Kernow House

Kernow House is part of the Barchester Healthcare group of homes. It provides personal care and nursing care for up 98 people. There were 71 people using the service at the time of our inspection. The service supports individuals with Huntington's disease, dual diagnosis, acquired brain injury, dementia and mental health issues.

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

Staff understood risks to people and how to help reduce them. Systems were in place to safeguard people. The service raised concerns appropriately.

People received their medicines on time from staff who had received training and competency checks in medicines administration.

Infection control measures were in place to prevent cross infection. People told us the service was kept clean. There were no malodours throughout the service during this inspection.

Staff were recruited safely in sufficient numbers to ensure people’s needs were met. The use of agency staff had dramatically reduced since the last inspection. Staff were supported by a system of induction, training and supervision. Staff told us they felt well supported by senior staff and the registered manager.

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. Any restrictive practices were regularly reviewed to ensure they remained the least restrictive option and were proportionate and necessary.

There were systems and processes in place to monitor the Mental Capacity Act, and associated Deprivation of Liberty Safeguards assessments and records. People were able to make choices about their life and how their care and support were provided. This information was reflected in people’s care plans. Staff understood the importance of respecting people’s wishes and choices.

People, relatives and health and social care staff agreed the staff were kind and caring. Staff respected people’s diverse characteristics and were clear that each person’s individual needs were their priority.

People told us they felt listened to and their privacy and dignity were respected. Comments included, “I love living here, food is lovely, staff are nice, spend time with me” and “It is a lovely here, it is a very caring home.” A relative told us, “I could not be happier with the care here. [Person’s name] even gets her hair done regularly.”

Visiting health and social care staff told us, “I have been coming regularly for some time now. They [Staff] do a good job, I have no concerns at all” and “I have seen improvements in staff morale.”

Everyone had a care plan which was regularly reviewed and updated. These provided staff with guidance and direction to enable them to meet people’s need. People’s preferences were sought and respected.

There were activities provided for people. Two activity co-ordinators supported staff to provide varied activities. Robotic pets and a ‘magic’ table were available for people to use. People were supported to go out in to the local area, with staff, in the service minibuses.

Audits were carried out regularly to monitor the service provided. Actions from these audits were being acted upon to further improve the service. Records were stored appropriately, accessible and up to date.

Systems were in place to deal with concerns and complaints. This enabled people to raise concerns about their care if they needed to. The registered manager told us there were no on-going complaints at the time of this inspection.

People and staff told us the service was well led. Staff told us, “This is a good place to work, I have worked in other places and this is one of the best” and “I really enjoy working here.”

People were given various opportunities to provide feedback about the service. The registered manager and senior staff had developed positive relationships with local organisations, which helped ensure people had their needs met promptly. Staff told us they enjoyed working at the service and that the team worked well together.

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:

At the last inspection the service was rated as requires improvement (report published 27 March 2019) and there was a breach of the regulation. At this inspection we found enough improvements had been made and the provider was no longer in breach of the regulation.

Why we inspected:

This was a planning inspection based on the previous rating.

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.

Kernow House is part of the Barchester Healthcare group of homes. It provides personal and nursing care to up to 98 people within three units. The service was supporting 80 people on three separate units on the day of our inspection. The service supports individuals with Huntington’s disease, dual diagnosis, acquired brain injury, Dementia and mental health issues”.

People’s experience of using this service:

The service was short staffed and significant numbers of agency staff were being used to meet people’s care needs. On the day of our inspection, in one unit, there were more agency staff on duty than employed staff and relatives told us, “I came to visit one day and the unit had all agency staff on it”.

Staff told us morale was low and some were contemplating leaving the service. Managers recognised and accepted that the service was experiencing difficulties recruiting and retaining staff. A targeted recruitment campaign was underway and the provider was making additional arrangements to support the service with recruitment.

Where risks had been identified, staff including agency staff, did not always understand how to manage these risks. During the inspection an incident occurred as the staff member providing individual support for a person did not understand how to meet their needs. In addition, action taken in order to manage specific risks following incidents had not proved effective. Known changes in risks had not always been included in people’s care plans and an equipment storage room was repeatedly left open and unattended during the inspection.

Recruitment procedures were robust and staff understood their role in protecting people from abuse. Medicines were administered safely.

Staff were sufficiently skilled to meet people’s needs and their training was regularly updated. People’s dietary needs were met and the service’s kitchen had a five star food hygiene rating. One unit was tired and in need of redecoration and replacement carpets. These works were planned and in the process of being commissioned.

Manager and staff had a good understanding of the Mental Capacity Act and necessary applications to deprive people of their liberty had been appropriately submitted.

People’s privacy and dignity was not always respected and staff did not consistently respond when people became distressed. During the morning staff were busy with limited time to provide individualised support.

Care plans were up to date and sufficiently detailed. The service was able to meet people’s needs at the end of their lives and relatives had written to express their gratitude to staff.

The register manager had left the service and one of the providers operations managers had become the service's acting manager two weeks prior to our inspection. Staff were complimentary of the acting manager’s approach and told us, “I am quite a fan [of the new manager]”.

Complaints had been appropriately investigated and resolved and the service had systems in place to monitor the quality of support it provided. These systems had identified that staff recruitment and retention was an ongoing issue.

Some care records had not been fully completed and the service’s recruitment records were disorganised.

Rating at last inspection:

Good (report published on 1 September 2018). The service had been rated requires improvement at a previous inspection in June 2017.

Why we inspected:

This inspection was brought forward in response to concerning information we had received about the service’s performance. This included an incident that had been reported to safeguarding and the police.

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 two units for people with Huntington’s Disease and three dementia units, one of which provided care for people who could become agitated and required more intensive staff support. At the time of our inspection there were 78 people living at the service. The service is large purpose- built home on two floors with access to the upper floor via stairs or two passenger lifts. Most rooms have en-suite facilities and there are shared bathrooms, shower facilities and toilets.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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.

As part of this comprehensive inspection we checked to see if the provider had made the required improvements identified at the inspection of 17 and 19 May 2017. In May 2017 we found the registered manager/provider was not ensuring the numbers of staff on duty was sufficient to help ensure people’s needs were met in a timely manner. People’s rights were not fully protected because the service had not acted within the legal requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards. Staff morale was extremely low. Recent changes to the way the service operated had not been effectively communicated to staff and staff’s perception of these changes was very negative.

At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met all the outstanding legal requirements from the last inspection and is now rated as Good.

Since the last inspection staffing levels had been reviewed and the way staff were deployed in the service meant people’s needs were being met. However, there was a continuous recruitment programme and there was a reliance on agency staff to support and maintain staffing levels.

Staff understanding of how to ensure people’s legal rights were protected had improved. Additional training had supported the management team to understand the legal requirements of the Deprivation of Liberty Safeguards (DoLS). Some people lacked the mental capacity to recognise the decline in their physical capabilities, which potentially put them at risk of harm, such as sustaining injuries from falls. These people were subject to restrictive practices or continuous supervision to protect them from the risk of harm and keep them safe. DoLS applications had been made to the local authority to seek the legally required authorisation to have these restrictions in place.

Regular engagement with all levels of staff through meetings and day to day overview meant communication had improved. Staff told us they felt supported by the management team. Staff comments included, “It’s got a lot better. We (staff) see the managers a lot,” “I think we get told a lot more about what’s going on now. There have been a lot of changes but it’s meant it’s got better” and “None of us like change but it helps when we get told about what’s going on and why.”

Risks in relation to people’s daily lives were identified, assessed and planned to minimise the possibility of harm whilst helping people to be as independent as possible. Records included evidence of reviews to make sure changes were being monitored and responded to. Care plans included information about people’s general health and who was involved in the person’s care and welfare.

Medicines were generally managed safely with regular audits identifying where any errors had occurred. However, the time of the morning round in one unit took up to four hours, meaning it finished close to lunchtime when the following round was due. On further investigation we found this had been due to a number of circumstances that morning. Medicines were stored securely and safely.

Some people’s health needs meant they needed to have their food and drink intake monitored to ensure they received sufficient each day. We found the records for monitoring were complete and helped staff to monitor peoples diet and nutrition. This was particularly important for people living with Huntington’s Disease where high calorific intake was necessary at certain stages of the disease.

Staff were supported by the registered manager through regular updates called ‘stand up meetings’. These kept the staff team up to date with any changes and provide any essential information that might be needed to be shared to support peoples care and welfare.

People received care and support that was responsive to their needs because staff had the information to support them. Staff supported people to access healthcare services. These included, social workers, psychiatrists, GP and speech and language therapists (SALT). The service had its own physiotherapist and occupational therapist which helped access to these services when they were required.

Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. There was a wide range of training available to all staff which met the diverse needs of people being supported. Staff were supported through formal and informal group supervision. There had been some gaps in recording formal individual supervision but a new system had recently been implemented to address this.

Some parts of the service had been refurbished including lounge areas and bathrooms. However, some areas of the environment required attention. For example, some chairs had cushions torn and stained. One lounge area had a malodorous odour and the carpet was stained. We spoke with the registered manager about this. We had received negative comments about these areas prior to inspecting the service. There was a maintenance and refurbishment plan continuing and this would improve all areas of the service.

Infection control measures were in place. Where people were at high risk of infection staff were knowledgeable about the risk and action to be taken. There was a housekeeping team who told us they had the training and equipment to keep the service clean and understood key issues for infection control.

Safeguarding procedures were in place and staff had a good understanding of how to identify and act on any allegations of abuse.

There was a system in place for receiving and investigating complaints. People we spoke with had been given information on how to make a complaint and felt confident any concerns raised would be dealt with to their satisfaction.

The provider had systems in place to monitor the quality and safety of the service.

Kernow House is part of the Barchester Healthcare group of homes. It provides personal and nursing care to a maximum of 98 people within five specialist units. There were two units for people with Huntington’s Disease and three dementia units, one of which provided care for people who could become agitated and required more intensive staff support. At the time of our inspection there were 70 people living at the service.

There was a registered manager in post who was responsible for the day-to-day running of the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Before this inspection we received concerns about staffing levels at night. We found these concerns related to one unit where the level of night staff had been reduced. However, the reason for the reduction in staffing was because the needs of the people living in that unit were lower. Also night staff were shared between this unit and an adjoining unit because the two units had joined together.

A recent review of staffing numbers, across all the units, had resulted in staffing levels being reduced, although the review also took into account that fewer people were living at the service. A dependency tool was used to determine the staff numbers in each unit, which assessed each person across a range of different needs. While we found the numbers of staff on duty in each unit were in line with the recorded assessments of people’s needs there were delays in people’s needs being met. For example, on the first day of the inspection all of the units were busy and lunch time took over two hours to complete. In one unit staff finished serving breakfast only 45 minutes before lunch started.

A review of how staff were deployed between the five units had also taken place. This meant staff were sometimes moved from their usual unit to work in another unit where the needs of people’s were the highest. Staff told us they did not always feel confident to support people in units they didn’t normally work in as they were not familiar with their needs.

From our observations and feedback from people and staff we judged that the dependency tool used had not sufficiently taken into account the level of staffing needed to meet some people’s needs. In addition we found staffing levels were not adjusted as people’s needs fluctuated or to take into account staff who may be new to the unit and therefore not so familiar with people’s needs. For example, on the first day of the inspection people’s needs were not being met in a timely manner. However, on the second day, with the same number of staff, people’s needs were being responded to more promptly.

Staff supported people to maintain a balanced diet in line with their dietary needs and preferences. During the inspection staff told us people no longer had access to snacks such as crisps, chocolate and frizzy drinks and some people enjoyed these snacks. We found while these items of food were not stored in the kitchens in each unit they were still available for staff to access from the main kitchen. The management told us a decision had been taken across the service to encourage people to eat healthier snacks, such as yoghurts and fruit. However, this decision had not been effectively communicated to staff as they were not accessing these snacks from the main kitchen. There was also no evidence that people had been consulted about the decision the service had taken to encourage people to eat healthier snacks.

We found staff morale in the service was very low. Staff’s perception of the recent changes to staffing levels, how staff were deployed and the decision to reduce the availability of certain snacks were extremely negative. Every member of staff we spoke with expressed their concerns about the changes. Comments from staff included, “There is no continuity moving around the units and it’s unsafe”, “They’ve cut staff. I have been sent home four times because they have changed the rota on my day off and not told me”, “They have taken crisps and chocolate away and people can only have one glass of juice in the morning” and “Nine times out of 10 there are not enough staff and we can’t take people out.” We judged that there had been poor communication and support for staff around the organisational changes.

Most people living at the service were unable to tell us their views of the staffing levels. One person did tell us, “The place hasn’t got enough staff.”

Management and staff applied the principles of the Mental Capacity Act 2005 (MCA) in the way they cared for people. Although, we found records did not clearly state on what legal authority staff were providing care for one person. Where people’s liberty was restricted in their best interests, authorisation for these restrictions had been sought from the local authority. For some people conditions had been applied to their Deprivation of Liberty Safeguards (DoLS) authorisation. Records to show that these conditions had been complied with were not being kept.

People’s care files included risk assessments which identified risks and the control measures in place to minimise risk. However, we found insufficient action had been taken to mitigate the risk of harm for one person because a long lead used to operate the bed in their room had not been removed. Once we alerted the registered manager to this omission the lead was immediately taken away.

Care records were personalised to the individual and detailed how people wished to be supported. They provided clear information to enable staff to provide appropriate and effective care and support. Any changes to people’s needs were recorded as part of the monthly review process. However, for some people these changes had not been updated in their main care plan which meant information about some people’s current needs was not easily available for staff to follow. We have made a recommendation about the recording of people’s care needs.

While most people were unable to tell us about their experiences we observed they were relaxed and at ease with staff. People had good and meaningful relationships with staff and staff interacted with people in a caring and respectful manner. People who were able to tell us about their experiences said, “It’s nice here. I’d rather be here than out in the rain” and “Everything’s OK. It’s tickety boo.” A relative told us, “Staff are responsive to my requests and don’t skive off when I want my son moved from chair to bed.”

People received their medicines on time. Medicines administration records were kept appropriately and medicines were stored and managed to a good standard.

The service worked closely with healthcare professionals such as dementia liaison nurses, psychiatrists, speech and language therapists and GPs to help ensure people’s individual needs were met. Incidents and accidents were recorded in each unit. An overview for the whole service was collated and analysed by the registered manager.

Staff had received training in how to recognise and report abuse. Staff told us if they had any concerns they would report them to management and were confident they would be followed up appropriately.

Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. Staff received appropriate training and supervision. New employees completed a thorough induction which incorporated the care certificate, which is an industry recognised induction that replaced the Common Induction Standards in April 2015.

People and their families were given information about how to complain. There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed.

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

After the comprehensive inspection the provider submitted an action plan to tell us what they would do to meet the legal requirements in relation to the breaches.

Prior to our inspection we received information of concern from the local authority safeguarding team about people’s call bells not being answered, the competency of nursing staff and staff’s understanding of safeguarding processes. We undertook this focused inspection on 11 November 2016 to check improvements had been made and to look into the concerns which had been raised by the local authority.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Kernow House on our website at www.cqc.org.uk.

Kernow House is part of the Barchester Healthcare group of homes. It provides personal and nursing care to a maximum of 98 people within five specialist units. There were two units for people with Huntington’s Disease and three dementia units, one of which provided care for people who could become agitated and required more intensive staff support. At the time of the inspection there were 70 people living at the service.

The service 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.

People told us they felt safe living at the service. Staff were confident and understood what action they should take if they were concerned someone was being abused, mistreated or neglected. People’s call bells were observed to be answered promptly. People’s medicines were managed safely, and when people’s medicines were administered covertly the Mental Capacity Act 2005 (MCA) had been implemented to ensure people’s human rights were protected.

People whose care needs meant they may require a restriction of their freedom of movement, were supported by staff who had received relevant training. However, not all staff had undertaken this training, so an action plan was in place to ensure all staff completed the training by March 2017.

People who had an accident or incident had care records in place to help support them and minimise ongoing risks. However, some people’s risk assessments and care plans had not been updated, which meant they may not receive the correct support to keep them safe. Action was being taken to educate staff on the importance of completing documentation.

Nursing staff received continuous clinical training to advance their knowledge and spoke confidently about their understanding of the safe management of people’s medicines, Huntington’s Disease, the Mental Capacity Act 2005 (MCA) and the reporting of accidents and incidents. Staff told us they received training to meet people’s individual needs and felt supported by the registered manager and deputy manager. The registered manager told us she felt more supported since the introduction of a new line manager. New quality monitoring systems had been put into place to enable a clearer overview of accidents and incidents and medicines, prompting action and improvement when necessary.

The Commission had not been informed of significant events in line with their legal obligations. However, immediate action was taken to submit the outstanding statutory notifications. The divisional director told us they would be implementing new processes within the service and across the organisation to ensure this did not happen again.

At the last inspection on 10, 12 and 16 November 2015 we asked the provider to take action to make improvements. We found that the systems in place to monitor the quality of the service people received were not effective, for example, audits had failed to identify areas of concern. We also found that records relating to people’s care were not always securely stored. In addition, there were issues around the deployment of staff within the service, meaning that people’s social needs were not always met and there was a lack of personalised activities on offer for people. The provider sent us an action plan which explained how they would address these breaches of regulation. During this inspection we found that some of these issues had been addressed.

Kernow House is part of the Barchester Healthcare group of homes. It provides personal and nursing care to a maximum of 98 people within five specialist units. There were two units for people with Huntington’s Disease and three dementia units, one of which provided care for people who could become agitated and required more intensive staff support. At the time of the inspection there were 76 people living at the service.

The service was in the process of registering a 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.

Incidents were recorded, however incident forms relating to safe holds or restraint lacked detail about the incident, which staff members had been involved and what action was taken. For example, where people had required restraint or “safe holds”, staff had not recorded the incident in sufficient detail and there was a lack of clarity about the process for recording incidents such as this. Audits of the incident forms had failed to identify this concern. Some staff had not received training around safe hold techniques, despite being in situations where this had been required. Minutes of staff meetings indicated that staff had been requesting training in this area since August 2015.

Staff generally managed people’s medicines safely, however people who had their medicines hidden in food or drink (covert administration) were not having decisions about their medicines recorded and reviewed in a way that ensured they were safe and their medicines were effective.

Staff had received training relevant to their role and there was a system in place to remind them when it was due to be renewed or refreshed. However not all staff had received training around safe holds. Staff were supported by a comprehensive induction and there was an ongoing programme of supervision, competency checks and appraisals.

We observed positive, compassionate and caring interactions between people and staff. Staff took the time to stop and chat with people and to share appropriate humour. Staff knew the people they cared for well and spoke about them with fondness and affection. One staff member said; “I love it here. I love the people”. A relative told us; “The care is marvellous. The way they encourage and support is incredible”.

People’s care plans were detailed documents which contained information about their background, history, likes and dislikes. Staff confirmed that the care plans contained the correct guidance and information in order to provide the right level of support for people. People’s care plans were linked to risk assessments and contained information for staff on how to reduce the likelihood of them coming to harm.

People enjoyed the meals. They told us they were of sufficient quality and quantity and there were alternatives on offer for people to choose from. People were involved in planning the menus and their feedback on the food was sought.

People had their healthcare needs met. For example, people had their medicines as prescribed and on time. People were supported to see a range of health and social care professionals including speech and language therapists, podiatrists, doctors and social workers.

People were kept mentally and socially engaged through a range of activities, both inside the service and in the local area. The service employed an activities coordinator and activities were personalised to people’s individual needs.

People were kept safe by suitable staffing levels. Relatives told us there were enough staff on duty and we observed unhurried interactions between people and staff. This meant that people’s needs were met in a timely manner. Recruitment practices were safe. Checks were carried out prior to staff commencing their employment to ensure they had the correct characteristics to work with vulnerable people.

There was a safeguarding adult’s policy in place and staff had received training around this. Staff confidently described how they would recognise and report any signs of abuse. There were policies in place around the duty of candour and whistleblowing which staff were aware of and applied to their practice. This encouraged an ethos of openness and honesty.

Staff were knowledgeable about the Mental Capacity Act and how this applied to their role. Where people lacked the capacity to make decisions for themselves, processes ensured that their rights were protected. Where people’s liberty was restricted in their best interests, the correct legal procedures had usually been followed. People were involved in planning their care and staff sought their consent prior to providing them with assistance. However, there were some issues in the recording of decisions for those who required the covert administration of medicines

People, staff and relatives were encouraged to give feedback through a variety of forums including team meetings, residents’ meetings and questionnaires. This feedback was used to drive improvements within the service. There was a system in place for receiving and managing complaints. Relatives said they felt confident that if they raised concerns these would be dealt with appropriately. There was a quality assurance system in place with a range of audits including care records and staff and resident satisfaction surveys, however not all audits successfully identified concerns.

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

We gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We gathered information from people who used the service by talking with them and observing care practices.

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

We were able to observe most of the 77 people who used the service at the time of our inspection. We were not able to converse with all of them as some had various stages of dementia and others were receiving palliative care. Those we did talk with seemed very happy in their environment and repeatedly said how lovely all the staff were.

We observed the staff, the staff we spoke with were happy in their work and had worked at the home for some time.

Is the service safe?

At the time of the inspection the service was safe.

Systems were in place to help the manager and staff team learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. Staff showed a good understanding of the care needs of the people they supported.

Kernow House alerted the local authority and the Care Quality Commission when notifiable events occurred or they had any concerns regarding people who used the service. Kernow House had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DOLS). This helped to ensure that people's needs were met.

Is the service effective?

At the time of the inspection the service was effective.

People's health and care needs were assessed with them, and people were involved in writing or reviewing their plans of care if they had the capacity to do so. During our inspection it was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people's needs.

Specialist dietary needs had been identified where required. Care plans were up-to-date.

We saw there was good liaison and communication with other professionals and agencies to ensure people's care needs were met.

The quality of recording seen was of a good standard enabling nurses and care staff to use the information correctly.

Is the service caring?

At the time of the inspection we found the service to be caring.

We could not speak with all of the people being supported by the service due to their health care needs. Those we did speak with were positive about the staff who cared for them, for example, 'Wonderful' and 'Staff are very friendly' and 'Very considerate carers'. When speaking with staff it was clear they cared for the people they supported.

People's preferences and interests had been recorded and life histories were evident.

Kernow House had regular support from the local GP practices and other visiting health professionals. This helped ensure people received appropriate care in a timely way.

Is the service responsive?

At the time of the inspection we found the service to be responsive.

Many people who lived at Kernow House had complex health and care needs and were either not able to, or chose not to join in group activities. The care records showed evidence of the lifestyle of these people and we observed that staff spent one-to-one time with people throughout the day.

The service worked well with other agencies and services to make sure people received care in a coherent way.

Is the service well-led?

At the time of the inspection we found the service to be well-led.

The deputy manager told us that regular staff meetings were held. This showed the management consulted with staff regularly to gain their views and experiences and improve support for people who lived at the service.

The service had a quality assurance system, and staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes that were in place. This helped to ensure that people received a good quality service at all times.

Some of the people that lived at Kernow House had a form of dementia and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences people had we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allowed us to spend time watching what was happening in a service and helped us to record how people spent their time, the type of support they got and whether they had positive experiences. Some people who lived at Kernow House were able to tell us about their experience and we also spoke with a visitor and a health professional.

A visit was undertaken by an NHS Pharmaceutical Advisor to look at the arrangements for safe handling of medicines. Commissioning services reviewed people's care. No concerns were identified from those reviews. We received information from one person's family that, over a 12 year period when they lived at Kernow, the professionalism at the home had been "faultless". We monitored events at the home.

We visited Kernow House on 7 and 8 January 2014 to check whether people remained safe and look at the measures in place to prevent a reoccurrence of events. We found those arrangements were now more robust. For example, the use of formalised, face to face staff supervision gave staff more opportunity to disclose poor practice or concerns.

We found that, although medicine management arrangements had been reviewed and improved they still required some further improvement to ensure risks were well managed.

One person told us that the unit in which they lived was quite nice but they thought they should move away and live independently. They said that the staff were "mostly" very nice. We found that staff understanding and practice ensured that people's legal rights were upheld and they were supported to have autonomy over their lives where ever possible. Otherwise decisions were made appropriately in their best interest.

There was a good understanding of people's needs, many of which were very complex. A GP with knowledge of the home said, "A high standard of care and excellent, well trained staff." A person's family said, "A good environment for him. Fantastic staff. They know him. I have no concerns and he is happier here." High standards ensured that care and nursing needs were well met.

Staff understood how to protect vulnerable people from abuse and uphold their rights. An overview by the organisation supported people's protection. For example, monitoring visits and audit of accidents and incidents.

Staffing numbers ensured that people were protected and their needs were met but staff told us, "It can be a struggle when there are trips out."

People's views were sought and service improvements ongoing. For example, changes to the layout of the building.