About the service:

Kenyon Lodge is owned by Trees Park (Kenyon) Limited, trading as Abbey Healthcare. The service is registered with the Care Quality Commission to provide nursing and personal care for up to 60 people. The single room accommodation is arranged over two floors and has lift access. On-site car parking is available, and the service is situated on a local bus route and is close to the motorway network.

At the time of the inspection 25 people were receiving nursing care on the first floor of the home and 11 people were receiving residential care on the ground floor of the home. A comprehensive refurbishment of the upstairs floor of the building had been undertaken since the last inspection.

People’s experience of using this service:

The service had an open and supportive culture. Systems were in place to monitor the quality and safety of care delivered. There was evidence of improvement and learning from any actions identified.

There were sufficient numbers of trained staff to support people safely. Recruitment processes were robust and helped to ensure staff were appropriate to work with vulnerable people.

People’s needs were thoroughly assessed before starting with the service. People and their relatives, where appropriate, had been involved in the care planning process.

Staff were competent and had the skills and knowledge to enable them to support people safely and effectively. Staff received the training and support they needed to carry out their roles effectively. Staff received regular supervisions and annual appraisals were planned.

Staff had awareness of safeguarding and knew how to raise concerns. Steps were taken to minimise risk where possible.

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. Staff supported people to access other healthcare professionals when required. Staff supported people to manage their medicines safely.

People’s outcomes were consistently good, and people’s feedback confirmed this.

Staff worked with other agencies to provide consistent, effective and timely care. We saw evidence that the staff and management worked with other organisations to meet people’s assessed needs.

We observed positive interactions between staff and people. Staff had good relationships with people and were seen to be caring and respectful towards people and their wishes.

People were supported to express their views. People we spoke with told us they had choices and were involved in making day to day decisions.

The provider and registered manager followed governance systems which provided effective oversight and monitoring of the service.

The premises were homely and well maintained. We observed a relaxed atmosphere throughout the home.

The service met the characteristics of Good in all areas.

Rating at last inspection:

At the last inspection of the service (published 04 May 2018) the home was rated Requires Improvement overall and there were two breaches of regulations in relation to safe care and treatment and good governance. At this inspection the overall rating has improved to Good.

Why we inspected:

This was a planned inspection based on previous the rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

When we last carried out an unannounced inspection of Kenyon Lodge on 22 and 23 August 2017 and on 20 September 2017 we found multiple breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in regard to safe care and treatment, safeguarding, meeting nutrition and hydration needs, good governance, person-centred care and staffing requirements. The overall rating for this provider was 'Inadequate' and the home was placed into 'special measures' by CQC.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the five key questions to at least good and the provider subsequently submitted action plans to CQC on a monthly basis. We also held regular meetings with the provider, local authority and clinical commissioning group (CCG) to monitor progress and to review the action plan.

At this comprehensive inspection on 01 and 02 February 2018 we found the provider had taken remedial action to improve some of the ratings but further work was needed to ensure compliance with all regulations. During this inspection, we found the process of improving the ratings was on-going and a work-in-progress and there were still breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in regard to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of this report.

Kenyon Lodge 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.

Kenyon Lodge is owned by Trees Park (Kenyon) Limited, trading as Abbey Healthcare. The service is registered with the Care Quality Commission to provide nursing and personal care for up to 60 people. The single room accommodation is arranged over two floors and has lift access. On-site car parking is available and the service is situated on a local bus route and is close to the motorway network. At the time of the inspection 18 people were receiving nursing care and 12 people were receiving residential care, all on the ground floor of the home. A comprehensive refurbishment of the upstairs floor of the building was due to start in May 2018 and this part of the building was empty and no-one was residing there at the time of the inspection.

Medicines were not consistently managed safely. Protocols were not always in place for all people prescribed a medicine ‘when required’; some protocols were dated 2016 and had not been reviewed to check they described the person’s current needs. Two people’s prescribed creams were out of stock. Nurses carried out daily stock checks of controlled drugs (CD’s) for people in their care but did not check CD’s prescribed for people receiving only personal care.

Regular audits were carried out in a number of areas but had not always been effective in identifying and resolving some of the issues we found during the inspection in regards to management of medicines and care planning documentation.

Accidents and incidents were recorded and audited monthly to identify any trends or re-occurrences but not all records were up to date and some did not clearly identify the actions taken following falls.

There was 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.

Comments received from people who used the service and their relatives about the registered manager were very complimentary, and everyone reported significant improvements had been made since the date of the last inspection. Comments from

Kenyon Lodge is owned by Trees Park (Kenyon) Limited, trading as Abbey Healthcare. The service is registered with the Care Quality Commission to provide nursing and personal care for up to 60 people. The single room accommodation is arranged over two floors and has lift access. On-site car parking is available and the service is situated on a local bus route and is close to the motorway network. At the time of the inspection 23 people were living on the ground floor nursing unit and 20 people were living on the first floor residential unit.

We carried out an unannounced inspection of Kenyon Lodge on 22 and 23 August 2017. We then carried out a further day of inspection on 20 September 2017 to check on the progress the provider had made since the date of the first inspection, and to check on people’s welfare. The inspection had been brought forward due to a significant number of safeguarding issues and concerns, including one serious incident. We are making further enquiries in relation to this incident.

When the home was inspected on 06 October 2015 the home was given an overall rating of inadequate and was placed into ‘special measures’ by CQC. The service was re-inspected on 25 May 2016 and again on 26 October 2016, where improvements were noted and the home was given an overall rating of requires improvement.

During this inspection, we found multiple breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in regard to safe care and treatment, safeguarding, meeting nutrition and hydration needs, good governance, person-centred care and staffing requirements. We are currently considering our enforcement options in relation to these regulatory breaches.

At the time of the inspection, there was no 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 and associated Regulations about how the service is run. A manager had recently been appointed but had not yet commenced their application with CQC.

People and their relatives told us they did not always feel they were safe living at the home. Relatives told us they felt the home was short staffed and people’s needs were not met in a timely way as a result of this. We received negative comments regarding the care provided. One relative told us [their relative] was unkempt and they didn’t have confidence in the care because nurses were not always sure about the treatment [their relative] had received. One staff member told us they would not want their own relative in the home.

People were not safeguarded from abuse as staff were not recognising safeguarding incidents and referring them to the local authority. We found at the time of the inspection there was a high number of safeguarding incidents, currently being investigated. Of these, the majority had been raised by visiting health care professionals.

A number of the safeguarding concerns related to the management of pressure care and wounds. We found information regarding the management of pressure care was inconsistent and differing instructions relating to the frequency pressure relief should be provided. This had placed people at risk of their skin breaking down.

Medicines were not handled, stored or administered safely. Effective systems for the safe administration and storage of drink thickeners were not in place, which placed people at risk of harm. Although medicines had been audited regularly, audits had failed to identify the issues we found during the inspection regarding the unsafe management of medicines.

The building was being adequately maintained, which ensured the premises were safe. People were protected from the risk of infection, as the provider had ensured good infection control practices were in place. This had been verified

The inspection took place on 26 October 2016 and was unannounced. The last inspection was undertaken on 25 and 26 May 2016 and there was a continued breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 with regard to consent and mental capacity assessments. This breach had been identified at the previous inspection and at the inspection in May we found insufficient progress had been made in this area. At this inspection we found progress had now been made in this area and the service was now meeting this requirement.

Kenyon Lodge provides nursing and personal care for up to 60 people. The single room accommodation is arranged over two floors and has lift access. A car park is available and the home is close to bus routes and a motorway network. On the day of the inspection there were 36 people using the service, of which 14 were in residential placements and 22 in nursing.

There was a registered manager at the service. 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 inspection had been brought forward due to a significant number of safeguarding issues. Some of these were subsequently substantiated and failings identified within the service. Corrective measures were now being put in place and needed to be sustained in the future to help ensure people’s continued health and well-being.

People told us they felt safe and secure at the home. The service’s recruitment procedures were robust and helped ensure people employed at the service were suitable to work with vulnerable people.

Staffing levels were sufficient to address the needs of the people who used the service and were based on a dependency tool. This was to be updated to ensure busy times were always covered appropriately.

Individual and general risk assessments were in place and these were reviewed and updated as required. We saw evidence of health and safety checks and regular maintenance of equipment.

Medication systems were safe and medicines were ordered, administered, stored and disposed of appropriately. Some issues, such as the application and documentation of topical creams needed to be tightened up.

Staff demonstrated a good understanding of people who used the services. Induction was thorough and training was on-going. This helped ensure staff’s skills and knowledge were kept up to date.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) applications were made appropriately. Consent was sought for all interventions and there was no use of restraint at the home.

People’s nutritional and hydration needs were assessed. Referrals to other agencies were made appropriately and advice followed where necessary. Special diets and requirements were adhered to by the service.

People told us they were cared for with kindness and we observed good interactions between staff and people who used the service throughout the day. We saw that staff respected people’s privacy and dignity at all times.

People who used the service, and their relatives where appropriate, were encouraged to be fully involved in care planning. People were supported to be as independent as possible.

Staff had undertaken training in end of life care and efforts were made to ensure people’s end of life wishes were adhered to.

Care plans were person-centred and included a range of health and personal information. This helped staff care for people in the way in which they wished to be cared for. Care plans were regularly reviewed, but we found a few inconsistencies in documentation. There were a range of activities on offer at the home.

Complaints and concerns were dealt with appropriately an

We carried out an unannounced inspection of Kenyon Lodge on 25 May 2016 and conducted a further inspection visit on 26 May 2016 which was announced.

Kenyon Lodge is owned and operated by Trees Park (Kenyon) Limited, trading as Abbey Healthcare. The service is registered with the Care Quality Commission (CQC) to provide nursing and personal care for up to 60 people. Single room accommodation is arranged over two floors with lift access. On-site car parking is available and the home is situated on a local bus route and close to the motorway network.

At our last inspection of Kenyon Lodge on 06, 07 and 13 October 2015, we found multiple breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. The home received an overall rating of ‘Inadequate’ and was placed into special measures. We took enforcement action against the Provider and issued four warning notices in respect of; Safe care & treatment; Meeting nutritional & hydration needs; Good governance; and Staffing. The provider submitted a Service Improvement Plan which gave timescales for the improvements that were required. During this inspection, we found the provider was now compliant with each of the warning notices we had served.

We found one continued breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 with regards to consent and mental capacity assessments. This breach had previously been identified during our last inspection and we found insufficient progress had been made in this area during this inspection. You can see what action we have taken at the back of the full version of this report.

Since our last inspection, CQC had been working collaboratively with Kenyon Lodge, stakeholders from Salford City Council and Salford NHS Clinical Commissioning Group, to monitor and assess the effectiveness of the Service Improvement Plan. This was to ensure people who used the service received care and support that was safe and met their individual needs.

At the time of our last inspection, a new manager had been appointed to Kenyon Lodge and the manager had submitted an application to CQC to become the Registered Manager. Following the outcome of this inspection visit, the manager’s application to become the Registered Manager was approved. A Registered Manager is a person who has registered with CQC. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During our last inspection we found improvements had been made in the way medicines were being managed. However, during this inspection we found there had been a deterioration in the way some people’s medicines were being managed on a day-to-day basis and that improvements were needed in this area.

We asked people living at the home if they felt safe and they told us they did. We looked to see how the service sought to protect people from abuse and found there were appropriate safeguarding and whistleblowing policies and procedures in place. All the staff we spoke with demonstrated they had an understanding of the types of abuse and the procedure to follow if they suspected that a person was at risk of, or was being abused.

We asked staff about whistleblowing. All of the staff we spoke with told us they would not hesitate to use the policy and identified internal reporting protocols. Staff also referred to local authority and CQC as external agencies they could contact.

We looked at staffing levels to ensure there was enough staff to meet people’s needs. At the time of our inspection the home was not at full occupancy. 21 people were accommodated on the nursing unit and 17 people were accommodated on the residential unit. We saw that a dependency tool was used by the home to determine the number of staff required and that staffing levels were consistently reviewed to meet people’s needs

Following our inspection on 16 April 2014, compliance actions were made as we had concerns the provider did not have appropriate arrangements in place to manage the safe administration of medicines and did not have an effective system to assess and monitor the quality of services that people received. We undertook this inspection to see what improvements had been made.

During the inspection we reviewed how medication was administered and recorded. We found medicines were safely administered and people who used the service received their medicines in the way they had been prescribed.

We found medication administration records (MAR) had been completed correctly and signed by the dispensing member of staff.

We looked at weekly and monthly audits that were now routinely undertaken. Where errors or admissions were identified we saw evidence that the service addressed these issues immediately.

We found there were systems in place to monitor the quality of the service provided.

We looked at a sample of four recently completed questionnaires that had been received by the service.

We looked at minutes from a recent residents and relatives meeting. We found that where concerns had been raised these had been addressed by the service

We found evidence that supervision with staff was now regularly undertaken and that training needs had been identified for each member of staff.

Kenyon Lodge provides nursing and personal care. As a result of safeguarding concerns we undertook a responsive inspection at the home. At the time of our visit there were 54 people who were resident at the home. We spoke with nine people who used the service, 14 relatives and three health care professionals. We also spoke with 15 members of staff during our visit.

Our inspection was co-ordinated and carried out by two inspectors, who addressed our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they were treated with respect and dignity by the staff. People told us they felt safe. One person who used the service said “I feel safe, they look after me very well. No concerns, staff are very kind and helpful.” Safeguarding procedures were in place and staff were able to demonstrate how they would safeguard the people they supported from abuse.

There were no clear consistent systems in place to make sure that the manager and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This meant that people were not benefiting from a service that was taking on board lessons learnt.

The service had policies in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had been submitted. Registered nurses were able to describe in detail requirements of the legislation. There was no evidence that any recent training had been delivered to care staff.

The service was safe, clean and hygienic.

People who used the service and staff told us there were now sufficient numbers of suitably qualified staff on duty. The provider had recently increased the numbers of registered nurses on duty at any one time. This helped to ensure that people’s needs were always met.

Recruitment practice was safe and thorough.

We found people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to managing medication and quality assurance.

Is the service effective?

People’s health and care needs were assessed. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Overall, people and their relatives said their care needs were being met.

Most relatives confirmed they were able to visit their loved ones at any time and speak in private. They felt welcomed by accommodating staff. One relative told us; “We are encouraged to come at all times, we have been late at times but get an excellent greeting.”

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, “I think it is a good home, they can’t do enough.” “Staff are very caring and compassionate.” “I feel my X’s needs are being met.” “Find it extremely clean and staff are very supportive.”

Overall people’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities inside the service regularly. The home employed an activities coordinator who organised daily activities and events.

People we spoke to were aware of the complaint procedure. One relative told us; “They have responded to our complaints well”. People can therefore be assured that complaints would be investigated and action taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. A visiting health care professional said “Everything I have asked the home they have delivered on, I have no concerns.”

The service had limited quality assurance systems in place to monitor the quality of the service delivered. It was not clear to us that identified shortfalls were addressed promptly. We were concerned that as a result the quality of the service was not continuingly improving.

People who used the service and their relatives had not completed any recent quality assurance questionnaires. As a result we were concerned that shortfalls were not addressed effectively.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to quality assurance.

During this inspection we spoke with eight people who lived at the home, five people’s relatives, staff and the manager. People told us they did not have any concerns about their care and they said if they did they would raise them either themselves or via their relatives. We found that people experienced care and support that met their needs.

Comments made included: “The care is fabulous. I cannot fault the staff at all. They look after 'X' very well; they can’t do enough for my relative”. Another person’s relative said; “The staff are caring, kind and compassionate.” People we spoke with spoke highly of the staff and the care they received.

People told us they enjoyed the food and the social activities. The provider had a system in place to identify, monitor and manage risks to the health, welfare and safety of people who use services. People told us they were looked after by a motivated and well trained staff team. Staff told us they felt well supported.

We found that improvements had been made to concerns we identified at the last inspection, that the provider did not have an effective system to regularly assess and monitor the recording of medicines. We saw that there were quality assurance systems in place to assess the effectiveness of the care and support provided to people who used the service.

We observed that care was unhurried and that staff supported and encouraged people who used the service to make choices.

During this inspection we found that people experienced care and support that met their needs. We saw that staff treated people who lived in the home with respect. We spoke with people living at the home and their comments included: “I can get up and go to bed when I am ready I don’t have to go when they say.” “The staff ask me what food I like and what I don’t like.” “They give us choices about everything and they come and chat with us.”

We asked people about the care they received and they told us: "They can't do enough for you." "Nothing is too much trouble if you need them they are there willing to help. "One person's relative told us; "I don't leave here feeling sad, I feel comfortable in the knowledge that my relative is looked after."

We asked if people felt safe and they told us: "I do feel safe here." "If I have any concerns I can speak to any of the staff and they will sort it out for me."

We found some shortfalls in the management of medicines which the manager told us she would address.

This review took place to check the provider had made improvements.

We spoke with several people during our visit to Kenyon Lodge, people who use the service told us they felt well cared for by the staff. Visiting relatives also confirmed their family member had their care needs well met by caring, approachable staff. They commented that they could approach a senior staff member who could update them about the needs of their relatives.

Our observations during the visit showed people’s dignity and privacy needs were maintained. People said they knew how to raise a concern and felt confident it would be dealt with.

Some of the comments we received during our visit included:

“The girls are very nice, they bathe me and shower me and make my meals.” Staff understood people’s needs and how they liked their care provided.

People were generally satisfied with the care they received and one person said “The staff have spoken to me about my care and any treatment.”

People told us they liked the environment and some of the social activities provided. One person said, “My bedroom is very nice. Sometimes they have a concert for us or we sometimes have bingo, I also like it when the artist comes in and sings for us.”

People told us they liked the food overall and were able to have some choice.

People felt any concerns they did have would be listened to and action would be taken to address them.

We carried out an unannounced inspection of this service on 6 October 2015, with a further two announced inspection visits on 7 and 13 October 2015.

Kenyon Lodge is owned by Trees Park (Kenyon) Limited, trading as Abbey Healthcare. The service is registered with the Care Quality Commission to provide nursing and personal care for up to 60 people. The single room accommodation is arranged over two floors and has lift access. On-site car parking is available and the service is situated on a local bus route and is close to the motorway network.

At our last inspection of Kenyon Lodge on 19 and 20 May 2015, we found two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 with regard to safe care and treatment and staffing. As a consequence of this, we gave an overall performance rating of ‘Requires Improvement’.

At the time of this inspection there was no registered manager in post at Kenyon Lodge. However, a new manager had been appointed and they were applying to the Care Quality Commission (CQC) to register as the registered manager for the service. A registered manager is a person who has registered with the CQC. Like registered providers, they are ‘registered persons’. Registered persons have a 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 eight breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in regard to person-centred care, dignity and respect, need for consent, safe care and treatment, meeting nutritional and hydration needs, good governance, staffing and requirement as to display of a performance rating. We are currently considering our enforcement options in relation to these regulatory breaches.

We found there to be insufficient numbers of suitably qualified and experienced staff to meet the needs of people who used the service. In particular, we found insufficient numbers of qualified registered nurses. The nursing unit at Kenyon Lodge can accommodate up to 30 people, yet we found for the vast majority of time only one registered nurse would be on duty. At the time of our inspection the service had three registered nurse vacancies and was reliant on the use of agency nurses.

The service did not always complete regular nurse-led assessments and reviews of people who used the service. This meant the service did not always recognise and respond to people who presented with clinical features of a condition that was likely to deteriorate. For example, during our inspection we found the service had failed to recognise and respond appropriately to a person who used the service who was clinically dehydrated.

During our last inspection of Kenyon Lodge we found the service was in breach of Regulation 12 of Health and Social Care Act 2008 because people who used the service were not protected against the risks associated with the safe management of medicines. However, during this inspection, we found significant improvements had been made. We found that medicines were now stored, administered, recorded and disposed of safely and correctly. Additionally, staff were adequately trained and kept relevant records.

We looked at how people who used the service with a high risk of malnutrition were being supported. This group of people each had a nutritional action plan prescribed for them by a community dietitian. However, the service was unable to demonstrate how peoples’ meals had been fortified and whether additional nutritional supplements were being provided. Furthermore, we found regular weights were not always obtained, recorded and acted upon.

Care and support plans of people who used the service at Kenyon Lodge were not of a consistently acceptable standard. We found gaps and omissions in recording and information was disorganised and not easy to understand. We found care plans were not sufficiently person-centred and did not effectively demonstrate peoples' likes, dislikes, personal preferences and their life history. Care plans also failed to demonstrate how people who used the service, and/or their lawful representatives, had been involved in planning and agreeing the care and support being provided.

We found the service did not always fully complete individual risk assessments for people who used the service. We found gaps in recording and some individual risk assessments in peoples' care plans were blank. Recording of accidents and incidents was inconsistent, particularly around falls. In a number of care plans we were unable to establish how people who fell on multiple occasions had been kept safe and what preventative strategies had been considered or implemented.

Personal emergency evacuation plans (PEEP) were not always completed and the evacuation status of each person who used the service was not readily available as the service did not maintain a PEEP ‘grab file’ in case of emergencies.

We looked at how staff were supported to raise concerns. The service had a whistle-blowing policy and associated procedures which contained the contact details of relevant agencies and internal contacts within Abbey Healthcare. However, despite the service having such policies and procedures in place, we found documentary evidence which demonstrated that not all staff had been supported appropriately when attempting to raise concerns about care and staffing.

We looked at a sample of recruitment files to make sure safer recruitment practices were being followed. We found the identity of people applying to work at the service had been checked, references had been sought and checks had been completed with the Disclosure and Barring Service (DBS). A DBS check helps to ensure that potential employees are suitable to work with vulnerable people.

We looked at how well people were protected by the prevention and control of infection. We found the service had previously been working with the local authority infection prevention and control team and had achieved an overall IPC audit score of 91%. However, we found over recent months attention to IPC issues had deteriorated. This was reflected in the services last audit which demonstrated an overall deterioration in IPC standards and an audit score 73%.

At our last inspection of Kenyon Lodge, we found the service was in breach of Regulation 18 of the Health and Social Care Act 2008 because professional development and supervision of staff was not effective. During this inspection, we found some improvements had been made to the frequency of one to one supervision. However, insufficient improvements had been made to professional development of staff.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA , and whether any conditions on authorisations to deprive a person of their liberty were being met.

We found the service had a policy in place concerning DoLS and information was included about best interests, lasting power of attorney and access to an Independent Mental Capacity Advocate (IMCA). DoLS literature was also clearly displayed in the reception area.

We looked at DoLS documentation concerning six people who used the service on the nursing unit and found that due processes had been followed by the service for each DoLS application and that decisions were made in those peoples' best interests. However, on the residential unit we found only two people who used the service to be the subject of a DoLS, this was despite the residential unit caring for significant numbers of people who lacked capacity and were not free to leave of their own accord.

We looked at the meal time experience for people who used the service on both the residential and nursing unit at Kenyon Lodge. We found dining tables were presented appropriately with table cloths, crockery and condiments. People who used the service told us the food was generally good and appetising. However, on the nursing unit, we found lunch time meal service was chaotic and noise levels were very high. On the residential unit we found the atmosphere to be less chaotic.

Kenyon Lodge employed two activity coordinators. We found information was displayed on a number of notice boards around the service which gave details of various activities. These included a knitting club, visit by a live singer and other activities such as board games and arts and craft. Holy communion was also available to people of faith.

During our last inspection of Kenyon Lodge in May 2015, the provision of end of life care was under review following a safeguarding incident. As part of this review, additional clinical support was provided to Kenyon Lodge by the local NHS district nursing service. At the time of this inspection, the review into end of life care was still on-going. However, we found one example of a person who used the service who was nearing the end of life had not been referred by Kenyon Lodge to appropriate palliative care professionals. The early intervention of such professionals is crucial to ensure those people nearing the end of life, are able to do so in a dignified and comfortable manner.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.