About the service: Kenwyn is a residential care home that was providing personal care to 23 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

People said they felt safe and well cared for by a staff team who understood their needs. Staff knew people’s needs, wishes and what was important to them. However, we were not confident they could always provide the right support safely. This was because there were significant gaps in staff training. The provider said this would be addressed as a matter of urgency. We have received confirmation some of this training has been booked.

Care and support were well planned and there were enough staff to meet people’s assessed needs. People were treated with kindness and respect.

People benefitted from the food, drinks and snacks being offered throughout the day. One relative raised the fact that snacks were available but may not be accessible to everyone.

People’s medicines were managed safely however some areas of medicines recording could be improved.

There were a range of activities which people enjoyed. This included regular visits from singers, arts and crafts and local ministers.

People were supported in the least restrictive way possible; the policies, systems and culture in the service supported this practice.

People said they were listened to and could make their concerns known, but these were not always recorded. Staff had raised some concerns which the providers quality assurance manager was in the process of addressing.

We have made a recommendation in respect of ensuring complaint investigations are fully recorded.

The provider own quality monitoring had identified gaps in training but this had not been robustly followed up.

Rating at last inspection: Requires Improvement – report published July 2018.

Why we inspected: This was a planned inspection to look at improvements the service had made following the previous rating. We did bring the inspection forward due to several concerns being raised to us about staffing and quality and quantity of food. We did not find anything to substantiate these concerns. We also brought the inspection forward due to some concerns raised and identified in the providers other services. We did however find improvements were needed in ensuring staff had the right training to keep people safe.

This is the third time the service has been rated requires improvement. We will be meeting with the provider to discuss their action plan to ensure this service improves to at least- Good.

Enforcement): Action we told provider to take. We have issued two requirements notice in relation to regulation 18- having sufficient and suitably qualified staff, and 17- good governance.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned based on the rating. If we receive any concerns, we may bring our inspection forward.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We completed a focussed inspection on 19 April 2018 as a result of some information of concern we had received in relation to possible poor care and there not being enough staff. We found there were breaches of legal requirements in regulation 9- person centred care, 12-safe care and treatment and 18-staffing and 17- good governance. We issued requirement notices for these four breaches. The provider had received their final report but had not yet had time to complete an action plan to show how they intend to be compliant with these breaches.

We have received some further information of concern which we have shared with commissioners and the local safeguarding board as well as the provider. These centred on

• Staff attitude and lack of knowledge of people’s needs

• Basic care needs not being met

• Possible poor moving and handling practices.

• New staff not having a full induction

• Lack of understanding around end of life.

We received information from Devon doctors outs of hour’s service who were asked to visit a person and was then later called to say they were no longer needed. The GP who took the call decided to visit the person at the service and found them to be in pain and needing to be admitted to hospital. The provider had taken disciplinary actions to ensure this incident did not occur again.

We attended a whole service safeguarding meeting on 23 May 2018 and heard that although visiting healthcare professionals had increased confidence in the manager and in people’s basic care needs being met, further improvements were still needed to ensure people’s social and emotional needs were met. .

This inspection was completed on the 1 June 2018 as a responsive comprehensive inspection. This means we looked at all five key areas to help make a judgement about the quality and safety of care and support being delivered.

This is the second inspection where the service has been rated Requires Improvement. At the focussed inspection completed in April 2018 we found all three areas we inspected as requires improvement. At this inspection we have found two areas requires improvement.

Where we had previously identified staffing needed to improve to meet people’s needs, this had been addressed. Following feedback at the inspection on the 19 April, the manager took urgent action to increase staffing by one additional care worker each day. This had had a positive impact for people. This was because staff had more time to ensure people’s needs were being met in a timely way. The medicines management had improved. The manager had ensured each person; including new people and those staying for short breaks had care plans. This enabled staff to plan their care and support safely and in a way the individual preferred. Some further work was being done to ensure that the provider’s quality assurance checks and audits looked at key aspects of how care was being delivered and the records relating to this.

Kenwyn is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Kenwyn is registered to provide personal and nursing care for up to 25 people. They provide care and support for frail older people and those people living with dementia, but do not provide nursing care. On the day of the inspection there were 18 people living at the home.

The manager has been in post since the beginning of January 2018 and is in the process of registering with CQC. 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.

Since the last inspection the provider had purchased more appropriate

This focussed inspection took place on19 April 2018 and was unannounced. We decided to complete this inspection in light of two safeguarding alerts raised by healthcare professionals, a concern raised by a friend of a person using the service and feedback from a mental capacity assessor. They had visited the service to reassess someone who was subject to a Deprivation of Liberty safeguard. Concerns were centred on there not being enough staff to meet people’s needs, answering the door bell in a timely way and lack of activities for people. The community nurse team were also concerned about the skills and experience of the current care staff team. There were also concerns expressed about one person who had gone to hospital. Concerns centred on whether they had been assisted to stay hydrated sufficiently and about the cleanliness of water jugs and glasses in people’s rooms. During this inspection we found some of these issues were substantiated. We found there were not always enough staff with the right skills for the number and needs of people. We did not find evidence to show people were not being supported to stay hydrated. Water jugs were being changed daily as a result of the complaint made.

In January 2018, we completed a comprehensive inspection and rated the service as ‘good’. However, due to there not being sufficient staff available at key times, we judged the ‘safe’ question as requires improvement’. We did not issue a requirement because we were assured by the provider and manager that they were addressing staffing levels.

At this focussed inspection we looked at three key questions safe, responsive and well-led. No risks, concerns or significant improvement were identified in the remaining key questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection

Kenwyn is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service provides care and support without nursing for up to 25 people. Most people are living with dementia and illnesses associated with frailty and old age.

The manager for the service joined the company in January 2018. He is in the process of applying to register with the Care Quality Commission(CQC). 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.

On this inspection, we again found there was insufficient staff at key times to meet people’s needs and keep people safe. There were three care staff which included the team leader for 20 people, some of whom had complex needs. We observed people during the morning sitting for long periods with little or no stimulation. One person remained in a transit wheelchair for all of the morning. This placed them at risk of developing pressure sores as transit wheelchairs are not designed for people to sit in for long periods. When we fed this back to the manager, they agreed this was not best practice and asked a member of staff to ensure the person was transferred to a more comfortable armchair after lunch.

We observed another person becoming increasingly agitated with people around them. They shouted out at people if they came close to them. The sun lounge was exceptionally hot as it was a hot day and the person refused to allow anyone to turn the fan on which was placed next to them. There were no staff available to monitor this situation. We asked the manager to monitor the temperature in this area as people looked

Rating at this inspection

At this inspection completed on 18 January 2018 we found the service remained Good- and the area which was identified as requiring improvement- Responsive was now also rated as good. This was because the provider had taken steps to show how staff ensured the needs of those people who chose to remain in their rooms, were being met. We did however find that there were key times when staffing levels needed to increase due to the number of people, their location and care workers having to complete additional tasks such as cooking the Sunday lunch. We have therefore rated Safe as requires improvement. The provider was actively recruiting for a cook and the lift is now working so people are mainly in the downstairs lounge areas. This meant staff can more easily check their safety and comfort.

Why the service is rated Good.

We brought forward this comprehensive unannounced inspection in light of some information of concern we had received. The main areas of concern were about staffing levels, low staff morale, staff leaving and there being a strong odour at the home. There was also a concern raised about the lift being out of order. During this inspection we found the provider had already taken actions to address staff morale and staff recruitment. There was no odour at the home. At the time of the inspection the lift engineers were in attendance trying to replace a part to fix the lift. This was the lift engineer’s second visit because their previous repair had failed.

The home was required by the Care Quality Commission to have a registered manager. 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 was away on leave at the time of the inspection. The provider said the registered manager had planned to resign from their role. The provider had a new manager who had started working at the service at the beginning of January 2018. It was their intention to become the registered manager of Kenwyn. The new manager had already had a positive impact on staff morale and team building.

People said they felt safe and well cared for. They praised the staff for their kindness, support and compassion. Some people did acknowledge there had been recent staff changes. Comments included “The carers ask you ask at each step and I'm always glad of their help. They are always gentle - no complaints at all.” And “We don't have anything wrong here. I think it's wonderful – I get lovely treatment. They are all great. Everything is here on the doorstep. The girl’s works so hard and I can't praise them enough. They put themselves out to make everything right…”

People had sufficient food and drink to keep them healthy and well nourished. On the day of the inspection people were unaware of what the menu options were. The provider said there was normally a menu board and staff went around to ask people for their choices. They agreed to remind staff this needs to happen so people can make choices each day. People said they enjoyed the meals. There were snacks and drinks available in each of the lounge areas in additional to the regular meals offered.

There were systems and audits in place to check the quality of care and ensure the environment was clean, safe and well maintained. We noted that two taps in the first floor bathrooms were running very hot and were a risk of scalding people. These had been checked two days previously and no fault was found. The provider immediately called in a contractor to re-set the mixer valves which prevented hot water from coming out at above 42 degrees. They had also asked them to review all water outlets whilst they were in attendance. We also noted that one downstairs communal toilet also had a door leading to a staff area where they stored their bags. We highlighted this may compromi

The inspection took place on 20, 21 and 22 January 2016 and was unannounced. The service was last inspected in January 2014 and was found compliant.

Kenwyn is located in a quiet cul-de-sac near to the centre of the small market town of Crediton. It consists of a main house with an extension which provides additional bedrooms and sitting areas. The location is registered to provide care for up to 25 people. Everyone living at Kenwyn had their own bedroom, some of which were en-suite. At the time of the inspection 19 people were living at Kenwyn, some of whom had been resident for a number of years. Some of the people living at the home had dementia.

People said they liked the home for example one person commented “I have been at this home for several years and think it is really good.” The home was clean and odour free throughout the inspection. Some areas of the home, for example bedrooms, a wet room and corridors had been newly decorated and furnished. Some areas of the home had been changed to make them more dementia friendly. For example, bedroom doors were painted in different colours and corridors had been decorated to give a more homely feel. There were plans to undertake further improvements to the home to support better dementia care.

Family and friends were welcomed into the home and were supported to be involved in their relative’s care, where appropriate. During the inspection we met three relatives who visited the home, two of whom said they visited several days a week. One relative said “I can call in anytime.” Another commented the staff “are brilliant” and another said “staff are really communicative” which they found helpful.

People were supported to have enough to eat and drink. Specialist dietary needs were also catered for. People said the food was really good. One person commented “you can’t complain about the food, it’s what makes this home worth staying in!” We observed people enjoying the meals they were being served and being offered alternatives, where they did not want the meal on offer.

There were sufficient numbers of staff to provide support and care for the people at Kenwyn. The provider said they were planning to increase staffing levels from February 2016 to support better dementia care. People were kept safe by staff who understood how to protect vulnerable adults from the risks of abuse. People’s risks, needs and preferences had been recorded when they arrived at Kenwyn and care plans had been developed to support them. Care plans described people’s care and the support they needed. Staff knew people well and worked in a compassionate and caring way. However we found, on some occasions, staff did not undertake sufficient regular checks to meet people’s needs.

Staff administered and recorded medicines safely. Stocks of medicines were kept secure and staff followed safe procedures to return medicines to the pharmacy when they were no longer required. People’s physical and mental health needs were addressed by staff working with health and social care professionals including the GP, dentist, optician and local hospital. A health professional commented; “the home works in partnership with the [health professional] team.”

Staff were recruited safely and received an induction when they commenced working at Kenwyn. This included work shadowing experienced staff as well as undertaking training. Staff had received training to ensure they were able to deliver care effectively. This included training identified as essential, for example health and safety, fire safety and safeguarding vulnerable adults. Staff also completed other courses to support them in developing specific skills, for example end of life care. Some staff were undertaking a year-long course on dementia care, which they were planning to deliver to other staff. They were also developing an action plan to introduce changes to the home to support better dementia care. This included ma

We carried out our inspection on 17 January 2014 as we had received some concerns from a member of the public. However, we found that these concerns were not founded and the provider was compliant with the outcomes we looked at. We also followed up on the previous inspection where a compliance action was made relating to the environment. This outcome area was also compliant.

There were 23 people living at the home at the time of the inspection, this was full capacity as two rooms are double rooms used as single rooms. We spoke with the senior care worker in charge, the provider on the telephone, five staff members and five visitors. We also spoke with five people who were able to tell us about their experiences of living at the home and we spent time observing care in the communal areas. Responses were all positive and although some people were living with varying degrees of dementia and unable to tell us directly about their experiences, we saw that their needs were well met in a dignified, inclusive and respectful way. We saw staff chatting with everyone throughout the day and recognising people’s body language signs such as anxiety or showing that they needed assistance or a drink. For example, one person repeatedly asked for their chair to be changed and then forgot they had asked. Staff were kind and respectful when meeting this person’s needs. Another person believed that they were living in a hotel and staff responded appropriately to ensure that the person did not become distressed.

People’s health and welfare needs were identified and well met including wellbeing and social needs. For example, care plans were detailed and clearly informed staff about how to meet people’s individual needs. When we met with people we saw staff delivering care as stated in the care plans. This meant that care was personalised for individuals. People were able to spend time with staff on a one to one basis and staff were friendly. We spoke with five visitors who all spoke highly of the care provided for their friends and relatives at Kenwyn. One relative told us “I’ve been visiting for many years and the manager runs a tight ship. It’s very nice here and I would be happy to complain but I haven’t needed to.”

People told us they were pleased with the environmental improvements, which were ongoing. We saw the provider had taken the comments and compliance action made by us at the previous inspection seriously. We saw a maintenance programme detailing how and when re-decoration and updating was being done. We toured the entire building and saw lots of evidence of improvements such as painting, updated toilets and bathrooms, new decorations and pictures and new flooring. We found there were no offensive odours. One relative said “There have been lots of changes for the better recently although long overdue. I visit most days and there are never any bad smells. It smells fresh and the cleaners are very good”. All areas were clean and we saw a cleaner working throughout the day. They told us it was a lovely place and they had no worries working there. Everyone we spoke to confirmed that the provider and manager were “lovely” and “very approachable” if they had any concerns or complaints.

The service was complaint with both outcomes that we looked at during this inspection.

There were 23 people at the home on the day of our visit - this included 22 people who lived there permanently and one person who was staying there for a limited time period only (respite care).

We spoke with four people living at the home, two relatives, ten members of staff, a visiting health care professional and a hairdresser. Some people were unable to comment directly on their care so we spent much time with them to help us understand what life was like at the home.

The manager was not present on the day of inspection.

People living at the home appeared comfortable, looked after and at ease with all the staff. One person told us “they all do their very best” and another said staff are "very good".

Care staff had a good knowledge of people's individual needs but not all information was held in the care records. Relevant referrals were made to the health care team.

People received nutritious and appealing food and one person commented "the food is good". Some people did not always receive the support needed to help them eat their meals.

Staff demonstrated that they understood the signs of abuse and how to report any concerns. The home was aware of the process to follow in cases of suspected abuse.

Staff were appropriately trained to give people their medicine.

All people had private rooms which were homely and personalised. Some areas of the home appeared tired and worn in places.

When we visited the home we found a warm friendly atmosphere, there was lots of musical entertainment going on and plenty of laughter. We spoke with six people who used the service who said they were happy living there and found the staff helpful. One person told us, "they are all very kind to us and help us a lot".

We saw people being treated with respect in a dignified manner, the needs and preferences of people were taken account of in their care plans, and they were able to participate in their care plan reviews. People who use the service are asked to consent to having treatment or support, some people who don't have the capacity to do so have mental capacity assessments recorded.

The home has a well developed care planning system, this was evidenced by care plans we that reviewed. There was also evidence that the home worked collaboratively with other professionals. The needs of people within the home are changing, leading to higher levels of dependency. We were told that protocols are in place to monitor increasing needs and enhancements to staffing can take place to maintain safe care.

The home offered a clean hygienic environment and had recently been awarded a five star Kitchen Hygiene award.

Staff are recruited to the home using recruitment policies that seek to appoint suitably experienced and qualified staff. Prior to appointments staff are subject to a series checks including references and CRB checks.

When we carried out this review 20 men and women over the age of 65 years were living at the home. Everyone was in single accommodation. There were 5 vacancies. We spoke with people individually in private. People told us that the staff team were kind, one person said that since moving in the staff ‘had become like friends’ to them. Where people expressed concerns to us they also told that they felt able to speak up to the manager, whom they believed would take action to improve things for them. This means that people feel safe living at the home.