This inspection took place on 2, 3, 9 and 10 July 2018. The inspection was unannounced: staff in the service did not know we would be carrying out an inspection.

At our last inspection in June 2017 we rated the service as requires improvement. We made recommendations regarding medicines and having person-centred care records. At the time there was not a registered manager in post. of our last inspection A new manager had been appointed and had yet to make their application to register with CQC. During this inspection we found breaches of regulations 9, 11, 12, 17 and 18. These appertained to the lack of person centred records, lack of consent obtained from people, unsafe care and treatment, lack of effective systems to monitor the service, out of date records, and lack of appropriate support to staff.

Kibblesworth 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 care home accommodates up to 16 people in one adapted building. At the time of our inspection 13 people were living at Kibblesworth. The home specialises in providing care to people living with an acquired brain injury.

At the time of our 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 2008 and associated Regulations about how the service is run.

Appropriate governance arrangements were not in in place to monitor and improve the service. Deficits we found during our inspection had not been identified when the limited audits in use had been applied to the service.

The service failed to use the guidance provided by National Institute of Health and Care Excellence on managing medicines in care homes. As a result, we found there were unsafe practices in managing the administration, storage and disposal of people’s medicines.

Staff had not completed daily roadworthy checks on the mini bus since January 2018. Arrangements were put in place during our inspection to re-commence these checks.

Checks were carried out on a regular basis to ensure people were cared for in a building which was safe. However, we found no fire drills had been carried out in line with the provider’s policy since December 2017.

People were sometimes put a risk of unsafe care through records which were out of date or inaccurate.

Pre-employment checks were carried out on permanent staff before they began working in the service. Staff had not been supported with training, supervision and appraisals. Agency nurses were working at service every day. Checks were not carried out on the agency staff to see if they were registered with the Nursing and Midwifery Council and were competent to meet people’s needs. Inductions into the service for agency staff failed to include any information on clinical practices. A new induction checklist for agency nurses was introduced to the service together with more rigorous checks on their competence before our inspection was concluded.

During our inspection visit furniture which could not be cleaned to reduce risks of infection spreading were removed. The home was clean and tidy throughout.

People who used the service were restricted with bedrails without having either their consent obtained or their capacity assessed with best interest decision being made. This meant the provider did not always meet the requirement of the Mental Capacity Act. Although staff including the manager had not been trained in Deprivation of Liberty Safeguards, applications had been made to local authorities to keep people safe.

Staff employed in the making of meals understood people’s dietary needs and how to make

This was an unannounced inspection carried out on 28 June 2017.

This was the first inspection of Kibblesworth since it was registered with the Care Quality Commission in September 2016.

Kibblesworth is registered to provide care and treatment to a maximum of 16 younger adults aged 18-65 with complex physical care needs, as a result of acquired brain injuries. At the time of inspection 14 people were using the service.

A manager was in place who was 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.

Staff and people said the management team were approachable. They were positive about the changes that were being made within the home. Communication was effective to ensure staff and relatives were kept up to date about any changes in people’s care and support needs and the running of the service.

Training was provided and staff were supervised and supported. Staff had an understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. People were able to make choices where they were able about most aspects of their daily lives. People received a varied diet to meet their nutritional needs. However, people were not all encouraged to make choices with regard to their food and people’s dining experience required improvement.

Risk assessments were in place that accurately identified current risks to the person. However, we considered a more robust risk assessment needed to be in put place for any person who smoked. This was addressed immediately to ensure people were kept safe. People’s privacy and dignity were respected. Records were in place that reflected the care that staff provided. People said staff were kind, patient and caring. However, we saw staff did not always interact and talk with people when they had the opportunity. We have made a recommendation about person centred care provision.

People were protected from the risk of abuse as staff had received training about safeguarding and knew how to respond to any allegation of abuse. Staff were aware of the whistle blowing procedure which was in place to report concerns and poor practice. There were enough staff available to provide individual care to people. Activities and entertainment were available for people and people were being consulted to increase the variety of activities and outings.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. Systems were in place for people to receive their medicines in a safe way. However, we have made a recommendation about the management of medicines.

A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to. The service 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 the issues that we found during the inspection to ensure people received individual care that met their needs.

People had the opportunity to give their views about the service. They were supported to maintain some control in their lives. There was consultation with people and/ or family members and their views were used to improve the service. People had access to an advocate if required.