Kynance Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide accommodation for up to 32 people. There were 28 people living at the home at the time of the inspection.

The home was based on two floors connected by a passenger lift, in addition to a basement where the kitchen and laundry are located. There was a good choice of communal spaces where people were able to socialise, including a conservatory that was used as the dining room. All bedrooms had en-suite facilities.

The inspection was conducted on 5 and 10 April 2018 and was unannounced.

There was a registered manager 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection, in February 2017, we rated the service ‘Requires improvement’ and identified breaches of Regulations 9 and 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to protect people effectively from the risk of choking and had failed to ensure people's care needs were met in a personalised way. The provider wrote to us, detailing the action they would take to address the concerns.

At this inspection, we found action had been taken to address all areas of concern and there were no longer any breaches of regulation.

The management team had made significant improvements to a range of processes and procedures, making them tighter and more robust to help ensure people were supported consistently in a safe and personalised way.

Three nutritional assistants had been appointed to support people to eat and drink safely and ensure their nutritional needs were met. This had helped people maintain a healthy weight.

Other individual and environmental risks to people were managed effectively. Risk assessments had been developed for all identified risks and people were involved in risk taking decisions.

People felt safe living at Kynance. Staff knew how to identify, prevent and report abuse. Safeguarding investigations were thorough and identified learning to help prevent a reoccurrence.

There were enough staff to meet people’s needs in a timely way. Appropriate recruitment procedures were in place to help ensure only suitable staff were employed.

Arrangements were in place for the safe management of medicines. People received their medicines as prescribed. The home was clean and staff followed best practice guidance to control the risk and spread of infection.

People’s needs were met by staff who were competent, trained and supported appropriately in their role. Staff acted in the best interests of people and followed legislation designed to protect people’s rights and freedom.

People described Kynance as homely. Some adaptations had been made to make the environment suitable for the people who lived there, including level access to an outside space.

People were supported to access healthcare services when needed. Staff made information available to other healthcare providers to help ensure continuity of care.

People were supported by kind, caring and compassionate staff. Staff made people feel they mattered by creating a family atmosphere and celebrating important events. They knew people well and supported people to maintain relationships that were important to them.

Staff expressed a commitment to treating people according to their individual needs, wishes and preferences. They protected people’s privacy and dignity. They encouraged people to remain as independent as possible and involved them in de

This inspection took place on 9 and 10 February 2017 and was unannounced. Kynance is a care home that provides accommodation for up to 32 people, including people with dementia care needs. There were 31 people living at the home when we visited. The home is based on two floors connected by a passenger lift, in addition to a basement where the kitchen and laundry are located. There was a good choice of communal spaces where people were able to socialise, including a newly built conservatory that was used as the dining room. All bedrooms had en-suite facilities.

There was a registered manager 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 2008 and associated regulations about how the service is run.

At our last inspection, in February 2016, we identified breaches of two regulations. Decisions taken on behalf of people were not documented in accordance with legislation designed to protect people’s rights; and people were not protected from the risk of being deprived of their liberty unlawfully. Following the inspection, the registered manager sent us an action plan detailing how they would become compliant with the regulations. At this inspection, we found action had been taken to address these issues, but concerns were identified in other areas.

The provider had not displayed their previous quality rating on the premises, although this was rectified during the inspection. The provider had also failed to ensure that information was provided in writing to relevant people after significant accidents and incidents occurred.

One person’s safety was compromised as their drinks were not always thickened to the right consistency; this put them at risk of choking. Staff had received fire safety training, but not all senior staff were clear about evacuation procedures. However, other individual and environment risks were managed appropriately and protected people from harm.

Suitable arrangements were in place for the safe administration of medicines. However, checks showed that two people had not received all of their prescribed medicines and photographs of some people were not available to help staff ensure they gave the right medicines to the right people.

People with diabetes were not always supported to receive appropriate care or an appropriate diet in line with their individual needs and preferences. Their care plans did not provide sufficient information to enable staff to deliver diabetes care in a personalised way. However, other people’s dietary needs were met; people praised the quality of the food and were supported appropriately to eat and drink enough.

People’s other care needs, including support with personal care, were met. Care plans contained comprehensive information about the way each person wished to receive care and support. People were empowered to make choices; staff were led by people’s wishes and accommodated them wherever possible.

Staff had received safeguarding training and knew how to identify, prevent and report incidents of abuse. Robust recruitment procedures were followed to help ensure only suitable people were employed to support people.

Staff followed legislation designed to protect people’s rights and freedom. They were suitably trained and were supported appropriately in their role.

People had access to healthcare services and were seen regularly by doctors, specialists and community nurses. People also had access to a range of activities to meet their welfare needs.

People were cared for with kindness and compassion. We observed positive interactions between people and staff. Staff knew people well, spoke about them warmly and showed consideration for their feelings.

People were supported to maintain and build relationships and their spiritual needs we

This inspection took place on 11 and 12 February 2016 and was unannounced. The home provides accommodation for up to 32 people, including some people living with dementia care needs. There were 28 people living at the home when we visited. The home was based on two floors connected by a passenger lift; there was a good choice of communal spaces where people were able to socialise; all bedrooms had en-suite facilities.

There was a registered manager 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 2008 and associated regulations about how the service is run.

People’s safety was compromised in some areas as some first floor windows did not have restrictors in place to prevent people falling and fire safety checks had not been conducted since the end of November 2015.

Other risks to people were managed effectively. However, measures needed to reduce the level of risk had not always been documented, so may not have been applied consistently.

Staff did not follow legislation designed to protect people’s rights and freedom or complete correct processes to help make sure decisions were only taken in the best interests of people. However, they did seek consent from people before providing care and support.

People received personalised care from staff who understood their needs and they were supported to make choices. However, this was not supported by the care planning system, which was not always personalised or up to date. The registered manager showed us a new care planning system they were introducing to address this.

People felt safe at the home. Care staff knew how to prevent, identify and report abuse, although non-care staff had not received safeguarding training.

Suitable arrangements were in place for managing medicines safely, but staff did not always record the use of topical creams or check that hand written entries on medicine records were accurate.

Whilst people received enough to eat and drink, we received mixed views about the quality and temperature of food. An extension was planned to the dining room to enhance the environment, and allow space for a food warmer, to help improve people’s mealtime experience.

Feedback was sought from people and changes were made to menus and activities as a result. However, two visitors felt they were not always listened to.

People were supported by sufficient staff and the registered manager followed safe recruitment practices. Staffing levels had recently been increased in order to meet people’s changing needs. Staff provided effective care; they were suitably trained and appropriately supported in their role.

People had access to healthcare services when needed. Staff enjoyed positive working relationships with external professionals, including doctors and nurses from the local surgery.

Staff treated people with kindness and compassion and formed caring relationships with them. They protected people’s privacy, promoted their independence and involved them in planning the care and support they received.

Staff recognised that people’s needs varied from day to day and responded effectively. People had access to a wide range of activities; these had been tailored to their individual needs and included trips to local attractions in the home’s minibus.

People liked living at the home and felt it was run well. There was a clear management structure in place. Staff understood their roles, were happy in their work and worked well as a team.

There was an open and transparent culture. The registered manager encouraged staff feedback and visitors were welcomed. Quality assurance processes were in place to assess key aspects of the service. These had identified the need for an improved care planning system, which the registered manager was imp

There were 31 people living at Kynance Residential Home at the time of our visit. We looked around the building which was clean and free of unpleasant odours. All the rooms were single occupancy with ensuite toilets and hand basins. The rooms were personalised with photographs, TV's and pictures. There was a lift so that people could access the first floor.

During our visit we spoke with four people who used the service and five members of staff including the registered manager, a health care professional who was visiting the home and two visitors. We observed how staff interacted and supported people. We saw staff treating people in a sensitive, respectful and professional manner.

People told us that they “that the staff were helpful” and that the food was “very good” and “fair”. One visitor told us that the staff were ok and another that they had no complaints. A health care professional we spoke with told us that they visited the home regularly and that they had no concerns or issues with Kynance Residential Home. However during our visit one person raised concerns about their experiences whilst at the home.

We spoke with nine of the 28 people who were living at the home. They said that they were “very happy” with their care and the staff “knew how to care for them”. People also said the “staff were friendly” and “available when I need them”. People told us they were “looked after very well”. Most people were happy with the meals that were provided and told us that choices were available. We spoke with three relatives who said they were “very satisfied with the care their loved one was receiving” and they were kept informed about any changes such as visits from the doctor. They said when visiting the home they had never observed or heard anything that caused them any concern.

We also spent time observing care in communal areas. We found people had positive experiences. We observed that staff were courteous and respectful of people's views. Choices were offered and where necessary informal consent was obtained. A group of people went out in the home’s minibus on the morning of our inspection visit. The staff knew what care and support people needed and they respected their wishes. The care people told us they received matched with what was recorded in their care plans.

We found that medication was correctly managed and appropriate recruitment and induction procedures were followed. People received a varied diet with a choice provided at each meal. Care plans were relevant to people’s needs and records were well maintained and stored securely.

Some people using the service were able to tell us about their experiences. However, other people were unable to talk to us due to their age related memory loss. We spent some time in the home’s communal lounge and dining room observing people and staff. Interactions were warm and friendly with staff clearly having a good knowledge about the people they were caring for.

Everyone we spoke with confirmed that their privacy and dignity were maintained at all times. People also said that they were able to make day to day decisions such as what time they got up and how and where they spent their time. People gave us examples of when their choices had been respected such as whether to go out on a mini bus trip or to remain at home. People told us they had a choice about what they had for their meals.

People said that they had no concerns about how their personal care needs were met. People said that if they were unwell then staff would contact a doctor for them. People said staff were available when they needed them and knew what care they required.

People told us that lots of activities were provided including minibus outings to various places chosen by them. We were also told about regular slide shows with old photographs and discussions that occurred.

People said that they felt staff were available whenever they needed assistance. They also said that staff were very pleasant and had the necessary time to meet their needs. People told us that call bells were promptly answered.

People told us about meetings that are held to discuss activities, menus and other things. People said that if they had any concerns or complaints they would raise these.

We also spoke with other professionals involved in the care of people. They stated that they had no concerns about how people’s health and care needs were met.