This unannounced inspection took place on 5 and 6 June 2018. The previous comprehensive inspection was undertaken in July 2017. At that inspection the provider had breached two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations. These breaches related to medicines and good governance. The service was rated as 'Requires Improvement'. At this inspection we checked whether improvements had been made and the service was no longer in breach of the regulations.

Kiwi House 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.

Kiwi House is purpose built and accommodates 78 people across three separate floors each of which have additional separate units and adapted facilities. One of the units specialises in providing care to people living with advanced dementia. At the time of our inspection there were 72 people using the service.

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.

At our previous inspection in July 2017 we found people did not always receive their medicines as prescribed. Improvements had been made and medicines were, in the main, managed safely. Some areas of managing medicines required further development. We found staff did not always follow procedures for ensuring medicines were used within the recommended expiry date and monitoring charts were not consistently in place for transdermal medicines.

At our previous inspection we found the provider did not have effective systems and processes for monitoring and improving the quality of care. Improvements had been made and detailed audits and checks were in place. Action plans had been developed to identify improvements and ensure these were made in a timely manner. People and relatives were supported to share their views of their care and these were used to make improvements and drive the development of the service.

Risks to people's health and wellbeing had been identified and assessed. Some records had not been updated to reflect people's current needs.

Staff understood about safeguarding and the many different types of abuse. They knew how to report any concerns they may have, within the structure of their organisation or externally or other regulators or local authorities.

Staff had good knowledge of how to keep people safe and had been employed following robust recruitment and selection processes. There were sufficient staff deployed to meet people's individual needs.

There were arrangements in place for the service to make sure that action was taken and lessons learned when accidents or incidents occurred, to improve safety across the service.

Staff received induction, training and supervision to provide them with the necessary skills and knowledge to meet people's needs.

People were supported to have enough to eat and drink. People were assessed for the risk of malnutrition and when required specialist advice and support was sought.

People's rights were upheld in line with the Mental Capacity Act (MCA) 2005. This is a legal framework to protect people who are unable to make certain decisions themselves. Staff supported people in the least restrictive way possible.

People had developed positive relationships with staff, who were kind and caring and treated people with respect and dignity. People were supported to maintain their independence.

People and their relatives were supported to be involved in the development of their care and information was provided to enable people to access and understa

This inspection took place on 25 and 26 July 2017 and the first day was unannounced.

The provider is registered to provide accommodation for up to 78 older people living with or without dementia in the home over three floors. There were 62 people using the service at the time of our inspection. This was the service’s first inspection since registration with the Care Quality Commission (CQC).

A registered manager was in post and was available throughout the inspection. 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 did not always receive their medicines as prescribed.

Risks were not always managed so that people were protected from avoidable harm. Staff did not always follow safe infection control practices.

Staff understood their duty to protect people from the risk of abuse and knew how to report any concerns. Sufficient staff were on duty to meet people’s needs and staff were recruited through safe recruitment practices.

People’s rights were protected under the Mental Capacity Act 2005, however, documentation was not always completed to fully demonstrate that capacity was being considered on a decision by decision basis and that decisions were being made in people’s best interests.

People told us they received sufficient to eat and drink but the mealtime experience required improvement in one dining room and food and fluid documentation was not always accurately completed. Adaptations could be made to the design of the home to better support people living with dementia.

Staff felt supported and received induction, training and supervision. Appraisals were in the process of being arranged. External professionals were involved in people’s care as appropriate.

Staff were kind and knew people well. Staff responded effectively to people showing signs of distress. People and their relatives were involved in decisions about their care. Advocacy information was made available to people.

People received care that respected their privacy and dignity and promoted their independence. People could receive visitors without unnecessary restriction.

People received personalised care that was responsive to their needs. People felt they were supported to access activities that met their needs.

Care records contained information to support staff to meet people’s individual needs.

A complaints process was in place and staff knew how to respond to complaints. Complaints were responded to appropriately.

Systems were in place to monitor and improve the quality of the service provided, however, they were not fully effective. As a result the provider and registered manager were not fully meeting their regulatory requirements.

People and their relatives were involved or had opportunities to be involved in the development of the service. Their feedback was acted upon by staff. Staff told us they would be confident raising concerns with the management team and appropriate action would be taken.

We found two breaches 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.