This inspection took place on the 13 and 18 July 2017 and was unannounced. Kitnocks House is a nursing home that provides accommodation and support for up to 63 older people. At the time of our inspection there were 57 people living at the home. People living at the home had high complex support needs in relation to their diagnosis of dementia, mental health conditions, learning disabilities and physical disabilities.

At the last inspection in October 2014, the service was rated Good overall. At this inspection we found that they remained good.

The home had a registered manager who has been registered since June 2017. 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 felt safe living at Kitnocks House and risks to people were minimized through risk assessments. There were plans in place for foreseeable emergencies.

Relevant recruitment checks were conducted before staff started working at Kitnocks House to make sure they were of good character and had the necessary skills. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe.

People were supported to take their medicines safely from suitably trained staff. Medication administration records (MAR) confirmed people had received their medicines as prescribed.

People received varied meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes and went out of their way to provide people with what they wanted.

Staff received regular support and one to one sessions or supervision to discuss areas of development. They completed a wide range of training and felt it supported them in their job role. New staff completed an induction programme before being permitted to work unsupervised.

Staff sought consent from people before providing care and support. The ability of people to make decisions was assessed in line with legal requirements to ensure their rights were protected and their liberty was not restricted unlawfully.

People are 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 place in the service supported this practice.

People were cared for with kindness, compassion and sensitivity. Care plans provided comprehensive information about how people wished to receive care and support. This helped ensure people received personalised care in a way that met their individual needs.

People were supported and encouraged to make choices and had access to a range of activities. Staff knew what was important to people and encouraged them to be as independent as possible.

A complaints procedure was in place. There were appropriate management arrangements in place. Regular audits of the service were carried out to assess and monitor the quality of the service.

The inspection took place on 24 October 2014 and was unannounced

Kitnocks House is a nursing home that provides care and support to people with mental health needs and people with a learning disability. Some people living in the home used a wheelchair and required support with their mobility. The home had suitable facilities and equipment in place to meet their needs. The home is able to accommodate up to 63 people.

A registered manager was in place. 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.

Staff understood the needs of people and care was provided with kindness and compassion. People, relatives and health care professionals told us they were happy with the care and described the service as excellent. One health care professional said: “The staff work well with people living here, they have good understanding of what people’s needs are”.

People were supported to take part in activities they had chosen. Records showed people’s hobbies and interests were documented and staff accurately described people’s preferred routines.

Staff were appropriately trained and skilled to deliver safe care. They all received a thorough induction before they started work and fully understood their responsibilities to report any concerns of possible abuse. Records showed staff received training in mental health, learning disabilities and how to help people who display behaviours that may challenge others.

The provider had employed skilled staff and took steps to make sure care was based on local and national best practice. Information regarding diagnosed conditions was documented in people’s care plans and risks to health and wellbeing were discussed daily during staff meetings. Staff consistently told us they communicated risks associated with people health and behaviours frequently.

The registered manager assessed and monitored the quality of care provided involving people, relatives and professionals. Each person and every relative told us they were regularly asked for feedback and were encouraged to voice their opinions about the quality of care provided. Records showed care plans had been reviewed regularly and people’s support was personalised and tailored to their individual needs.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm. We observed people’s freedoms were not unlawfully restricted and staff were knowledgeable about when a DoLS application should be made.

Referrals to health care professionals were made quickly when people became unwell. Each health care professional told us the staff were responsive to people’s changing health needs. One health care professional said: “We work well together and they always contact us if they need advice or they want if they want to hold a review of someone’s care”.

Staff spoke with people in a friendly and respectful manner. The service had a personalised and people told us they were encouraged to raise any concerns about possible abuse.

Care plans were reviewed regularly and people’s support was personalised and tailored to their individual needs.

We previously inspected Kitnocks House on 19 July 2013 and found that staff were knowledgeable about consent, however we did not always see that care records documented best interest decisions or that capacity to consent to care was regularly reviewed.

We returned to Kitnocks on 24 January 2014 and found that improvements had been made. Records demonstrated that best interest decisions were now being reviewed. We also saw that the provider had a system in place to monitor when best interest decisions were to be reassessed.

Staff we spoke with were knowledgeable about consent and explained that some people in the home had capacity to consent to some aspects of their care but not in others. Where people did not have the capacity to consent, the provider did not always act in accordance with legal requirements.

Staff were knowledgeable about Deprivation of Liberty Safeguards (DoLS) and people were supported appropriately in accordance to the measures that were put in place.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care records showed that each person had an assessment of their needs and a care plan, including risk assessments.

Staff we spoke with were knowledgeable about people's dietary requirements and were able to tell us who had allergies. The chef correctly confirmed people's dietary needs.

There were enough qualified, skilled and experienced staff to meet people’s needs.The matron explained that the service had recently started to conduct monthly dependency assessments.