Kenton Manor

Kenton Manor is a care home providing personal and nursing care to people aged 65 and over. The service can support up to 65 people. There were 60 people living at the home at the time of the inspection.

The home supports people living with dementia; however, the provider had not requested the service user band ‘dementia’ to be added to Kenton Manor. Service user bands are categories CQC use to identify a range of specialist ‘needs’ of people who will receive a service. The registered manager told us this would be addressed.

People’s experience of using this service and what we found

Whilst a system was in place to monitor the quality and safety of the service; records relating to the assessment of risk, people's nutritional intake and their care and support were not always accurate or up to date. Records also did not demonstrate how the provider was meeting their responsibilities under the duty of candour. The provider’s quality monitoring system had not identified all the issues with the maintenance of records.

Appropriate legal authorisations were in place to deprive a person of their liberty. However, records relating to MCA and consent were not always well maintained. The registered manager told us this would be addressed.

Relatives considered people were safe at the home. One relative told us, “It’s by far the best home here. It’s safe and secure, problems are very rare.” Checks and tests were carried out to make sure the building and equipment was safe. Staff followed safe moving and handling procedures.

There were sufficient staff deployed to meet people’s needs. Where people required one to one support, this was provided. Due to the current workforce pressures in Adult Social Care, agency staff were sometimes used. We received some feedback around staff communication and language barriers. The nominated individual and registered manager were aware of this issue. We did not see any issues around communication or language barriers on the days of our inspection. We observed positive interactions between permanent staff, agency staff and people.

Staff were trained and supported to meet people’s needs. One relative told us, “Their (staff) qualities are being well trained and knowing what they are doing. They are friendly, have a laugh and crack on with their work. They are professional.”

There was a positive atmosphere at the home. People, relatives and a health professional spoke positively about the caring nature of staff. One relative told us, “It’s the love and care they give that stands out. It’s second to none. I wouldn’t take them (person) anywhere else.”

People and relatives told us they thought the home was well managed and communication was good. Comments included, “The home is run smoothly. The manager, she is good and very efficient” and “Once a month I get a phone call to see if I have any questions and I’m asked for any problems, but, there aren’t any.”

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 16 June 2021).

Why we inspected

The inspection was prompted due to concerns received about falls management, staff deployment, moving and handling procedures, the provision of meals and the maintenance of records. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led key questions of this full report. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘All inspection reports and timeline’ link for Kenton Manor on our website at www.cqc.org.uk.

Enforcement

We identified 2 breaches in relation to good governance and the duty of candour. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Kenton Manor is a residential care home providing personal and nursing care to 36 people aged 65 and over at the time of the inspection. The service can support up to 65 people.

People’s experience of using this service and what we found

Since our last inspection the service had a new registered manager in post, and we found positive changes throughout the home.

Relatives we spoke to were positive about the care provided and praised the registered manager and staff team. Their comments included, “Staff are very good and kind. I am always made welcome when I visit, and I also feel valued,” and “The new manager seems approachable. Staff I have spoken to seem to be working well together and said they are enjoying being under direction of a new manager. Overall changes seem to be happening.”

Staff spoke fondly about the people they supported. We observed staff spending one to one time with people and there were positive interactions throughout the home.

Medicine management had improved but we did find areas which required reviewing. The service had implemented new procedures and processes following the last inspection; however, these were not fully embedded. We also identified areas which required further improvements to ensure people were safe.

We have made a recommendation that the provider reviews all medicine care plans and associated records.

During the inspection process the registered manager addressed the issues we identified with medicines and had already implemented a new recording system for recording and monitoring of fluid thickeners.

The premises were safe and there were enough staff to safely support people. Accidents and incidents were recorded, investigated and analysed to find areas for improvement. Any lessons learned from incidents were shared with staff to help reduce the risk of repeat events occurring.

People’s care plans were person-centred and highlighted individual choices. Staff worked with families to make sure people’s choices were respected. People could participate in meaningful activities.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff had received regular training and the registered manager was providing targeted training sessions every month. Staff were supported and the staff culture had improved. Regular meetings were taking place and staff felt able to provide feedback at these or with the registered manager.

The quality and assurance systems effectively monitored the service and allowed for areas of improvement to be identified. Relatives told us that the communication from the service was improving and the registered manager was engaging with them via zoom and newsletters.

Rating at last inspection and update

The last rating for this service was requires improvement (published 29 September 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Kenton Manor is a residential care home providing personal and nursing care to 32 people at the time of inspection, some of whom were living with a dementia. The service can support up to 65 people in one large adapted building.

People’s experience of using this service and what we found

Medicines were not always managed safely. People did not always get their medicines as prescribed. People’s care plans for medicines prescribed as ‘when required’ were not always person centred and some required a review. The management team took action after our inspection to address this.

Risk assessments were in place for people, but these were not always accurate or reviewed. Risk assessments relating to the use of emollient creams were missing from people’s care records.

Some care files were not a person centred or completely reflected the needs of people. The management team took positive action with this and are currently reviewing and updating all people’s care records.

The new management team in place were currently implementing a new quality and assurance framework to monitor the safety and quality of care provided. We found this required further development to identify issues.

Staff knew people well and we saw positive interactions between people and staff. Relatives praised care staff for the support they provided to people. Relatives told us they felt people were safe with the care staff and this had improved since our last inspection.

Staff told us the communication had greatly improved and they were confident with the new management team. Some relatives said communication had improved but some commented that they did not feel communicated with particularly during the pandemic.

There was an effective infection prevention and control policy in place and staff were following this to keep people safe. This had been reviewed and updated to reflect the current pandemic relating to COVID-19 and extra steps were in place to minimise the risk to people living at the service.

Staffing levels were appropriate to support people. There continued to be a robust recruitment process in place and clinical staff had their registration checked by the manager. Agency staff received an induction and all clinical staff had their medication competencies checked regularly.

Accidents and incidents were recorded and monitored by the manager. Any incidents or concerns were investigated fully and shared with the local authority and CQC. Lessons learned from incidents were shared with the staff team to prevent the risk of repeated events and to improve the quality of care provided to people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection (and update)

The last rating for this service was inadequate (published 03 December 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

This service has been in Special Measures since December 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an announced comprehensive inspection of this service on 07 October 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve person-centred care, safe care and treatment, governance and employing fit and proper persons.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kenton Manor on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to safe medicines management and the governance framework in place at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider, local authority and the NHS Clinical Commissioning Group (CCG) to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Kenton Manor is a residential care home providing personal and nursing care to 60 people at the time of inspection, some of whom were living with a dementia. The service can support up to 65 people in one large adapted building.

People’s experience of using this service and what we found

The arrangements for medicines management did not keep people safe. People were at risk of serious harm, injury or death due to unsafe management of 'as required' medicines, diabetes management and epilepsy management.

People were also at risk of serious harm as staff did not have clear guidance within care records in relation to risk assessments, care plans or protocols to support people safely. Clinical staff did not always follow the provider’s processes, best practice guidance or prescribing instructions.

Clinical staff did not always refer people in a timely way to other health care professionals, for example the GP. People’s health needs were not always fully assessed and recorded.

The quality assurance processes were not effective to ensure people were safe from risk of serious harm. The provider did not have oversight of the service and they were not aware of the issues we identified as part of the inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 4 December 2019) and the service was placed into ‘special measures’. At the last inspection there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do, and by when, to improve.

At this inspection enough improvement had not been made and the provider was still in breach of the regulations.

Why we inspected

We undertook this targeted inspection to make sure all aspects of the provider’s action plan had been completed. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

CQC are currently trialling targeted inspections, to measure their effectiveness in following up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

Enforcement

We have identified two continued breaches Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is in relation to safe medicines management, leadership of the service and the quality and assurance systems in place.

Please see the action we have told the provider to take at the end of this report.

Follow up

At the time of the inspection the provider was working towards completing an action plan from our previous inspection which reflects what they are doing to improve the standards of quality and safety, and we are receiving regular assurances of the progress of improvements. We will work with the provider, local authority and Clinical Commissioning Group (CCG) to monitor progress and discuss on-going concerns.

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Kenton Manor is a residential care home providing personal and nursing care to 64 people at the time of inspection, some of whom were living with a dementia. The service can support up to 65 people in one large adapted building.

People’s experience of using this service and what we found

People were at risk of harm due to medicines not being managed safely and clinical staff did not follow best practice guidelines. Prescribing instructions for medicines were not always followed correctly by staff.

Risk assessments and care plans were missing from people’s care records. Care records and risk assessments that were in place were not always legible and therefore could not be followed safely by staff. Care plans were not personalised and did not reflect people’s individual choices or needs.

The service was not well-led and there continued to be a lack of oversight by the provider and registered manager. The quality and assurance systems in place at the service were not effective. Issues identified were not always acted upon to remove or mitigate risks. Actions we asked the provider to complete after our last inspection had not been fully completed.

Staff did not always demonstrate knowledge or competence when delivering support to people. Best practice guidance was not always followed, and staff did not follow processes created by the registered manager or provider.

Since our last inspection the registered manager had worked with care staff to improve the culture and care provided to people, but this positive staff culture was not always demonstrated by clinical staff. Staff did not follow infection control procedures and associated risks had not been identified or mitigated.

People told us that they felt safe and happy living at the home, and relatives agreed with these comments. People were engaged in a range of meaningful activities and had access to the local community. The service encouraged people’s social relationships and welcomed all visitors into the home.

People were provided with a range of food and drinks to help them to maintain a healthy balanced diet. People were happy with the food and the selection available. People were regularly asked for their feedback about the service and care provided.

Staff received regular training and supervisions. Staff, people and relatives were complementary about the registered manager. Staff had access to regular team and handover meetings. Care staff were very kind and caring with people, and respected their privacy and dignity.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update:

The last rating for this service was requires improvement (published 7 November 2018) and there were multiple breaches of the regulations. At this inspection we found the provider and registered manager had not made improvements to the safety and quality of care provided to people or to the leadership and governance of the service. Improvement had been made with regards to staffing levels within the service, but we found clinical staff were not always fully competent to keep people safe.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected:

This was a planned inspection based on the previous rating.

Enforcement:

The service met the characteristics of inadequate in three key questions of safe, effective and well-led. The service has been rated as requires improvement in caring and responsive. We have identified breaches in relation to medicines management, infection control, staffing knowledge and competency, providing person centred care and the effectiveness of the leadership and governance of the service.

We have requested that the provider reviews all care records, including 'as required' medicine protocols, to ensure that they are fully completed, accurate, and legible.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety and seek assurances of the progress of improvements. We will work with the provider, local authority and Clinical Commissioning Group (CCG) to monitor progress and discuss on-going concerns. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We inspected the service to follow up on the breaches and to carry out a comprehensive inspection.

At the last inspection in September 2017 the service was not meeting all of the legal requirements with regard to regulations 9, person-centred care and regulation 12, safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found some improvements had been made but there were continued breaches of regulations 12, safe care and treatment and regulation 9, person-centred care as further improvements were required with regard to aspects of people’s care. At this inspection we found two other breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to regulation 18, staffing levels and regulation17, good governance.

You can see what action we told the provider to take at the back of the full version of the report.

Kenton Manor is a care home. People in care homes receive accommodation and nursing or personal care as 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.

Kenton Manor accommodates a maximum of 65 older people, including people who live with dementia or a dementia related condition, in one adapted building. At the time of inspection 64 people were using the service.

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 2008 and associated Regulations about how the service is run.

The provider had a quality assurance programme to check the quality of care provided. However, the systems used to assess the quality of the service had not identified some of the issues that we found during the inspection and those that had been identified were not actioned in a timely way.

People said they felt safe and they could speak to staff as they were approachable. However, we had concerns that staffing levels were not sufficient or that staff were appropriately deployed to ensure people received person-centred care. People said staff were kind and caring. However, we saw staff did not always interact and talk with people. Limited activities and entertainment were available to keep people engaged on the middle and top floor of the home. In some parts of the home there was an emphasis from staff on task-centred care.

Improvements were required to the management of medicines. People were not always supported to have maximum choice and control of their lives with staff supporting them in the least restrictive way possible, the policies and systems in the service did not always support this practice. We have made a recommendation about the management of medicines.

Record keeping was inconsistent. Detailed guidance was not available for staff to minimise or appropriately manage risks to all people. Written information was not available to ensure all people were supported safely and in a person-centred way. There were some opportunities for staff to receive training to meet people's care needs. A system was in place for staff to receive supervision and appraisal. However, we have made a recommendation about staff training

Changes had been made to the environment. Some areas had been refurbished. However, not all areas of the home were clean and well-maintained for the comfort of people who used the service. Further improvements were required to ensure the environment was designed to promote the orientation and independence of people who lived with dementia. We have made a recommendation that the environment should be designed according to best practice guidelines for people who live with dementia.

People were protected, as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

People had access to health care professionals to make sure they received appropriate care and treatment. People received a varied and balanced diet to meet their nutritional needs. However, improvements were required to people’s dining experience.

Staff followed advice given by professionals to make sure people received the care they needed. Communication was effective to ensure staff and relatives were kept up-to-date about any changes in people’s care and support needs and the running of the service.

A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to. People had access to an advocate if required.

The home provides accommodation, nursing and personal care for up to 65 people, including people living with dementia. There were 63 people living at the home when we inspected.

The home had a registered manager. 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.

During this inspection we found the provider had breached the regulations relating to safe management of medicines and person-centred care. People did not have care plans to guide staff as to when to administer when required medicines or covert medicines. Other records were available to confirm regular medicines were administered and stored appropriately. We found people’s care was often rushed and there was a lack of stimulation and engagement for people in communal areas.

You can see what action we have told the provider to take at the back of the full version of this report.

People and relatives said the home was safe.

Staff had a good understanding of safeguarding and the provider’s whistle blowing procedure. They knew how to report concerns. Safeguarding concerns had been referred to the local authority safeguarding team and fully investigated by the provider.

People, relatives and staff said there were enough staff deployed to meet people’s needs in a timely way.

Regular health and safety related checks were carried out, such as checks of fire safety, gas and electrical safety and specialist equipment. The provider had a business continuity plan to deal with unforeseen emergencies. People had personal emergency evacuation plans (PEEPs) which described their support needs in an emergency.

Accidents and incidents at the home had been recorded and investigated. These were monitored to look for trends and patterns.

There were effective recruitment procedures and protocols to ensure staff were recruited safely. This included taking up references and completing Disclosure and Barring Service (DBS) checks.

People were 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 the service supported this practice.

Although people were supported with eating and drinking as needed, we noted some people were brought to the dining room a long time before their meal arrived.

Staff told us they were well supported and had access to training to enable them to carry out their role effectively.

Staff supported people to access healthcare services when required.

People’s needs had been assessed which included identifying their care preferences. Although medicines care plans were not available for most people, other care plans we viewed were personalised. These had been reviewed regularly to help ensure they reflected people’s current needs.

There were some opportunities for people to participate in group activities if they wished. This included a coffee morning and arts and crafts sessions.

People and relatives knew how to raise concerns. Previous complaints had been investigated and action taken to resolve the complaint.

Staff had opportunities to give their views and suggestions about the home. For example by attending staff meetings or speaking with the registered manager.

There were regular quality assurance checks. Where improvements had been identified action had been taken to deal with the issue. However, we noted medicines audits were not fully effective as they had not identified people did not have medicines care plans.

There were opportunities for people and relatives to provide feedback about the home. The most recent feedback was positive. Regular residents’ meetings were held although these were not always well attended. We have made a recommendation about this.

We undertook this focused inspection on 6 October 2016 to confirm that they now met legal requirements. We also examined staffing levels as a recommendation had been made previously, and personal care, as this was raised as an area of concern by a relative and dealt with by the local safeguarding adult’s team. This report only covers our findings in relation to the legal requirement, the recommendation and areas raised as being of potential concern. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Kenton Manor on our website at www.cqc.org.uk.

Kenton Manor provides accommodation, nursing and personal care for up to 65 people, including people living with dementia. There were 64 people accommodated there on the day of our inspection.

The service had 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.

We found the provider had complied with the legal requirement in relation to the safe management of medicines. We found the provider was in breach with the regulation relating to the safe use of the premises.

The registered manager and staff had taken steps to ensure that medicines required on a weekly basis and before food were administered as prescribed.

People and staff said staffing levels were sufficient to ensure people’s needs were met safely. Staff were busy but not rushed. We found some people could not use their call bells, so required staff to monitor their wellbeing. Guidance to staff to ensure those individuals were kept safe was not clear.

The home was mostly clean and hazardous areas controlled. However kitchenette areas required refurbishment or replacement to ensure they could be kept clean and corrosive dish washer liquid stored securely. A large number of cartons containing dietary supplements were out of date.

Risks in relation to poor nutrition and hydration were assessed and monitored. We highlighted the need for nursing staff to more consistently guide care workers on target fluid intakes and on what to do should these not be achieved.

Staff helped people with their hygiene and personal care. People were well groomed and appropriately dressed in clean clothing. Some records relating to the support staff provided were inconsistently completed.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to the safe care and treatment and ensuring good hydration. You can see what action we told the provider to take at the back of the full version of this report.

Kenton Manor provides accommodation, nursing and personal care for up to 65 people, including people living with dementia. There were 65 people accommodated there on the day of our inspection.

The service had 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 felt safe and were well cared for. Staff took steps to safeguard vulnerable adults and promoted their human rights. Incidents were dealt with appropriately, which helped to keep people safe.

The building was generally safe and well maintained. Chemical feeds for the kitchenette dish washers were accessible and had to be secured to limit unintended access. This was resolved at the time of the inspection. Many easy chairs were low and difficult for some people to get out of. We were told new chairs were on order. Other risks associated with the building and working practices were assessed and steps taken to reduce the likelihood of harm occurring. The home was clean.

We made recommendations regarding the way staffing levels were assessed and determined and the suitability of the furnishings available for people.

We observed staff acted in a courteous, professional and safe manner when supporting people. We received mixed comments about whether the levels of staff on duty were sufficient to safely meet people’s needs. The provider had a robust system to ensure new staff were subject to thorough recruitment checks.

Improvements were required to the way certain medicines were managed. Systems to ensure medicines requiring administration on a weekly basis needed strengthening. Other medicines were safely managed.

As Kenton Manor is registered as a care home, CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found appropriate policies and procedures were in place and the registered manager was familiar with the processes involved in the application for a DoLS. Arrangements were in place to assess people’s mental capacity and to identify if decisions needed to be taken on behalf of a person in their best interests. Where necessary, DoLS had been applied for. Staff obtained people’s consent before providing care.

Staff had completed safety and care related training relevant to their role and the needs of people using the service. Further training was planned to ensure their skills and knowledge were up to date. Staff were well supported by the registered manager.

Staff were aware of people’s nutritional needs and where people were at risk of malnutrition, appropriate support was provided. People’s health needs were identified and external professionals involved if necessary. This ensured people’s general medical needs were met promptly. People were provided with assistance to access healthcare services.

Activities were offered within the home and people also had occasional trips out. We observed staff interacted positively with people. We saw staff treated people with respect and explained clearly to us how people’s privacy, dignity and confidentiality were maintained. Staff understood the needs of people and we saw care plans and associated documentation were clear and person centred.

People using the service and staff spoke well of the registered manager and felt the service had good leadership. We found there were effective systems to assess and monitor the quality of the service, which included feedback from people receiving care and oversight from external managers.

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

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found -

Is the service safe?

We saw that risks to personal safety were assessed and steps were taken to protect people from avoidable harm.

Staff closely observed and supervised people to ensure their safety. People's mental frailty was taken into account to identify their vulnerabilities and prevent them from being harmed.

Staff who worked at the home were properly checked and vetted to make sure they were suitable to be employed to care for vulnerable people.

Is the service effective?

People living at the home were given care and support that was appropriately planned to meet their needs. They told us, 'I'm very happy here, I get all the help I could possibly need', and, 'It's all good, we get well looked after'.

The service supported people to have adequate nutrition and hydration. People were given choices of suitable food and drinks and told us they liked the meals. One relative told us their family member had gained weight since living at the home and another said their relative had made progress in eating independently. They said, 'He couldn't even use a spoon to feed himself when he came here from hospital. Now he can use a knife and fork again'.

Is the service caring?

People's care was focused on meeting their individual needs and was provided by staff who we observed were patient and encouraging. Relatives confirmed this and told us, 'I've never heard the staff be anything other than kind and polite', and, 'Some of the staff transferred here from the previous home my mother was in. They already knew her needs, they're fabulous with her'.

Is the service responsive?

People's needs were assessed before they moved into the home. Care was planned according to individuals' preferences, interests and diverse needs. When people's needs changed, staff adapted their care to ensure their welfare and safety was protected.

People had access to activities that were important to them and were supported to maintain relationships with their family and friends.

Is the service well-led?

The manager and staff had good understanding of the ethos of the service and their roles and responsibilities. Quality assurance systems were in place to keep checks on standards and get people's views about the home.

There was a clear complaints procedure and comments and complaints were acted on to make improvements to the service that people received.

Staff understood their roles in protecting vulnerable people. Any concerns that people were not being safeguarded from harm were responded to appropriately.

Systems were in place to check the quality of the service provided, and to make any necessary improvements.

Care and other records in the home were held securely and were accurate and informative.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

People and their relatives spoke positively about the service and expressed no complaints. Their comments included: 'In my opinion the care is excellent'; 'We're treated very well here'; and, 'The staff keep me up to date. They're very good and will do whatever you ask'.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.