We inspected this service on 13 March 2018. Kingsmead Care Home is a residential setting which means people receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Kingsmead Care Home is registered to provide support for up to 40 older people. The service comprises of three units, ground floor Honeysuckle general nursing, first floor’s Cherry Blossom unit for people living with dementia and a small, five bedded Lavender wing. On the day of our inspection there were 35 people using the service.

At the last inspection on 21 and 22 February 2017 the service was rated Requires Improvement in Safe and Well-led domains, and overall. Caring, Effective and Responsive domains were rated as Good.

At this inspection we found the service improved to Good in Safe and Well-led domains and Good overall. Caring, Effective and Responsive remained Good.

On our last inspection we found the provider’s quality assurance processes were not always effective. We issued a requirement notice and asked the provider to submit the action plan how they were going to address these concerns. The registered manager promptly wrote to us to say how they were going to meet the requirements in relation to breach of Regulation 17. We found the systems to monitor the service had improved and allowed the team to identify areas for improvement effectively. There was an open and transparent culture demonstrated by the team. People and relatives were positive about the team and how the service was run.

We also found the provider addressed the concerns around medicines management we identified on our last inspection and people received their medicines as prescribed. People remained safe at the service. Staff knew how to protect people’s safety and how to raise any safeguarding concerns. Risks related to people’s well-being were identified and guidance how to manage these risks was incorporated into people’s care planning.

There was a registered manager in post. 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.

The team worked well together, staff praised the management and told us they were led by example. The staff were enthusiastic and there was a positive, cheerful atmosphere at the service.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

There were enough staff to keep people safe and people were supported with no unnecessary delay. The provider followed safe recruitment procedures when recruiting new staff. Staff had the relevant training and told us they felt well supported.

People were supported in a caring and compassionate way. Staff ensured people’s privacy was respected and they were treated with dignity. People’s confidentiality was maintained. People’s individual needs in relation to accessing information were respected.

The service worked well with external professionals when required. People were supported to access external health professionals when needed and to meet their nutritional needs. People were positive about the food at the service.

People’s needs were assessed prior to admission to Kingsmead and care plans in place that ensured people’s needs were recorded. People had opportunities to engage in social activities including one to one support if needed.

We inspected this service on 21 and 22 February 2017. Kingsmead Care Home provides accommodation, personal and nursing care for up to 43 older people. The home is located in central Swindon. At the time of our visit 31 people were using the service.

There was a registered manager in post. 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.

People told us they were safe. Risks to people’s well-being were assessed and recorded. People were protected from the risk of abuse as staff had a clear understanding of their responsibilities to identify and report abuse. The registered manager ensured there were sufficient numbers of staff on duty to keep people safe. The registered provider followed safe recruitment procedures.

People received their medicine as prescribed and the medicine was kept securely. However, we identified issues around stock control and found the medicines that required cold storage were not always stored as per manufacturer’s instructions.

The provider ensured staff had been appropriately trained to meet the needs of the people. Staff were supervised in their roles and told us they were well supported. People were supported to meet their nutritional needs and have access to health professionals if needed.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. Staff and the registered manager understood the MCA and DoLS and the provider followed the legal requirements.

People benefitted from caring relationships with staff. People were cared for by caring staff that knew people well. Staff treated people with dignity and respect. People were encouraged to be independent and their cultural needs were respected.

People’s care records documented their needs and preferences for how they wished to be supported. The provider had a system in place that ensured people and their relatives had opportunities to provide feedback.

The provider had systems for monitoring and assessing the quality of the service. However, these were not always effective as they did not identify the issues we found on our inspection. The registered manager was open and transparent and acknowledged our findings.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

This was an unannounced inspection which took place on 26 January 2015.

Kingsmead Care Home is registered to provide care with nursing for up to 43 people. There were 38 people in residence on the day of the inspection. The home does not use the double bedrooms for two people. People have their own bedrooms and all but one bedroom have en-suite facilities. The home is purpose built over two floors. There are spacious shared areas within the home and gardens.

There is a registered manager running the 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.

People told us that they felt safe in the home. The registered manager and staff team were trained in and understood how to protect people in their care from all types of harm or abuse. People said: ‘‘nothing unpleasant happens here’’. A relative said: ‘‘I am 100% happy my mum is safe’’

General risks and those specific to the individual were identified and managed appropriately. The service looked at any accidents and incidents and learnt from them. They tried to ensure they did not happen again, if possible. The staff and registered manager took all health and safety issues seriously to ensure people were kept as safe as possible.

The service had enough staff to keep people safe and meet their needs. The minimum numbers of staff, as identified by the registered manager, were always on duty. The way staff members were recruited meant that the provider was as sure as they could be that staff were suitable and safe to work there.

People were given their medicines in the right amounts at the right times. Medicines were stored safely. People and their families told us they received: ‘‘very good healthcare’’. People were supported to make GP appointments and make contact with other healthcare specialists as necessary.

The service understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision. DoLS provide a lawful way to deprive someone of their liberty, provided it is in their own best interests or is necessary to keep them from harm. They had taken any necessary action to ensure they were working in a way which recognised and maintained people’s rights. The service liaised with the local authority with regard to people’s mental capacity and made appropriate DoLS referrals.

People’s capacity was identified on their care plans. Plans clearly described which decisions people were able to make, about what and when they could make them. Staff knew what action to take if people did not consent to care.

People told us the: ‘‘food is very good, you can’t fault the food’’. Menus included fresh healthy food and people were helped to eat their meals, as necessary. People’s nutritional needs were assessed regularly and any action needed to meet changing needs was taken.

Staff had built strong relationships with people who lived in the home and their families. Staff members knew people well and were able to describe and meet their needs. Staff interacted very positively with people throughout the inspection. They used humour and appropriate physical contact to relate to and comfort people.

The home provided a variety of activities which people could participate in if they chose to. People were treated as individuals and their choices and wishes were respected. Treating people with dignity and respect was an important part of the way care was given. Those people who were able were encouraged to maintain their independence for as long as possible.

People who used the service, families and staff told us the service had a good manager and they had every confidence in her. Staff told us that the home had a very open and positive culture and they felt valued and respected. The registered manager was well known to the people who lived in the home and was very involved with their care.

The service checked the quality of care they were providing by using a variety of methods. These included the registered manager regularly looking at all aspects of the running of the home. Improvements and developments were made as a result of the quality checks.

When we inspected there were 37 people living in three units, which divided into a 5 bedded residential unit, a nursing unit for 15 people and a dementia unit for 17 people. We spoke with four people who used the service, five staff and two relatives. We used a number of different methods to help us understand the experiences of people using the service, because some people had complex needs, which meant they were not able to tell us how they felt about the service.

People who used the service told us they were satisfied with the service they received. People felt the staff supported them well and met their needs. One person who used the service said, "the staff are very friendly, they take time and make me feel safe."

The staff team were led by an enthusiastic, motivated manager.

The care records showed us that people's health needs had been assessed before they came to live in the home. These records included information from health and social care professionals which helped ensure that people got the care and treatment they needed.

We spoke with two people who lived in the home. They both said that the all the staff were very helpful and they always asked what help and support they needed. They both told us that the food was very good. One person told us "the staff are kind" and "the food is lovely." They also said that they had information about the complaints procedure. Both people knew how to make a complaint, although they had no complaints.

People were supported to make decisions about their care and where able they consented to the care and treatment provided. When people lacked capacity decisions about their care were made in their best interests.

Each person had had an assessment of their needs and they had a series of care plans to meet these needs. Risks were assessed and action was taken to reduce risks to people and keep them safe.

Staff had accessed to information about the local safeguarding procedures. They had had training about different types of abuse and how to prevent and report abuse. This meant that staff were trained to support people and protect them.

There were appropriate recruitment processes. Staff had checks before they started to work with people. This ensured that people were supported by staff who were suitable to care for vulnerable people.

People were given information about the complaints procedure so that they knew how to make a complaint. Complaints were investigated and improvements were made to the service when needed.

We spoke with four people, three relatives and five staff in addition to the manager. People said they “liked the home”,and that the staff were" friendly” and “cheerful and patient”. Relatives commended the home saying “staff are brilliant”, “the home is excellent” and “I know mum is in good hands”. People told us they knew how to complain but didn’t have any complaints. All of the people and their relatives thought the food was good. One person said the gravy they had that day was the best ever.

We saw that the home was clean and tidy and observed house keeping staff going about their work. Nursing and care staff were seen to be warm and attentive towards people. The records we looked at demonstrated that people’s needs were being met.

People told us that they were happy living in the home, that staff are supportive and that the care is good. One person said that she prefers the assistance of a female carer and this choice is respected.

All of the people said that they would speak with the manager if they had cause to complain with one person stating that a complaint made in the past had been resolved to her satisfaction.

People said that their relatives are made to feel welcome and are offered hot drinks when they visit.

The food was described as good and we were told that the Cook spends time with people that live in the home to discuss their food preferences.