We inspected the service on 25 January 2019. The inspection was unannounced.

Kippingtons Nursing Home is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Kippingtons Nursing Home is registered to provide accommodation, nursing and personal care for 55 older people and people who live with dementia. There were 46 older people living in the service at the time of our inspection visit.

The service was run by a company who was the registered provider. 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. In this report when we speak about both the registered provider and the registered manager we refer to them as being, 'the registered persons'.

At the last comprehensive inspection on 20/21 June 2016 the overall rating of the service was, 'Good'. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found that the service remained, 'Good'.

People continued to be safeguarded from situations in which they may be at risk of experiencing abuse. Risks to people's safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. Medicines were managed safely. There were enough nurses and care staff to provide people with the care they needed. Background checks had been completed before new care staff had been appointed. Suitable provision had been made to prevent and control infection and lessons had been learned when things had gone wrong.

Care continued to be delivered in line with national guidance and nurses and care staff had the knowledge and skills they needed to promote positive outcomes for people. People were supported to eat and drink enough to have a balanced diet. Suitable arrangements had been made to ensure that people received coordinated care when they used or moved between different services and they had been helped to access healthcare services. People were supported to have maximum choice and control of their lives. The registered persons had also taken the necessary steps to ensure that people only received lawful care that was the least restrictive possible. Policies and systems in the service supported this practice. The accommodation was designed, adapted and decorated to meet people’s needs. Older parts of the accommodation were being refurbished.

People continued to be treated with kindness, respect and compassion. They had also been supported to express their views about things that were important to them. This included them having access to lay advocates if necessary. Confidential information was kept private.

People continued to receive personalised care that promoted their independence. Information had been presented to them in an accessible way so that they could make and review decisions about the care they received. The registered manager, nurses and care staff recognised the importance of promoting equality and diversity. People were offered opportunities to pursue their hobbies and interests and there were plans to further develop the calendar of social activities. Complaints were promptly resolved to improve the quality of care. People were supported at the end of their life to have a comforta

The inspection took place on 20 and 21 June 2016 and was unannounced. Kippington is a large country house dating back from the 19th century, adapted to provide accommodation and nursing care up to 55 older people some of whom live with dementia. There were 45 people living in Kippington at the time of our inspection, 20 of whom lived with dementia.

There was a new manager who had been in post for four months and who was registered 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.

Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.

There was a sufficient number of staff deployed to meet people’s needs. Thorough recruitment procedures in place which included the checking of references.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

All areas in the home were decorated in similar tones and did not make areas easily identifiable for people living with dementia or visual impairment. Some of the people living in the home were not able to locate their bedrooms as their doors were not personalised. We have made a recommendation about this.

Staff knew each person well and understood how to meet their support and communication needs. Staff communicated effectively with people and treated them with kindness and respect. People were able to spend private time in quiet areas when they chose to.

Staff had received all essential training and regular one to one supervision sessions.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options had been considered. Staff sought and obtained people’s consent before they helped them.

People’s mental capacity was assessed when necessary about particular decisions. When necessary, meetings were held to make decisions in people’s best interest, in line with the requirements of the Mental Capacity Act 2005.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. People praised the food they received and they enjoyed their meal times. Staff knew about and provided for people’s dietary preferences and restrictions.

People’s individual assessments and care plans were reviewed monthly or when their needs changed. Clear information about the service, the facilities, and how to complain was provided to people and visitors.

People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.

People were involved in the planning of activities that responded to their individual needs. People’s feedback was actively sought at relatives and residents meetings.

Staff told us they felt valued by the new registered manager and they had confidence in his leadership. The registered manager was open and transparent in their approach. They placed emphasis on continuous improvement of the service.

There was a system of monitoring checks and audits to identify an

One inspector undertook this inspection. This was a follow up inspection to check if action had been taken regarding non-compliance identified with one outcome at our previous inspection.

We used the information to answer the five questions we always ask; 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

Is the service safe?

We saw that people’s care records identified the support people needed to keep them safe, and that the information was reviewed and kept up to date.

Is the service effective?

People’s needs were assessed before they moved to the service to make sure that it could meet them effectively. The service recognised if people might need to move to a more specialist service if their needs had changed. The manager discussed a current example of this.

Is the service caring?

During this inspection we observed that staff were supporting people in the ways they preferred and offered them a range of afternoon activities.

Is the service responsive?

The service had responded to the actions required to achieve compliance identified at our last inspection, and made changes to the systems in place for making sure records were kept up to date.

Is the service well led?

The manager had taken prompt action to address the areas of non-compliance and had made sure that staff were aware of where improvements were needed. This had included discussions at staff meetings.

The inspection was carried out by one inspector over eight and a half hours. We were supported on this inspection by an expert-by-experience. This is a person who has personal experience of using or caring for someone who uses this type of care service. We spoke with twenty three people who used the service, five relatives and six staff members.

We used the information to answer the five questions we always ask; 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

Is the service safe?

People told us that they felt safe at the service. There were safeguarding vulnerable adults procedures in place. Staff we spoke with demonstrated that they understood when to raise a concern about a person’s safety and who to report it to.

The manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). They made appropriate applications for DoLS assessments for people when it had been assessed this action was needed.

There were systems in place to make sure that any accidents, incidents were tracked to identify any trends. We saw that effective measures were put into place when necessary as a result.

Systems to make sure that the service and equipment used was clean, and to check that cleaning had been completed satisfactorily had been improved upon. This was to make sure the environment was clean and hygienic for people.

Is the service effective?

People’s needs had been assessed before they moved into the service. People and relatives were involved in the process. Information about people was updated if their needs had changed. However, we found minor concerns in respect of some aspects of record keeping and the security of people’s records. People told us that staff understood their individual needs.

The service liaised with health and social care professionals to make sure that people received the services they required and carried out advice given.

Is the service caring?

Staff were patient and attentive towards people who used the service and we observed good interactions between people and staff. We saw that staff encouraged people’s independence. Relatives told us that staff were kind and caring. People told us that overall staff were “Very, very caring”, “They will do anything you want “and “Have hearts of gold”.

Is the service responsive?

We observed that staff were quick to respond if people requested assistance. Relatives told us that the home responded quickly if people were unwell. Staff responded to people’s wishes and preferences, by consulting them and their representatives about the running of the home and their individual needs.

The provider had responded to the need to recruit new staff, including increasing the compliment of care workers employed and employing additional housekeeping staff. Recruitment was underway and some new staff had been recruited or had already started work.

Is the service well led?

There were effective quality assurance systems in place. People felt that the manager was approachable and listened to them. We saw that a number of improvements and changes to the service had been made over recent months. We saw that an action plan had been developed to identify areas where further work was needed and these were being progressed.

This inspection was to follow up on the findings from our previous inspection of 1 May 2013 to ensure that appropriate action had been taken by the provider to address our concerns. We asked the provider to send us a report of the changes they would make to comply with the standards they were not meeting.

We found that the provider had taken action to involve people who used the service and their relatives in making decisions about their care.

We found that people who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We found that that the provider had an effective complaints system available. Comments and complaints were responded to appropriately.