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Inspection carried out on 15 January 2020

During a routine inspection

About the service

Kent House is a residential care home in one adapted building providing personal care to 21 people aged 65 and over at the time of the inspection. The service can support up to 27 people.

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

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.

The service provided safe care to people. People felt safe and supported by staff. Comments included: "I feel safe here. The staff are always there if I am worried about anything." Comprehensive risk assessments were in place. Medicines were safely managed on people’s behalf.

Care files were personalised to reflect people’s personal preferences. People were supported to maintain a balanced diet. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

Staff relationships with people were caring and supportive. Staff treated people with dignity and respect when helping them with daily living tasks. The service ensured people led meaningful and fulfilled lives.

There were safe staff recruitment and selection processes in place. People received effective care and support from staff who were well trained and competent. Staffing arrangements met people’s needs.

Staff spoke positively about communication and how the registered manager worked well with them and encouraged their professional development.

A number of methods were used to assess the quality and safety of the service people received, and continuous improvements were made in response to the findings.

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

Rating at last inspection

The last rating for this service was requires improvement (published 18 January 2019), there were no breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made.

Why we inspected

This was a planned inspection based on the previous rating.

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

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.

Inspection carried out on 8 November 2018

During a routine inspection

This unannounced comprehensive inspection took place on 8 and 9 November 2018. Kent House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Kent House provides accommodation and personal care to a maximum of 27 people who may have a physical condition or are living with dementia in one adapted building. At the time of our inspection there were 21 residents at the service and two people were in hospital.

Following the last inspection in January 2018, we met with the provider in February 2018 and asked them to complete an action plan to show what they would do, and by when, to improve the key questions safe and well-led to at least good. We also met with the provider with the local authority Quality Improvement Team in November 2018 to discuss governance and quality arrangements across all of the providers services.

At the previous inspection, we found the provider had failed to ensure risk management was robust, infection control procedures were not safe and medicines were not always managed safely. The providers audits had failed to identify these issues as part of their monitoring of the service.

This inspection found significant improvements had been made, with regards to risk management being more detailed for staff to follow; the areas of concern identified had been remedied and medicines were now managed effectively. However, we found further improvements needed to be made to cleanliness, information for staff about people’s specific needs whilst in bed and minor maintenance actions. Each of these concerns, were immediately corrected during our inspection.

This is the third time that the service has been rated as Requires Improvement.

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.

Staffing levels met people’s personal care needs. The service provided safe care to people. One person commented: “I feel very safe here.” Measures to manage risk were as least restrictive as possible to protect people’s freedom. People’s rights were protected because the service followed the appropriate legal processes. Medicines were safely managed on people’s behalf.

Care files were personalised to reflect people’s personal preferences. Their views and suggestions were taken into account to improve the service. People were supported to maintain a balanced diet. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

Staff relationships with people were caring and supportive. Staff were motivated to offer care that was kind and compassionate. There were effective staff recruitment and selection processes in place. People received effective care and support from staff who were well trained and competent. Staff spoke positively about communication and how the registered manager worked well with them.

A number of more robust methods were used to assess the quality and safety of the service people received. The service made continuous improvements in response to their findings.

Further information is in the detailed findings below.

Inspection carried out on 31 January 2018

During a routine inspection

This unannounced comprehensive inspection took place on 31January and 2 February 2018. At our last inspection in June 2017 we found a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 ‘Good governance’. This was because we found that some audits and checks had not identified issues around staffing levels at handover times and care records lacked details about people’s preferences. Following the last inspection in June 2017, we asked the provider to complete an action plan to show what they would do and by when to improve the key question of ‘well-led’ to at least good. This inspection found improvements had been in these areas. However, we found new concerns linked to whether the service was safe and well-led.

Kent House is a ‘care home’ providing personal care and accommodation to a maximum of 27 older people who may live with dementia or physical disability in one adapted building. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Kent House does not provide nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection there were 26 people living at the service.

This inspection was prompted in part by concerns raised by visiting safeguarding nurses. These concerns related to a lack of detailed risk assessments and care plans; lack of detail in daily records; no check charts in place to monitor people’s general well-being; suitability of equipment; incident reporting; staffing levels; issues about medicines not being given as prescribed and staff understanding of the procedure in the event of an emergency.

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.

Risk management was not always robust. People’s individual risks were identified and the necessary risk assessments were carried out. For example, risk assessments for falls management, moving and handling, personal care, nutrition and skin integrity. However, care plans lacked sufficient detail to ensure appropriate care and treatment. We discussed our concerns about care plans with the registered manager. They explained that staff knew people very well. For people identified with complex and high needs their care plans and risk assessments had been updated with more detail in response to concerns raised by visiting professionals. In addition, the registered manager was in the process of reviewing all care plans to ensure sufficient detail for staff to follow. Also, following a serious incident in November 2017, the service had purchased additional equipment to keep people safe whilst in bed.

Aspects of infection control were not safe. We found that the sluice was not clean; Control of Substances Hazardous to Health (COSHH) were not stored securely and staff were not wearing aprons when carrying out personal care. However, by the second day of our inspection, we found that the sluice room had been thoroughly cleaned; staff were wearing aprons appropriately and COSHH products were stored safely out of reach of people.

Medicines were not always managed safely. The medicine policy and procedure for the service stated that there should be specific plans for medicines that were to be given ‘as required’ available within the service user’s care plan and with the MAR charts. No plans were available for any of these medicines; therefore there was insufficient information for staff to give these medicines in a consistent manner.

The service had made improvements in relation to the concerns raised at our previous inspect

Inspection carried out on 29 June 2017

During a routine inspection

This comprehensive inspection took place on 29 June and 11 July 2017 and was unannounced on the first day.

The home provides accommodation and personal care for up to 27 older adults. At the time of our inspection 25 people were living at Kent House. Some of these people were living with dementia or had a physical impairment.

The home is situated close to Dartmoor in a quiet cul-de-sac near Okehampton town centre. Bedrooms are located over three storeys including the ground floor. The first and second floors are accessed via a lift and stair lifts. There is a communal lounge, conservatory and dining room all located on the ground floor.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was previously inspected in April 2015 when the service was rated as Good overall. However the effectiveness of the service was rated as requiring improvement. This was because the home environment did not always promote independence for people living with dementia. At this inspection, we found improvements had been made to support people with dementia.

People and their relatives were very positive about the home and said they felt safe at Kent house. They said the care provided by staff and the registered manager was good. Comments included “It’s lovely.”; “They look after me well.” and “I am very happy and want to come in myself when the time comes.” Throughout the inspection, we observed staff interacting with people in positive and caring ways. People appeared very relaxed and happy, laughing and joking with staff.

The registered manager had been in post for a number of years and led by example. They spent time working alongside staff. People and staff were involved by the registered manager in improving the service. Resident meetings, staff meetings and surveys were undertaken and provided people and staff a means to make suggestions. There was a complaints procedure and people said they knew how to complain. Complaints were managed in line with the provider’s complaints policy.

There were sufficient staff to support people safely, although at times staff were not present in communal areas for extended periods of time. Staff worked with people in a calm and unrushed manner and knew people well. People were supported to do a range of activities both inside and outside the home, which they said they chose to do and enjoyed. Staff understood people’s individual communication skills, abilities and preferences and ensured they took these into account when providing care.

People’s health was monitored and, where necessary, staff ensured that health professionals were contacted for advice and support. People were supported to attend appointments with the GP, their dentist and other health professionals.

People were provided with a healthy balanced diet with food of their choice. People said they enjoyed the food and could have alternatives if they did not like the meal on offer. Specialist diets, including pureed food, coeliac and diabetic diets, were catered for. Where people required support with eating and drinking, staff made sure that people were encouraged and helped to eat and drink. Comments about the food included “home cooked, good food.” and “Very nice.”

Staff were recruited safely as checks were carried out before they started working at the home. Staff completed an induction to ensure they were competent to work with people. Staff also received refresher training and were supported to undertake nationally recognised qualifications in care. Staff administered stored and managed people’s medicines safely. Staff had regular meetings with their supervisor.

Inspection carried out on 8 -10 April 2015

During a routine inspection

The inspection visits took place on 8 and 10 April 2015 and were unannounced.

The previous inspection, on 07 August 2014, found the home was meeting the required standards.

Kent House is a care home providing personal care and accommodation to a maximum of 27 older people who may live be living with dementia or have a physical disability. There were 23 people using the service at the time of the inspection. People’s health care needs are met through the community health care services, such as district nursing.

The service has 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.

The home environment provided limited promotion of independence for the people living with dementia and was not based on good practice for dementia care. We have made a recommendation relating to the home environment.

People were protected from abuse in that staff received training and had relevant information available to them but they were not confident in how to alert concerns outside of the organisation.

People, or their family members, were fully involved in decisions about their care and the staff understood legal requirements to make sure people’s rights were protected. However, it was not clear how the principles of the Mental Capacity Act 2005 (MCA) were applied to ensure people’s decision making was promoted.

The numbers and deployment of staff were sufficient to keep people safe. Staff recruitment was robust and protected people from staff who might not be suitable to work in a care home. Staff received training and supervision which supported them in their role.

Medicines were handled in a safe way and people received them as prescribed. People’s health care needs were met through the community services and staff at Kent House made sure health care professionals were contacted promptly when needed. People’s physical and emotional needs were well met; the staff knew people well and were kind and caring.

People received sufficient food and fluids to maintain their health and well-being. People benefitted from a friendly and happy staff team and a relaxed and homely environment. People were treated with dignity and respect. People’s privacy was upheld.

People’s opinion and views were sought through care planning, meetings, individual time with staff and feedback surveys. The registered manager and senior staff were available to listen to any requests, comments or concerns.

The home was well-led by a registered manager who identified where improvement was required, ensured staff were made aware and followed through any issues. The provider organisation supported the registered manager and reviewed the service provided on a regular basis. Staff felt very well supported.

Inspection carried out on 7 August 2014

During a routine inspection

Our inspection team was made up of one inspector who helped to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service safe?

Individual needs and risk assessments were undertaken before care was delivered and care plans to address these were put in place to support people's safety.

Staff received training in safeguarding, the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). They were able to describe what to do if they had a safeguarding concern which showed they understood how to safeguard the people they supported. The provider had followed correct procedures when they had needed to get people assessed for DoLS.

There were systems in place to ensure the provider learned from events such as accidents and incidents, complaints and concerns which reduced the risks to people and helped the service to continually improve. The registered manager reviewed and analysed recorded incidents.

The provider had plans in place to deal with unforeseen emergencies, such as fire or flood, which required moving people to other accommodation. The provider also had systems to ensure that they had sufficient staff in the event of adverse weather or an outbreak of illness.

We saw evidence staff underwent an induction to ensure they were able to work effectively. This included shadowing existing staff as well as completing an induction handbook. All staff completed mandatory training and were also encouraged to undertake a nationally recognised qualification in care to support them in their role. We saw evidence the majority of staff were up-to-date with all their mandatory training and were either enrolled on or had completed a national qualification in care.

The provider had systems in place to ensure equipment was suitably maintained and staff were trained to use it appropriately,

Is the service effective?

People�s health and care needs were assessed and written in care plans. We saw evidence that people with capacity had been involved in writing their care plan and they reflected their current needs. We also saw evidence that where a person did not have capacity, their relatives had been involved in identifying the person's need and writing their care plan.

People told us they were able to get involved in a range of activities to suit their interests and this had helped to improve the quality of their lives. We saw people going out to a local coffee morning. We also saw people being supported to play games. People told us they enjoyed the activities which helped them to pass the time agreeably.

We spoke with one relative who told us they had seen improvements in people living in the home because of the range of activities which helped provide physical and mental stimulation. One person had their dog living with them in the home, which staff said was very important to them.

We saw evidence of staff involving other health professionals in a people's care when issues arose. We spoke with a visiting community nurse, who told us they visited the home regularly and staff always brought issues of concern to their attention. We reviewed records where staff had made referrals to other health professionals, including the continence nursing team and the community mental health team.

Is the service caring?

During our inspection we talked with six people living at Kent House and also spoke with four relatives who were visiting. We observed activities during the day, including lunch in the dining room. We saw staff taking time with people to make sure that they got a meal of their choice. We observed staff sitting with people who were not able to feed themselves, helping them to eat. We saw that staff talked kindly, encouraging them to eat and offering alternatives if they did not like something. We saw one person arrive late for lunch, having been out for an appointment. The person was offered the main dish of the day, but chose instead to have bacon, eggs and chips, which was then freshly prepared. They told us "the food is really good and they will always cook me something I like if I don't want to have what's on offer."

People we talked with said they thought staff were kind and attentive. One person told us "I feel really well cared for here."

We talked with staff, who told us they got to know the people they cared for really well and enjoyed caring for them. During the day, we observed staff talking to people in a friendly way, taking an interest in their lives and demonstrating they had a good knowledge of the person's preferences.

Relatives told us that they were always "made to feel very welcome" and could call in whenever they wanted,

Is the service responsive?

We reviewed minutes of meetings which people living at Kent House were invited to. Meetings were held three or four times a year to allow people to air views and make suggestions for improvements. The most recent meeting had been held in May 2014. We saw evidence of actions taken to address issues.

A survey had also been undertaken in the last twelve months to find out what people, their relatives, staff and visiting professionals thought about the home. Feedback from both these surveys had been summarised, showing that there was a high level of satisfaction. However where there were areas where improvements could be made, we saw evidence that actions had been taken by the provider to address them.

We saw evidence the provider gave people information about how to make a complaint and recorded written complaints. The registered manager told us there had been no formal complaints since 2012. They told us they talked with people living at Kent House and their relatives and friends frequently. They told us that if someone had a concern or issue, they always tried to deal with it before it escalated.

Is the service well-led?

The registered manager together with senior care workers worked to ensure care workers were supported to deliver care to people according to their needs. They provided support and guidance when staff had concerns.

Staff told us they were clear about their roles and responsibilities. We talked with six staff during our inspection. They had a good understanding of the ethos of the provider and worked to promote good relationships with all the people they worked with as well as other staff. This helped to ensure that people received a good quality service at all times. One member of staff told us "I really enjoy working as I feel supported to do a good job".

We saw evidence that staff received regular supervision on a bi-monthly basis and staff told us they felt confident they would get additional support if they needed help. Staff were also encouraged to undertake nationally recognised care related qualifications in addition to the mandatory training to help them support people.

We observed a staff meeting that was held during our inspection. Staff were praised for being prepared to work flexibly whilst there had been some staff shortages. Issues were raised during the meeting by both the registered manager and by staff. We saw that staff contributed ideas about how to resolve these issues.

During a check to make sure that the improvements required had been made

When we visited the home on13 May 2013 we found that the hazard of fire safety was not managed in that faulty fire doors had not been mended. We found no other area of concern relating to health and safety and people told us that they were very satisfied with the service. We therefore judged that we did not need to visit the home to check that risks from fire were now properly managed.

The provider informed us that the faulty fire doors had been mended and that there had also been a fire safety check on 1 July 2013 and all was in full working order. They said that they had also introduced a closer audit so that the situation could not occur again.

Inspection carried out on 13 May 2013

During a routine inspection

We spoke with four people who used the service, one person who had used the service, two people's families and a visiting district nurse. We also saw the home's feedback questionnaires and reports from meetings.

People spoke positively about the home with comments including, "The care is very good"; "Xxx is an excellent manager", They're very good. They come when I call" and "There is plenty of food. If not liked they get something else." A district nurse said, "Care is provided very well."

We found that people received the care and support they needed to promote their wellbeing. This included close attention from care workers, equipment and a pleasant environment.

People received a nutritious diet which was to most people's liking. However, there were not enough care workers to help people eat their lunch in a dignified way.

Medicines were handled in a safe way. A robust recruitment process protected people from unsuitable staff.

There were several ways in which people could comment about the home. The registered manager promoted good standards, for example, through discussion at staff meetings. However, there had been insufficient overview of checks at the home and some fire doors had not closed properly for five months. This was addressed immediately we highlighted it.

Records were kept in a secure way and had been completed so as to provide information about people's needs, how those needs were met, and for health care monitoring purposes.

Inspection carried out on 7 January 2013

During an inspection looking at part of the service

Our inspection of October 2012 found that people were not always fully protected against the risks of unsafe premises because risks had not always been fully considered and records were not always kept securely or in a way which promoted people's health and welfare. The provider wrote to us and told us how they intended to improve.

During this visit we spoke to two people about the home environment. They told us that they had what they needed. We saw that there was upgrading of the bathrooms and shower rooms, which would provide people with more choice and a nicer environment. We found that, where risk had not previously been assessed, this was now done and the home environment was safer for people.

We found that personal records were now kept out of sight so that people with no right to view them could not do so. We looked at the records of three people where there had been recent acute episodes of illness. We also spoke to their GP surgery and confirmed that GP�s were happy with the care that had been provided. We saw that the people�s records were detailed and had provided the information care workers needed to deliver appropriate care.

Inspection carried out on 4 October 2012

During a routine inspection

People were offered choice and consulted and involved in decisions about their care. Care workers spent time ensuring people were treated with respect and their privacy and dignity were upheld.

Care needs were met and people were supported to present as they wished. A district nurse said she had no concerns about the home. People were well supported to engage in meaningful activities of their choice.

There had been building works and upgrading of the home. The decor was in good order and new furniture and furnishings in use. People told us that they had what they needed and liked their rooms. However, some aspects of the environment were not risk assessed and there were hazards therefore not identified, such as leads trailing across a room.

Complaints and comments were managed effectively and people's views were listened to and acted upon.

People's records were not kept in a confidential way as they could be seen by any person in the corridor. Other records were not always completed and so the information was not available or not clear.

Inspection carried out on 30 September 2011

During a routine inspection

We conducted an unannounced visit to Kent House on 30 September 2011 as part of our planned inspections, spending five hours there in total. We met most people who use the service, all staff, spoke to the family of three people and looked at some care records. Prior to the visit we had received information from district nurses who attend people living at the home. We also received information from the manager and from the organisation following our visit to the home. The manager had been unable to attend during our visit to Kent House.

People using the service were cared for by staff who were liked and considered to be good at what they do. Comments included: �Excellent care. Can�t speak highly enough of them�, and �they�re lovely staff�.

People were assisted at a pace that suited them and the atmosphere at the home was relaxed and unhurried. People received care in a respectful and kind manner.

Community nurses had confidence in the staff and people�s health was monitored so that any concerns could be addressed.

Although care workers knew how to safeguard people from abuse, there was not enough understanding around the assessment of a person to make decisions about their own welfare. This could lead to them not having the control over their life to which they are entitled, and protected in law to do so.

The organisation checked people�s backgrounds before recruiting them to work at the home and staff received training, and supervision of their work.

People knew the manager well and had confidence that they could discuss anything with them. The home had systems in place to ensure that servicing and maintenance were properly managed.

People were living with risk from loose radiator covers, some of which come away from the wall. Also, some people had the inconvenience of having to use bathroom facilities on a different floor of the home to the location of their room. One person had an uncomfortable mattress because the springs were prominent and staff did not always lock doors which are labelled to be kept locked.

Reports under our old system of regulation (including those from before CQC was created)