s a bit quiet today, but sometimes I go out to the pub down the road with my friends.”

“It’s ok. I would like a bit more to do. The food is good.”