This inspection was unannounced and took place over two days; 1 and 5 December 2016. The service was previously inspected in November 2014 where we found improvements were needed in one of the five key areas. This was because people felt they had to wait long periods for their needs to be met. We did not issue a requirement as actions were being put in place to improve staffing and the deployment of care staff at key times. At this inspection, we found there were sufficient staff and people’s needs were being met in a timely way.

Kenwith Castle is registered to provide nursing and personal care for up to 59 older people. It is divided into two floors or units. One provides for people with nursing needs and the other provides care and support for people without nursing needs. At the time of this inspection there were 50 people living at the service.

There was a registered manager running the service who was supported by a deputy and team of nurses; senior care staff and administrators. 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 benefitted from a service which was extremely well run. The registered manager had worked at the service for over 11 years and showed a strong commitment to continuous improvement via training, support and learning from audits and feedback. The management approach was open and inclusive with people, relatives and staff all having a strong degree of confidence in the registered manager and her team. Effective quality monitoring systems were used to help drive up improvement and this included seeking the views of people, their relatives and staff.

There were enough staff with the right skills, training and support to meet the number and needs of people living at the service. Staff said they felt valued and were encouraged to contribute to how the service was run and how care and support was being delivered. Staff understood people’s needs and knew what their preferred routines and wishes were. This helped them to plan care in a person centred way.

People were supported to express their views and were involved in decision making about their care and were offered day to day choices. Staff sought people’s consent for care and treatment and ensured they were supported to make as many decisions as possible. Staff confidently used the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, capacity relatives, friends and relevant professionals were involved in best interest decision making.

Medicines were well managed and kept secure. People received their medicines in a timely way and where errors were noted, staff acted quickly to ensure people were not at risk. People were offered pain relief and received their medicines on time.

People mattered and staff cared for people in a way which showed empathy, kindness and respect. People’s healthcare needs were well met and staff understood how to support people with changing healthcare needs.

People were supported to enjoy a healthy balanced diet. Mealtimes were seen as important events and staff ensured this was an unhurried and enjoyable part of people’s day.

We spoke with seven of the 44 people using the service and two visitors. Their comments included: "This is my room and I can do as I like and the care is excellent"; "You can ask for anything for breakfast and supper and you get it"; "You are always treated with friendly respect" and "It's a very happy place. Lovely food and if you mention something to matron she fixes it".

We found that people were consulted and involved in decisions about their welfare and that the personal and health care they received met their individual needs and preferences. Care needs were assessed, planned and reviewed. The home was very proactive in listening to people and acting on their requests.

People were protected from abuse and the registered manager (matron) was very well known to people, who spoke highly of her. They said that any issue would be dealt with promptly. Two said, "I would take any concern to matron".

There had been staff reorganisation and there were a lot of temporary (agency) staff working at the home. Neither people using the service or regular staff found this to be a problem provided the agency staff knew the home adequately. The home was currently recruiting new permanent staff to meet the shortfalls. Staff received induction and ongoing training and people said that staff were competent.

There were good systems in place to ensure that people could influence their care and service and also to ensure health, welfare and safety at the home.

This unannounced inspection took place on 12 and 17 November 2014.

The service has 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 and associated Regulations about how the service is run. 

Kenwith Castle provides residential and nursing care for a maximum of 59 people. There were 52 people resident the day of our first visit.

We previously inspected this service on 2 May 2014 and found action was needed to meet standards in staffing, supporting workers, assessing and monitoring the quality of service provision and records. This inspection found actions had been taken toward those required improvements although some were still in progress and needed further time to be fully embedded.

Most staff had noted improvement due to increased staffing levels and spoke of the extra time available to meet people’s needs. However, many people who used the service felt there was still a need for additional staff, one saying “worst thing…having to wait. You don’t know how long it’s going to be before the carer comes”.  Staff lacked the time to complete the personal histories of people which meant their individual needs might not be met. Neither were they always able to complete one to one time with people who did not enjoy group activities and where there was the potential for the person to become isolated.

The home was very responsive to people’s requests. For example, people had asked for a care worker to be in attendance in the dining room in addition to the waitress staff as this gave them more confidence and this had been arranged as requested. There was a broad programme of activities and people living and working at the home praised the activities worker.

People said they felt less anxious now they lived at Kenwith Castle and commented how their independence and enjoyment of life had increased. People lived in a safe environment where health and safety was well managed. Risks to people were assessed and managed, such as the use of bed rails and prevention of falls and pressure damage to their skin.

Staff understood how to protect people from abuse and harm. They had access to regularly reviewed policies and procedures to inform their work practices. People’s individuality and diversity was promoted and supported and they were safe from discrimination.

Staff recruitment was robust so that staff found to be unsuitable were not employed. Staffing numbers, skills and staff mix had been reviewed by the organisation and staffing numbers increased. This review was continuing.

People were receiving their medicines as prescribed or were supported to administer their own where this was their choice. The arrangements for medicine management were safe.

People’s health and care needs were met. Health care professionals expressed no concerns about the service people received at Kenwith Castle. One GP said “Most staff are extremely good”. A second GP said “Staff are very knowledgeable”. We found staff had very detailed knowledge of people’s individual care needs and how to meet them.

People were fully involved in decisions about their care and the staff understood legal requirements to make sure people’s rights were protected.

People were very complimentary about the food at Kenwith Castle. Individual food choices and specialist diets were well met by chefs and catering staff who presented attractive and nutritious meals. Any dietary concerns were followed up appropriately to promote people’s health and wellbeing.

People were cared for with kindness, patience and respect. People’s preferences were known and provided for. People’s dignity was promoted. We saw many examples of staff knowing when to provide reassurance when a person was anxious.

People’s views were sought through care planning arrangements, surveys, meetings and the “open door” policy of the registered manager. Staff spoke of improved supervision of their work, training arrangements and the use of staff meetings. Staff felt more supported.

The service was under regular review by both the home’s management and the provider organisation. This included audits of how people’s needs were met and the service provided.