Kenwyn

Kenwyn provides accommodation with personal care for up to 109 people. There were 72 people using the service at the time of our inspection. Some people were living with physical disabilities, long term physical health and mental health conditions including dementia. Kenwyn occupies a large detached purpose-built building over two floors and is divided in to four units, two on each floor.

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

At our last inspection we made recommendations in relation to staffing levels, how staff were deployed, guidance for the use of agency staff and the provider taking advice about the development of a consistently open culture.

At this inspection we found there were enough staff on duty to meet people’s needs. Staff were allocated to work in specific units, which meant people received care from a consistent staff team. Staff told us there were occasions when staffing levels were lower than planned, when short notice sickness occurred. However, staff were re-deployed between units, to cover for absences, to ensure there was the appropriate skill mix in each unit.

The service had not used agency staff since the start of the pandemic, to reduce the risk of cross infection. This had resulted in people being cared for by permanent staff who had the skills and knowledge to meet the needs of everyone living at the service.

There was a positive culture within the staff team and staff told us they felt supported by the management team. The registered and deputy managers had built open and trusting relationships with staff and this had helped bring about the culture change since the last inspection.

Staff were recruited safely. The service had continued to recruit throughout the COVID-19 pandemic, to ensure there were enough staff to cover for sickness or for staff who needed to shield or self-isolate. Staff were supported by a system of induction, training, supervisions, appraisals and staff meetings.

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.

Care plans were accurate and up to date. They provided staff with comprehensive guidance to ensure people’s needs were met. Risks were identified and staff had clear instructions to help them support people to reduce the risk of avoidable harm.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately. Staff were informed about people’s changing needs through effective shift handovers and informative records of the daily care provided for people.

Medicines were well managed, and people received their medicines safely as prescribed for them.

Cleaning and infection control procedures had been updated in line with COVID-19 guidance to help protect people, visitors and staff from the risk of infection. Government guidance about COVID testing for people, staff and visitors was being followed.

Visiting arrangements for people’s families had been facilitated, in line with government guidance at any given time, throughout the pandemic. Recently nominated relatives were making regular visits to see their loved ones, and this was welcomed.

People, their relatives and staff told us management were approachable and they listened to them when they had any concerns or ideas. All feedback was used to make continuous improvements to the service.

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. (Report published on 5 September 2019) and there were two recommendations. At this inspection we found improvements had been made.

Why we inspected

The inspection was carried out to follow up on the action we recommended the provider take at the last inspection. As a result, we carried out this focused inspection to review the key questions of Safe, Effective and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. 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.

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.

The overall rating for the service has changed from requires improvement to good. 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 Kenwyn on our website at www.cqc.org.uk.

Follow up

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

Kenwyn provides accommodation with personal care for up to 109 people. There were 78 people using the service at the time of our inspection. Some people were living with physical disabilities, long term physical health and mental health conditions including dementia

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

The service had not had a registered manager for over a year. A new manager had started working at Kenwyn two days prior to this inspection and was being supported by the deputy and regional managers.

CQC had received several anonymous concerns from staff, members of the public and people living at the service, about staffing levels, poor care and poor management. The local authority had also investigated several safeguarding concerns since the last inspection. CQC had reported these concerns to the provider who had recognised the low morale of staff, investigated each event and provided us with a report on the actions they had taken. The provider had also sought to discuss with CQC their plan to help ensure staff felt listened to and well supported in the future.

The provider used a dependency staffing tool, to help ensure there were sufficient staff to meet people’s needs. However, staffing levels had been lower than planned on several occasions in the last month. A safeguarding concern had been raised by a staff member about one specific weekend. Complaints had been received by the provider regarding this. The provider assured us this had been investigated and action had been taken to help ensure staffing was always at a level to meet people’s needs. On the day of our inspection there were the planned number of staff on duty.

There were short notice staff absences. Some staff had left without notice. Staff morale was low. Staff told us they did not trust the management team and felt their views and experiences were not heard or acted upon. The provider had provided may opportunities for staff to share their concerns.

A visiting healthcare professional told us, “We see high levels of stress in the staff, they came to us to seek support.” The healthcare professional and their colleagues met with the management team to discuss the staffs concerns. They told us, “We were told there was no problem. There were enough staff. So, I can see the staff members predicament. It is a pity that they [provider] have spent a great deal of money on the décor but don’t seem to get the staffing right. After all, that is what the business is all about, caring for people, and that requires staff.”

Audits were carried out regularly to monitor the service provided. However, actions from these audits had not always been carried out in a timely manner. Regional directors’ reports showed actions needed to be carried forward from a previous audit in February 2019. This meant opportunities to further improve the service may have been missed.

Some staff had not always received appropriate training and support to enable them to carry out their role safely. The provider had recognised that training was required for some staff. We were advised after this inspection that training shortfalls had been addressed. At inspection supervision and appraisals appeared to have not always been provided according to the policy held at the service. After the inspection the provider sent additional evidence that staff had been appropriately provided with supervision.

There were systems and processes in place to monitor the Mental Capacity Act, and associated Deprivation of Liberty Safeguards assessments and records. We had concerns about the effectiveness of these processes at our last inspection and made a recommendation about this in the last report. The records held at the service were now accurate.

Staff were kind. People had their privacy and dignity protected

People were provided with the equipment they had been assessed as needing to meet their needs. For example, pressure relieving mattresses. These were correctly set for the person using them.

Staff were recruited safely in sufficient numbers to ensure people’s needs were met.

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.

There were activities provided for people by four activity co-ordinators seven days a week.

Everyone living at the service had a care plan which was regularly reviewed.

Risk assessments provided staff with sufficient guidance and direction to provide person-centred care and support.

Complaints were recorded, and responses were seen. The provider told us they had received complaints regarding the recent period of low staffing and that they were meeting with families to resolve this concern.

Rating at last inspection:

At the last inspection the service was rated as Good (report published 30/11/2018)

Why we inspected:

The inspection was prompted in part due to concerns received about low staffing levels, poor care and poor management support. A decision was made for us to inspect and examine those risks. We also checked if the positive conditions applied to the provider’s registration were met. Positive conditions were applied at a previous inspection in and remained in place after the inspection in March 2018. At this inspection the service had not embedded changes sufficiently to keep the overall rating as Good. the overall rating has changed to Requires Improvement and the conditions remain in place.

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

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.

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

At the last comprehensive inspection on 3 and 9 October 2017, we had concerns about medicines management. People did not always receive their prescribed medicines in a timely manner, or as prescribed. Medicine records were not always accurate. Nursing staff did not follow the choking protocol when a person choked at the service. Identified specific risks to people living at the service were not always reviewed and updated in a timely manner. We issued a requirement action against the provider for a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

The action plan sent to the Care Quality Commission (CQC) following the previous inspection, had not been effectively put in to place or monitored and omissions and errors continued to occur. Complaints from healthcare professionals and families of people living at the service were not always satisfactorily resolved. Records relating to Deprivation of Liberty Safeguards (DoLS) authorisations held at the service were not accurate. Care plans did not provide clear guidance and direction for staff. Records relating to the provision of commissioned one to one support had not been kept by staff. This meant it was not possible to establish if the commissioned care had been provided. We took enforcement action against the service as a result of the repeated breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 and issued a warning notice.

At the focused inspection on 22 January 2018 we reviewed the actions taken to meet the requirements of the warning notice. We inspected only the Safe and Well Led sections at that time. Weekly and monthly medicines audits were being carried out on all areas of medicines administration and management and these were effectively identifying when errors occurred. However, medicine errors continued to take place. Three medicine errors had been reported since the last inspection. This led to a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Risks in relation to people's daily lives were identified, assessed and planned to minimise the risk of harm. However, some guidance was not always sufficient to guide staff to reduce risks effectively. Staff were being injured by one person's behaviour that challenged. Agreed action had not been taken to record such events, and specific guidance was not provided to staff to help reduce such events in the future. Whilst the service had met the specific concerns in the warning notice, further concerns were identified which led to a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. The service had been commissioned to provide 12 hours a week of one to one support with activities for one person. This had not been recorded as having always taken place. This meant this person was not having the activity levels provided as commissioned by the local authority. Staff did not have the skills and knowledge to meet this person's needs. We issued a requirement notice to the provider for a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Due to the repeated nature of concerns found at the past three inspections a condition was applied to the registration certificate of the service. This condition states that the provider must report to the CQC bi-monthly on the action it has taken to address the repeated concerns found at the last three inspections. This inspection was carried out to review the action taken to comply with the outstanding breaches of the regulations and to review the reports sent in to CQC by Barchester Healthcare Limited as required.

Kenwyn is a nursing home which offers care and support for up to 109 predominantly older people. At the time of the inspection there were 86 people living at the service. Some of these people were living with dementia. Some people were living with physical disabilities, long term

physical health and mental health conditions including dementia. Kenwyn occupies a large

detached purpose-built building over two floors. The service was divided in to four units.

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.

There were systems in place for the management and administration of medicines. It was clear that people had received their medicine as prescribed. Regular audits were being carried out on specific areas of medicines administration and these were effectively identifying if any error occurred such as gaps in medicine administration records (MAR). Whilst there continued to be medicine errors reported by Kenwyn, these were being identified in a timely manner and addressed with the specific individual. The system for monitoring people who self-administered their own medicines was effective.

We spent time in the communal areas of the service. Staff were kind and respectful in their approach. They knew people well and had an understanding of their needs and preferences. People were treated with kindness, compassion and respect. The service was comfortable and appeared clean with no odours. People’s bedrooms were personalised to reflect their individual tastes.

People told us, “Oh yes it’s beautiful. I love the birds in the grounds” and “Yes, it’s very good here.” Relatives told us, “We are very happy and lucky to have [Person's name] here. We fought very hard to get him back here.”

The premises were well maintained. There was renovation and redecoration work taking place throughout the service during this inspection which was due to be completed in a few weeks. People were supported to use quiet areas in other parts of the building during this work. There was some pictorial signage at the service to support people, who were living at the service with dementia, who may require additional support with recognising their surroundings. The premises were regularly checked and maintained by the provider.

Equipment and services used at Kenwyn were regularly checked by competent people to ensure they were safe to use. One person told us, “The rooms are pleasant and the general atmosphere here is good.”

Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs were recorded. Daily notes were completed by staff. Risks in relation to people’s daily lives were identified, assessed and planned to minimise the risk of harm whilst helping people to be as independent as possible. Risk assessments provided appropriate guidance and direction for staff.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. The service had staff vacancies at the time of this inspection which were being covered by a number of agency staff. There was some concern on one unit regarding the staffing levels due to the dependency of one person at the time of this inspection. The management team agreed to review this. One person with specific healthcare needs was being supported by some staff who did not have the necessary knowledge and skills to meet their needs. We have made a recommendation about this in the Safe section of this report.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

People had access to activities. An activity co-ordinator was in post. There were three staff who provided activities throughout the service. However, there was little activity recorded for people who were being cared for in bed. We spoke with the manager about this who agreed to address this issue.

Technology was used to help improve the delivery of effective care. Some people has sensors on their bedroom doors which were activated when a person entered or left the room. However, on several occasions throughout this inspection these sensors were found to be off following staff visits to the person in their rooms. This meant the person could leave, or another person could enter the room, without staff being aware. Call bells were available to people to summon assistance when needed.

Staff were supported by a system of induction training, supervision and appraisals. Staff felt happy working at Kenwyn and told us that morale was good.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. The service held appropriate policies to support staff with current guidance. Mandatory training was provided to all staff with regular updates provided. The manager had a record which provided them with an overview of staff training needs.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards (DoLS) were understood and applied correctly. However, the records held by the service regarding the DoLS authorisations which were in place were not always accurate. We have made a recommendation about this in the Effective section of this report.

The service had experienced some changes recently with three manager changes in recent years. Kenwyn had been managed by an interim general manager for several months prior to the current new manage

The service was rated as Requires Improvement at that time. Following this inspection the service remains Requires Improvement. Following the last inspection the service sent us an action plan stating the actions it was taking to meet the legal requirements of the regulations. This focused inspection was carried out to check they had followed their action plan and to confirm they now met the legal requirements. This report only covers our findings in relation to the Safe and Well led domains. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kenwyn on our website at www.cqc.org.uk

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. Kenwyn is a care home which offers nursing care and support for up to 109 predominantly older people. At the time of the inspection there were 80 people living at the service. Some people were living with physical disabilities, long term physical health and mental health conditions including dementia. The service occupies a large detached building over two floors. The service is divided in to four units providing different levels of care to people according to their needs.

The service had reported two further medicine errors since the last inspection. A third took place days before this inspection. The nurse did not follow the service policy to seek medical advice or contact the person’s family following the error. There were systems in place for the management and administration of medicines. Recently implemented weekly and monthly medicines audits were being carried out on all areas of medicines administration and management and these were effectively identifying when errors occurred. Audits looked at areas such as daily stock tallies, stock balances carried forward, self-administration assessments and the signatures on medicine records. The most recent medicine error was identified by the next shift, after the error occurred, due to nurses counting medicines at every medicine round.

Risks in relation to people’s daily lives were identified, assessed and planned to minimise the risk of harm whilst helping people to be as independent as possible. However, some guidance was not always sufficient to guide staff to reduce risks effectively.

Lessons were not always being learnt by the service following events that took place. One person had been identified as having behaviour that challenged staff, agreed actions had not been implemented to address the concern. Staff were being injured on a daily basis. One member of staff had been reported as having responded inappropriately to being injured by this person. This matter was being investigated at the time of this inspection by external agencies. The service had not taken adequate internal action to advise staff on how to support the person and record incidents each time staff were injured. One person had conflicting information in their care plan and room charts regarding when staff should re-position them.

One person was not having their specific needs met by staff who did not have sufficient knowledge and skills to meet their needs. Staff recognised this but no specific action had been carried out to try to improve things for the person. Records did not evidence that this person was receiving the agreed individual support commissioned.

Another person had discussed and agreed their specific dietary requirements with the staff and chef at the service. However, during this inspection this person was offered inappropriate foods. This meant people did not always receive person centred care.

Records about the assessment of a person’s mental capacity were not clear. One assessment stated they did not have capacity for a decision about having bed rails. A second assessment was delayed having recognised the person understood but could not, at that time, make their own decision. The treatment escalation plan (TEP) stated they had capacity. Later in their care plan it stated this person had a Deprivation of Liberty Safeguards authorisation in place when this was incorrect. No authorisation was in place. An application had been made to the supervisory body (Local authority) for this to be assessed. This meant staff were not being provided with accurate information to guide their care practice.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. The service had staff vacancies at the time of this inspection which were being actively recruited for. Agency staff were being used to cover vacant posts and were often the same staff working regularly at the service. This meant they were familiar with people living at the service and their needs.

At the last inspection people were not supported to leave the service and go out in to the local area as staff were not trained to use the service’s vehicle. At this inspection staff had been provided with the necessary training and people were supported by staff to go out, to visit the local area.

The registered manager had resigned two weeks prior to this inspection. An acting manager was in place at the time of this inspection. The manager was supported by a deputy manager and a clinical lead. The provider was also supporting this service with regular visits.

The staff were happy working at the service and recognised positive changes in the service over the past few weeks. They felt well supported and able to seek advice and guidance at any time. There was a significant amount of work in progress and it was too soon for us to judge the impact of these changes at the time of this inspection. We will review the service again with a comprehensive inspection in the future.

We found a breach/breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

This responsive comprehensive inspection took place on 3 and 9 October 2017. The first visit was unannounced, the second visit was announced. Concerns were received by the Care Quality Commission and Cornwall Council safeguarding unit from the service about medicine errors which had occurred at the service. There had also been concerns raised by the public and healthcare professionals that some people had not always had their care needs met and their concerns had not always been resolved to their satisfaction.

The last inspection took place on 4 and 10 October 2016. There were two breaches of the regulations found at this inspection. We were concerned that medicines management was not always safe and that regular medicine audits and checks had not identified the concerns found at the inspection. We found that care plans were not always updated to take account of people’s changing needs. The registered manager had not appropriately recorded an investigation into a medicine error. This meant it was not possible to establish the details of all decisions made to help ensure a re-occurrence of such events did not take place in the future.

Following the inspection in October 2016 the provider sent the Care Quality Commission an action plan outlining how they would address the identified breaches. We carried out this inspection in response to concerns raised and to check on the actions taken by the service to meet the requirements of the regulations.

Kenwyn is a nursing home which offers care and support for up to 109 people. At the time of the inspection there were 96 people living at the service. Some people were living with physical disabilities, long term physical health and mental health conditions including dementia. The service is made up of a large detached building over two floors. The service was divided in to four units.

We walked around the service which appeared clean, comfortable and found that there were no incontinence odours. People’s rooms were personalised to reflect people’s individual tastes. People’s choices were respected.

Systems for the management and administration of medicines were not robust. Three medicine errors had been identified by the service since the last inspection. Two errors, which occurred a week apart, involved two people not having their prescribed pain relief given to them. This was because the service did not have sufficient stock.

We found during this inspection further concerns regarding the safe management and administration of people’s medicines. Three people were found to have not received their medicines as prescribed.

Regular medicines audits and ‘resident of the day’ checks were not consistently identifying when errors and omissions occurred. 'Resident of the day' was a system when a named person was chosen daily for a full review of all aspects of their care including their medicines. Recent support and training provided to all the nurses had not been effective in addressing the medicine concerns found at this inspection.

Nursing staff did not always follow the service's policies. For example, the specific action to take when a person choked. The registered manager was investigating an incident where a person had choked and did not receive the care and treatment from a nurse as set out in the service policy.

Staff were supported by a system of induction training, supervision and appraisals. People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s care and support needs were mostly assessed and planned for to minimise the risk of harm. These risks were regularly reviewed to take account of changes in people’s care needs. One person’s care plan did not contain required risk assessments to help protect them from the risk of abuse from another person.

Staff received training relevant for their role and there were good opportunities for on-going training and support and development. More specialised training specific to the needs of people using the service was being provided. For example, tracheostomy care. Staff meetings were held regularly for all teams of staff. There was a daily ‘stand up’ meeting held with each units nurse and team leads from throughout the service to discuss both people living at Kenwyn and the service's needs.These daily meetings allowed staff to air any concerns or suggestions they had regarding the running of the service and helped communication throughout the service. Staff told us they felt well supported by the management team.

The registered manager carried out dependency assessments for each person. These assessments identified the minimum numbers of staff required to meet people’s needs. We found the staffing levels were above those dictated by the dependency assessment carried out by the service. People, families and staff felt there were sufficient staff to meet people’s needs. However, some families and visiting healthcare professionals told us it was sometimes difficult to find staff when they visited.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005 (MCA). The principles of the Deprivation of Liberty Safeguards (DoLS) were understood. The registered manager was not clear how many DoLS authorisations were in place, we were told there were nine, when the DoLS team told us there were actually10. Eight DoLS authorisations had not been notified to the Care Quality Commission in line with legal requirements.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary, staff monitored what people ate to help ensure they stayed healthy. People had their weight monitored regularly. Referrals were made to healthcare professionals where necessary to seek guidance and support with people’s changing needs.

The premises were well maintained. There were two resident maintenance staff who carried out repairs although we were concerned some works such as redecoration of one unit and repairing showers had been delayed. The dementia unit had been due to be re-decorated at the last inspection and this had not taken place. One unit had some pictorial signage to meet the needs of people living with dementia.

Care plans were well organised and contained information to guide and direct staff to meet people’s needs. We found the 'Resident of the day' review system took place but was not always effective in identifying issues found at inspection.

Some care plans did not always contain accurate and up to date information. Care planning was reviewed regularly and people’s changing needs were mostly recorded. People, and where appropriate relatives, were invited to the reviews which took place, although care plans did not show any recorded evidence that people, or if appropriate families, had been shown and agreed to their own care plans.

People had access to planned activities. An activity team was in post, providing 90 hours of activities each week throughout the service. They arranged regular events for people. These included, craft, music, exercise, dancing and housework tasks. People were not able to access the local community in the service's mini bus, as it had not been possible to have a member of staff assessed as competent to drive the bus and support people travelling in it safely. We were assured by the registered manager this was being addressed.

The registered manager was supported by a deputy manager, a team of nurses, carers and activity staff. The registered manager received regular support from the regional director for the provider.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 related to poor medicines management, ineffective audits and systems in place to identify the concerns found at this inspection and ineffective resolution to some people's concerns.

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

Kenwyn is a care home which provides nursing care for up to 109 people. At the time of this inspection there were 100 people living at the service. Some people were living with physical disabilities, long term physical health and mental health conditions including dementia. The service made up of a large detached building over two floors. The service was divided in to four units.

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.

The registered manager had carried out an investigation into the concerns raised about medicines management at Kenwyn. The report stated, “We will continue to monitor medicines management closely to ensure robust systems are in place.” However, the registered manager had not documented interviews with key staff which had taken place as part of the investigation.

There had been a robust audit of medicines management at Kenwyn at the beginning of August 2016. There were some issues found at this audit which needed to be addressed. We found these issues had continued to occur and were found at this inspection visit. This meant the management team at Kenwyn had not taken effective action to address the concerns identified by the audit.

At this inspection we found there were some concerns with the recording practices of staff when receiving, recording and administering medicines. Handwritten entries on to the medicines administration record (MAR) following verbal instructions from a medical practitioner, were not always signed by two staff to reduce the risk of any errors. Out of 15 staff who administered medicines, 11 had been provided with appropriate training and regular updates. We were assured by the registered manager, that the four staff who required an update would be addressed immediately.

Risks to people living at the service were identified and assessed. However, risk assessments were not always updated to take account of any changes to people’s needs. This meant that the risk assessment records for some people were not accurate.

Staff were clear on how to report any safeguarding concerns they may have. The service had raised safeguarding alerts to the local authority appropriately in the past. Staff were confident that any concerns raised would be listened to and action would be taken to protect vulnerable people.

Kenwyn was fully staffed at the time of this inspection. There were sufficient numbers of staff to meet the needs of people living at the service. Short notice absence, such as staff sickness, was covered by agency staff where possible.

Activities were provided for people by a dedicated activities team who worked in the service seven days a week. Some people were supported to go out in to the local community to take part in activities they enjoyed.

Care plans held clear information and guidance for staff on how to meet an individuals care and support needs. Reviews of people's care plans took place regularly. However, they were not always updated in a timely manner to help ensure they were accurate and up to date following any change in a person's needs. Such changes were not always clearly recorded on handover records. This meant that staff may not always be made aware of a change in a person's care needs.

Staff told us they found the management team approachable and supportive. Staff were provided with supervision, although this was not always in accordance with the policy held at the service. Staff meetings were held regularly to discuss any concerns staff may have and share information. Staff morale was good and staff told us they were happy working at Kenwyn.

Kenwyn was well maintained. The service was in the process of redecorating each unit with new carpet and furnishings. There were maintenance staff who addressed any faults that occurred and were reported by staff. Staff told us that all their equipment was functioning effectively. One staff member told us that if they requested any specific equipment such as pressure relieving mattresses these were provided in a timely manner.

The service had a unit for people living with dementia. This unit had good signage to help people who required support with recognising their surroundings, such as pictorial signs on bathrooms and toilets. People's bedroom doors were personalised to help people recognise their own room. This signage increased people's independence when moving around the service.

Staff were kind and caring. We observed staff assisting people with patience and respect. Staff were always available to assist people to move around the service and at mealtimes. People enjoyed the food at the service. Mealtimes were a sociable occasion with many people eating and chatting together in the dining rooms on each unit.

The service carried out an annual survey of people’s views and experiences in October 2015. The 2016 survey was due to go out to people and their families this month. A food survey had been carried out at Kenwyn with several responses received which were positive about the food and its presentation. However, there had been no residents and families meetings held at Kenwyn in the last nine months.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we told the provider to take at the end of this report.

Kenwyn is a nursing home which offers care and support for up to 109 people. At the time of the inspection there were 97 people living at the service. Some people were living with physical disabilities, long term physical health and mental health conditions including dementia. The service comprises of a large detached building over two floors. The service was divided up in to four units.

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 walked around the service which was warm and comfortable. Bedrooms were personalised to reflect people’s individual tastes. People were treated with kindness and respect.

We looked at how medicines were managed and administered. We found it was always possible to establish if people had received their medicine as prescribed. Regular medicines audits were consistently identifying when errors occurred.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met.

Staff were supported by a system of induction training, supervision and appraisals. However, staff were not receiving supervision according to the policy held at the service, which stated staff should be supervised four times a year. More specialised training specific to the needs of people using the service was being provided, such as dementia care. Staff meetings were held regularly. These allowed staff to air any concerns or suggestions they had regarding the running of the service.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs recorded. Where appropriate, relatives were included in the reviews.

There were staff dedicated to providing 80 hours a week of activities for people at the service. However, the activities provided were not meaningful and relevant to people’s specific interests and abilities.

The registered manager was supported by a deputy manager and senior staff from the four units at the service. The provider supported the management team with regular visits from the area managers.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

At the time of our inspection we found the service was safe because people's rights and dignity were respected and they were involved in decision making about risks.

People told us they felt safe living at the home and with the staff.

We saw that risks to people had been assessed and plans were in place to minimise any risks.

People's care and support monitoring records were completed and regularly reviewed to ensure they received the right care and support.

Staff were trained in safeguarding and knew how to report any allegations of abuse.

Staff were aware of the Mental Capacity Act 2005 and how to involve appropriate people, such as relatives and professionals, in the decision making process if someone lacked the mental capacity to make a decision.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguard (DOLs). We found the service to be meeting the requirements of the legislation. Applications had been submitted appropriately, policies and procedures were in place and we found staff to be well informed.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints and concerns. This reduced the risks to people and helped to continually improve the service.

Is the service effective?At the time of our inspection we found the service was effectively meeting the needs of all the people who used the service. Staff had a good understanding of people's needs and responded to changes in their needs in a timely way.

People told us 'it is very good here', 'we have a choice of menu and food is excellent', 'they give us a list of things we can do each day' and 'you get privacy if you want it.' People told us they could go to bed and get up whenever they chose.

People, or their representatives were involved in their assessments and developing their care plans.

People received appropriate support from healthcare professionals when required.

Newly appointed staff received an induction prior to starting work which included a period of shadowing more experienced staff and a probationary period of three months.

People's end of life wishes had been planned for. People and their relatives told us they were involved in decision making. We saw evidence of advocacy services being used to support people where they did not have any family or representatives and required support in making some decisions.

The premises had been sensitively adapted to meet the needs of people with physical impairments.

Is the service caring?

At the time of our inspection we found the service to be caring as people were treated with dignity and respect and were listened to.

People spoke positively about the care they received and that staff were kind, caring and compassionate. One person told us 'I really rate it 'and 'The staff know me really well, I don't like going to bed and that's ok.'

People's privacy and dignity was always maintained. We saw staff maintained people's dignity during personal care and during moving and handling.

We saw people's preferences and dislikes were clearly recorded and respected. Life histories were recorded along with lifestyle choices, this meant staff had all the information to be able to care for and support people as individuals.

Is the service responsive?

At the time of our inspection we found people received a service that responded to their needs. We saw people had their capacity assessed in relation to making decisions, and best interest decisions were made in consultation with relatives, staff and professionals.

We saw a GP from the local practice had been asked to see a person who was unwell. They told us 'They always call us appropriately and in a timely way, they are pretty good.'

People told us they had access to call bells when they required assistance. We were told by most people the staff responded quickly, but one person told us 'Staff don't always come as quickly as I would like when I ring the call bell but they are usually tied up with someone else.' This person told us this happened occasionally and it was usually due to staff being required to assist another person who was unwell. This person told us 'staff levels have improved recently and it has not happened for a while.'

Kenwyn had two activity co-ordinators who planned and organised activities throughout the four units of the home. We saw some evidence of people receiving 1:1 activities in their rooms. Staff told us they enjoyed spending time with people having a chat or encouraging them with some activity.

We saw the complaints procedure was available to people. Many compliments and thank you cards had been received by the home, praising the care received.

People's views and experiences of the service were sought and any issues were responded to promptly.

Is the service well ' led?

At the time of our inspection we found the service was well-led, staff told us the registered manager was approachable, supportive and had made a real difference to the service.

Observations and feedback from people, relatives, staff and visiting professionals was that the culture of the home had improved and become more open and transparent. This was because people, relatives and staff said they felt listened to by the manager and that action was taken when they raised concerns.

The management had systems in place to assess and monitor the service provided.

There were robust systems in place to monitor the safety of the building and equipment.

Staff had begun to receive regular supervision and appraisals.

There were 80 people using the service at the time of our inspection, 42 on Trellisick and Pencarrow, 32 on Tresco and 12 on Glendurgan.

We saw people's privacy and dignity were being maintained. People we spoke with told us 'they treat me okay really, they close the doors and curtains, that's good and use my name when helping me', ' they talk to me, we have a conversation' and 'They always make sure the room is warm and close the doors when caring for me'. Another person told us 'they wake me up, always eight o'clock, they won't let me sleep'. This person did not know they could sleep in if they wished to.

We saw care plans were detailed and generally gave direction to staff as to the care and support people needed. They had been regularly reviewed. We saw they were not always developed and reviewed with the person using the service and /or their relatives where appropriate.

People were protected from the risks of inadequate nutrition and dehydration.

There were enough qualified, skilled and experienced staff to meet people's personal care and nursing needs. We noted some training needs around the management of specialist diets.

We saw evidence of on-going audit in areas including medicines management, complaints and health and safety. Results of satisfaction surveys were shared with people who used the service and their representatives. Notifications had not always been submitted to the Care Quality Commission in a timely fashion.

We spoke with the provider, registered manager, area manager, staff, and one person who lived at the home. Most of the people who lived at Kenwyn were unable to comment on the care they received, we therefore observed how staff assisted them throughout the day whilst we reviewed the records.

We saw that there were adequate staff to meet the needs of the people that lived at Kenwyn, in a relaxed and dignified manner.

The care plans had recently been reviewed and/or rewritten to ensure that staff were directed on how to care for a person in a clear and concise way.

People's meal choices and dietary requirements had been gathered and there were snacks and drinks available throughout the day.

Care staff assisted people with meals in a timely manner and staff interaction during these times had improved since our previous visit to the home.

Training had taken place on issues regarding nutrition and hydration. This meant that staff were aware of their responsibilities and the importance of the overall dining experience.

During this inspection we saw a number of improvements made by the provider, manager and staff. We will continue to monitor Kenwyn to ensure that the recent improvements and new processes have been sustained.

People that had been assessed as at risk of malnutrition and/or dehydration were not effectively monitored. Food and fluid charts were not completed consistently and people were not weighed in line with their care plan.

People that used the service were not protected from the risks of inadequate nutrition and dehydration.

Staff felt supported by the heads of department, managers and nurses. Formal supervisions had commenced for care staff and nurses.

Training was provided to new staff within a week of them commencing work within the home, this included manual handling, infection control and safeguarding. Most staff had completed safeguarding of vulnerable adults and manual handling training.

There was not an effective system in place to regularly monitor the service and to respond to any issues or concerns that were raised.

The staff demonstrated a good knowledge of the care needs of the people that lived at Kenwyn nursing home. Care plans did not always reflect the needs of the people that lived at the home.

People were seen to take part in a number of activities. The manager told us that they would be recruiting more staff in order to provide more activities.

We saw and heard most people being offered choices and treated with respect, However care workers were seen not to interact well with the people they were assisting with their lunch time meal.