Archived: Kettlewell House Nursing Home

Ratings

• Overall

  Inadequate

• Safe

  Inadequate

• Effective

  Requires improvement

• Caring

  Requires improvement

• Responsive

  Requires improvement

• Well-led

  Inadequate

Our view of the service

Date of assessment: 26 August to 29 August 2025.
The service is a care home with nursing, providing care to older and younger people, people living with dementia, and physical disabilities. At the time of our visit the service was led by an interim manager.
This assessment was prompted following concerns received around safeguarding people from harm and abuse, and concerns around governance of people’s care. This inspection found the provider to be in breach of 6 legal regulations relating to safe care and treatment, safeguarding, governance, staffing, recruitment and duty of candour.
The provider did not have an effective quality assurance and governance system in place. This had resulted in shortfalls that placed the people who use the service at risk of harm.
We found not all incidents and allegations of serious psychological and physical abuse were reported to appropriate agencies. We found although some allegations were reported, these were not always done without delay. The provider failed to evidence these were all investigated appropriately, and systems and processes were implemented to tackle closed culture. Learning outcomes and actions were not immediately implemented following these concerns, and the provider did not provide immediate assurances all people were protected from risk of ongoing harm and abuse. The provider’s recruitment systems and processes were not robust to ensure all available information was gathered appropriately, and to confirm fit and proper staff were employed. This meant people were at risk of being supported by unsuitable staff.
This service is being placed in special measures. The purpose of special measures is to ensure services providing inadequate care make significant improvements. Special measures provide a framework within which we use our enforcement powers in response to inadequate care and provide a timeframe within which providers must improve the quality of care they provide.

In instances where CQC has begun a process of regulatory action, we may publish this information on our website after any representations and/or appeals have been concluded, if the action has been taken forward.

People's experience of this service

During our assessment, we found people's care did not always meet expected standards. People were not always enabled to make independent choices about their meals. Care records did not always accurately reflect people's needs. Systems and processes in place to ensure safe medicines management were not robust. People had been put at risk because of safeguarding, staffing, lack of oversight and governance.
Most people were positive about the quality of care and support they received. People described how staff treated them with kindness. People told us they felt safe, and we observed activities were available for people to engage with for social wellbeing.
Some people could not directly tell us about their experience. We used observations, reviewed care plans, daily notes and risk assessments to assess whether they received good care. We observed people were listened to and staff interacted positively with them.