We carried out a review of the data available to us about Kendal Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Kendal Care Home, you can give feedback on this service.
We found the following examples of good practice.
The home was in outbreak at the time of our inspection. The registered manager had followed government guidance around supporting people who had tested positive for COVID-19 to isolate in their rooms.
The registered manager ensured outbreak guidance about testing staff and people living in the home was followed.
The provider had very robust systems to prevent visitors from catching or spreading infection. Visitors to the service were required to have a negative Lateral Flow Device test for COVID-19. Staff assisted visitors to wear appropriate Personal Protective Equipment, (PPE), to reduce the risk of transmission of infection.
The provider had ensured appropriate PPE was available. They had taken and followed advice from the local authority Infection Prevention and Control team about the use of face visors to further reduce the risk of infection spreading.
The provider had systems to check everyone deployed to work in the home were fully vaccinated against COVID-19 or exempt.
The registered manager was following government guidance on supporting visiting. This included supporting essential care givers to continue visiting during the COVID-19 outbreak. Essential care givers were included in the home’s regular COVID-19 testing and were supported to wear appropriate PPE.
The provider had ensured there were enough staff to care for people. They had employed agency staff to supplement the permanent staff employed in the home.
Kendal Care Home is a care home providing accommodation and personal and nursing care to 90 people at the time of the inspection. The home accommodates up to 120 people in three units. One unit specialises in supporting people who are living with dementia. Accommodation is arranged over three floors and the home has passenger lifts to help people access the accommodation on the upper floors.
People’s experience of using this service and what we found
People were safe and protected from abuse. The provider used thorough recruitment procedures to check new staff were suitable to work in the service. There were enough staff to meet people’s needs. The provider had identified and managed risks to people’s safety. We were not fully assured that all staff were consistently using Personal Protective Equipment (PPE) effectively and safely. The provider took immediate action to ensure proper use of PPE. Medicines were managed safely and people received their medicines as they needed. We have made a recommendation about the management of some medicines. The provider had systems to learn from incidents to further improve the safety of the service.
People received person-centred care which promoted a good quality of life. The provider was committed to the continuous improvement of the service. They monitored the quality and safety of the service and took account of people’s feedback to further improve the service. The provider understood and acted on their responsibilities under the duty of candour. The registered manager and staff worked cooperatively with other services to ensure people received appropriate care.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 14 February 2019).
Why we inspected
The inspection was prompted in part due to concerns received about areas of care and treatment including medicines and in part by a notification of a specific incident. As a result, this inspection did not examine the circumstances of the incident. The information CQC received about the incident indicated concerns about unsafe medicines management, this inspection examined those risks. We undertook a focused inspection to review the key questions of safe 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. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
We found evidence during this inspection that the provider had made improvements to how medicines were managed. Please see the safe section of this full report.
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 remains good. This is based on the findings at this inspection.
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.
At our last comprehensive inspection of the service in September 2017 we found the service had improved sufficiently to be removed from special measures. It had been rated in January 2017 as being overall inadequate. At the inspection in September 2017 we rated the service as still requiring improvement because there was not sufficient evidence to demonstrate the sustainability of the improvements we found and we made two recommendations.
Since the last inspection in September 2017 the service had engaged with commissioners and their quality teams in ensuring the improvements that had been achieved were sustained. At this inspection we found that the service was compliant with all the fundamental standards of safety and quality and these had been consistently maintained. We also recognised there was a commitment for continually developing the quality of the service provision.
Kendal Care Home 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. It provides nursing and residential care for up to 120 older people, some of whom are living with dementia.
The home is arranged over three floors and has a passenger lift for access to these. There are three units in the home, one designated to residential care, one for nursing and one for dementia care. All bedrooms are single occupancy with ensuite facilities. Each of the three units has its own communal dining and lounge and recreational areas. The home is set back from the main road, with level access to garden and outdoor areas. At the time of the inspection there were 83 people living in the home.
There was a registered manager in post who had been appointed since the last inspection in September 2017. 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.
There were sufficient numbers of suitably trained staff to meet people’s needs. Staff training was ongoing and staff had received a variety of training that enabled them to safely support and care for people. Staff were also supported through regular staff meetings, supervision and appraisals.
We saw that the service worked with a variety of external agencies and health professionals to provide appropriate care and support to meet people’s physical and emotional health needs.
Where safeguarding concerns or incidents had occurred, these had been reported by the registered manager to the appropriate authorities and we could see records of the actions that had been taken by the service to protect people.
When employing fit and proper persons the recruitment process had included all the required checks of suitability.
People’s rights were protected. The registered and deputy managers were knowledgeable about their responsibilities under the Mental Capacity Act 2005. People were only deprived of their liberty if this had been authorised by the appropriate body or where applications had been made to do so.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
Hazards to people’s safety had been identified and managed. People were supported to access a wide variety of activities that were made available to them and pastimes of their choice.
People were treated with respect and their dignity and privacy were actively promoted by the staff supporting them.
Auditing and quality monitoring systems were in place that allowed the service to demonstrate effectively the safety and quality of the provision. The oversight of quality and safety in the home had improved and was seen to be consistent.
During this inspection, we saw that the provider had taken action to improve the safety and quality of the service. However, we did find some areas still needed to improve and demonstrate they could be sustained.
This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection, the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.
Kendal Care Home provides nursing and residential care for up to 120 older people, some of whom are living with dementia. The home is over three floors and has a passenger lift for access to these. There are three units in the home, one designated to residential care, one for nursing and one for dementia care. All bedrooms are single occupancy with ensuite facilities. Each of the three units has its own communal dining and lounge areas. There is a cinema room for all people living in the home to use. The home is set back from the main road, with level access to garden and outdoor areas. There is ample car parking for visitors. At the time of the inspection there were 58 people living in the home.
There was a manager in post who had commenced their application to become registered at the time of the inspection. A registered manager is a person who has registered with the (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People told us they were very happy with the improved care and treatment at Kendal Care Home.
The management of medications had improved and was seen to be much safer. We saw that the service had worked hard to improve in this area since the last inspection. Medicines were being stored, administered and recorded appropriately.
While there were significant improvements we have made a recommendation about the management of some medicines.
There had been a number of new staff appointed since the last inspection and we found that one of the checks of suitability, before commencing employment, had not been completed.
We have made a recommendation that the service ensures that all the checks of suitability for fit and proper persons being employed are completed.
Since the last inspection, the provider has been responsive and proactive in implementing and improving the systems used in the recording of information about people’s needs and the planning of their care. We saw that risks related to peoples care and treatment were being better recorded and managed. Records had been improved to ensure accurate details about the changing needs of people were available to the staff looking after them.
We saw that all staff had completed a revised programme of induction training and had received specific training to ensure they had the right skills to meet people’s needs. We saw that improvements to how the ongoing training of staff was managed had been made. Staff told us how they felt supported through supervision and training to fulfil their roles.
The level of staffing on the day of the inspection was sufficient to ensure that the current number of people living in the home had their needs met. The numbers of staff on shift during the day and night were consistent with the dependency levels of people identified.
The provider had recruited specific staff to support people with their choice of activities.
We observed staff displayed caring and meaningful interactions with people and they treated them with respect. People living and visiting the home spoke highly of the new manager and senior management team.
Kendal Care Home provides nursing and residential care for up to 120 older people, some of whom are living with dementia. The home is over three floors and has a passenger lift for access to these. There are three units in the home and all the bedrooms are single occupancy with ensuite facilities. Each of the three units has communal dining and lounge areas. There is a cinema room for people to use. The home is set back from the main road, with level access grounds. There is car parking for visitors. At the time of the first day of the inspection there were 81 people living in the home.
The service had a registered manager in post at the time of this inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.
We had inspected the service on 30 September and 06 October 2015. At that inspection, the registered provider had not met with all of the requirements of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. We found significant concerns in relation to person centred care, the safe management of medicines, safeguarding people, the correct application of the Mental Capacity Act (2005), meeting people’s nutritional and hydration needs, maintaining accurate records and good governance, staffing levels, training and recruitment procedures for fit and proper persons. As a result, the service was rated as ‘inadequate’ and placed in ‘special measures’ by the Care Quality Commission (CQC). The special measures framework is used to help make sure that registered providers found to be providing inadequate care significantly improve.
We last carried out a full comprehensive inspection of this service on 3 May 2016. At that inspection, we found that improvements had been made and the service was meeting the fundamental standards with the exception of two regulations. There was a breach of Regulation 12, safe care and treatment, of the Health and Social Care Act 2008 (Regulated Activities) 2014. This was because the registered provider had not demonstrated that clear monitoring and analysis was being done to make sure that avoidable risks were prevented. There was also a breach of Regulation 17 regarding good governance because the registered provider had not made sure systems were in place to ensure an effective governance structure to monitor the safety and quality of the service provision. As a result of the improvements that had been made, the service was rated overall as ‘requires improvement’ and the service was taken out of the ‘special measures’ it had been placed in following an inspection in September and October 2015.
At this inspection in January 2017, we reviewed actions the provider had taken against the breaches in regulations identified at the previous inspection in May 2016 and how they had maintained the improvements that had been seen at that inspection. We found that the registered provider had not met the requirements from our previous inspection. There was a continued breach of Regulation 12, safe care and treatment and Regulation 17, Good governance of The Health and Social Care Act 2008 (Regulated Activities Regulations) 2014. We also found that improvements noted at the inspection in May 2016 had not been sustained and developed. During this inspection we found there were multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 that could have an impact upon the safety, health and wellbeing of the people who lived there.
We found breaches of regulation in relation to person centred care, safe care and treatment, safeguarding people from abuse and improper treatment, obtaining consent from people or the correct relevant persons, staff training and good governance. The overall rating for this service is 'Inadequate' and the service has been placed in 'Special Measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
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.
We received mixed feedback from people who lived in the home. Some told us they felt safe living there and others told us they did not feel secure in the bedrooms as other people living there came in and invaded their privacy. We were also told that people often had to wait for staff to be available to help in the way they wanted We also received mixed feedback from relatives. We spoke with the relatives of a person who were living with dementia who told us they were considering moving their relative and that they felt staff did not have time to give people the care they wanted or needed. Another relative told us they had found no faults with the home and told us, “I have found the staff to be lovely and friendly”. We observed some good interactions and friendly banter between staff, visitors and people who used the service.
We found that the registered provider had not made sure that the procedures and processes within the home were effectively safeguarding people from receiving improper treatment or unlawful restraint. In addition, staff did not demonstrate a good understanding of how and when to raise a safeguarding concern, if they believed someone was at risk in some way. The management of accidents and incidents was not robust and incidents were not being reported to management by the staff on the units.
We found that the registered provider had not ensured care and treatment was always provided with the consent of the relevant person. We saw that care and intervention provided was not consistently in line with current legislation, nationally recognised guidance or good practice.
Medicines were not being safely managed and monitored and could place people at risk of not receiving their medicines as prescribed. It was unclear from the records we looked at whether creams had been applied to people as they had been prescribed. It was unclear if fluids had been thickened properly in order to reduce risks associated with swallowing difficulties.
There were not always enough staff available to meet the needs of people who used this service and sometimes people had to wait for help, we found that day shifts were staffed according to the dependency levels within the service however staff were not always responsive when people called for help. Staff levels on night duty were not always in line with meeting people’s assessed needs and should evacuation be needed in the event of an emergency.
Care plans and risk assessments had not always been developed to meet the individual needs of people who used the service. We observed that much of the support provided by staff was 'task orientated' rather than centred on people's individual preferences and needs.
We have made a recommendation that the service finds out more about training for staff in relation to supporting the needs of people living with dementia and its different presentations.
At this inspection we found that staff were still not acting in line with legislation, national guidance or good practice. On the dementia nursing unit restrictive practices had been recorded, and used, for people that were not in line with the Mental Capacity Act (2005) and its codes of practice. We found care plan reviews had not highlighted there was insufficient, incorrect or out of date information in some plans and lacked information around managing different behaviours and restraint.
The registered provider had not made sure all staff had training relevant to their roles and to meet people’s individual needs. The records of staff training were not being kept up to date and contained conflicting data so we could not assess with any accuracy what training or induction training had been provided for staff.
We found care plans in relation to the management of skin integrity that lacked review of a
We last carried out a full comprehensive of this service on 30 September and 06 October 2015. The registered provider did not meet the requirements of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 and was rated as ‘Inadequate’. The service was placed in ‘special measures’ by the Care Quality Commission (CQC). The special measures framework is used to help make sure that registered providers found to be providing inadequate care significantly improve. It requires there is a timely and coordinated response from a provider where CQC has judged the standard of care to be inadequate. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Kendal Care Home on our website at www.cqc.org.uk.
We further carried out four other visits to the service between 20 December 2015 to 01 February 2016 to follow up on two warning notices issued.
During this inspection in May 2016, we found the provider had made improvements and was meeting the fundamental standards inspected with the exception of Regulation 12 (Safe care and Treatment) and Regulation 17 (Good Governance) 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.
As a result of the improvements made, the service has been taken out of special measures. The service will be expected to sustain the improvements and this will be considered in future inspections.
Kendal Care Home provides nursing and residential care for up to 120 older people, some of whom are living with dementia. The home is over three floors and has a passenger lift for access to these. There are three units in the home and all the bedrooms are single occupancy with ensuite facilities. Each of the three units have communal dining and lounge areas. There is a cinema room for people to use. The home is set back from the main road, with level access grounds. There is ample car parking for visitors. At the time of the inspection there were 58 people living there.
The service did not have a registered manager in post at the time of this inspection . A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered provider had recruited a suitable person for this post and they were working in the home when we inspected. They were in the process of applying to register with CQC as the registered manager.
We found that the registered provider had been making improvements as outlined in their action plans . We found that medicines were now being handled safely and the management of training had improved with a programme of planned training in progress. The service was also using a dependency tool assessment to help ascertain the numbers of staff they needed based upon people’s dependency and individual needs.
At this inspection we saw that improvements had been made in applying the principles of MCA and training was being given to help staff deal with situations where restraint might be needed. At this inspection the monitoring of nutrition and hydration had significantly improved and was being addressed through monitoring by management. At this inspection we found that improvements had been made in reviewing and monitoring all care plans and assessments.
The two new breaches of regulations were in relation to making sure there were appropriate governance structures in place for all aspects of care being provided and to continuously improve the welfare of people. The registered provider had not demonstrated to us they had done everything possible to ensure the care and interventions provided were in line with nationally recognised guidance for the use of low level restraint. This lacked clear monitoring and analysis to make sure people received appropriate intervention a to prevent avoidable risks.
People we spoke with who were living in the home were positive about their care and the changes that had taken place within the home. They told us, “I feel safer living here” and that “The staff are lovely” and “Nothing is too much trouble”. We spent time with people on all the units during the day. We saw that the day staff offered people assistance and took up the opportunities they had to interact with them and offered reassurance if needed. Care staff knew how to protect people’s privacy and we observed this in practice.
People living at Kendal Care Home were able to see their friends and families as they wanted and go out when they wanted with them. There were no restrictions on when people could visit them. We could see that people who were able to made day to day choices about their lives in the home and were able to follow their own faiths.
We found that the registered provider was keeping the numbers of staff up to acceptable levels in line with the dependency tool the service used and were using some agency staff to meet this. We found that a system of management staff cover and on call systems was in place and this was well advertised throughout the home. This meant that a member of management staff should be easily contactable outside normal working hours. People living in the home told us they felt the staff “worked hard” to look after them.
During observations at lunch time we saw that people who required support with eating received this in a respectful way with staff prompting people with their meals and asking them what they wanted to eat and drink. We saw some good interactions between staff and people living there including encouraging people to help themselves to what they wanted.
Sometimes on the unit where people were living with dementia staff from other units supervised for short periods on night duty. This was when all three staff on the unit were giving personal care to a person needing three to assist them. This was not ideal to take staff from their work duties on other units and we recommended that the registered provider take advice on risk assessing this practice.
We saw that recruitment was continuing in the home and new staff had been employed in activity provision, nursing, care assistants and a new manager. There were safe systems of recruitment being used and the staff recruitment files showed that a Disclosure and Barring Service (DBS) check had been completed before they had started working in the home. The registered provider had systems in place to train staff in recognising possible abuse and how to respond if they suspected it
Medicines were now being safely administered and we saw that accurate records were kept of medicines received and disposed of so they could be accounted for. The time between morning and lunchtime doses of the some medicines were not always recorded and we recommend that the service seek advice and guidance from a reputable source on how to manage this risk. For medicines requiring refrigeration we recommended that the registered provider consider current best practice guidance on this.
Some audit findings on care plans that required updating had not been followed up to ensure they had been addressed. We recommended that the service seek support and training on managing the follow up on audit results to make sure all care plans were updated promptly.
We found during this focused inspection that the home had made improvements since the inspection in September 2015 in some aspects of quality monitoring and had introduced and maintained more quality assurance audits, including regular medication audits since the last visit. There were now daily walk rounds by a member of the management team covering the home to monitor staff practices on each floor and check staffing deployment. Care plans had been subject to reviews and had been updated to reflect any changes in people’s needs or preferences. Risk assessments had been carried out for people living there to help identify risks and audits had been carried out to monitor that nutrition and weights were being reviewed. The registered provider had improved the overall systems in place to monitor and report back on quality monitoring issues and assurance monthly. The acting manager had carried out audits, including for medication procedures and medication training for staff and had also completed. However there was still room for improvement in the consistency of monitoring of medication management and adherence to clear procedures.
There continued to be a breach of Regulation 17 (Good Governance). This was in relation to the lack of accessible and known procedures being in place for staff to refer to regarding the scheme of delegation within the home in the event of an emergency situation that could impact upon the service provision to people living at Kendal Care Home. As a result staff did not follow a recognised procedure they knew and understood when they encountered difficulties such as the adverse weather affecting travel and staff. The rotas and logging in systems within the home were not always clear and accurate records of the staffing situation. As a result there was not a clear audit trail of the process to show what staff were on which unit and in what capacity they were working. During the course of this inspection we found that operating systems were not being effective in ensuring the safe running of the home in the event of emergency situations. There were not clear and detailed contingency plans and escalation systems in place for responding to emergencies and untoward events. We issued a warning notice in relation to the continued breach that required the registered provider to make improvements to ensure operating systems were being effective in ensuring the safe running of the home in the event of emergency situations.
We had visited on 20 December 2015 out of normal working hours and again on 1 February 2016 as part of the inspection to monitor the service after CQC had received concerns from other agencies, health care professionals and individuals in relation to the levels of suitably qualified nursing and care staff and the levels of management staff being deployed in the home to make sure meet people's needs were being safely met. We visited to make sure there was effective management oversight in the home at all times and to check that there would be sufficient staff on duty period over the Christmas holidays. Rotas showed that sufficient staff would be on duty and that there would be management on call. Staff levels were safe during the times we visited.
We found over the course of the inspection that there was a breach of Regulation 18 (Staffing) that had an adverse impact upon some of the people living there. At all the visits made people living there we spoke with told us they felt staff were not always available when they wanted them and specifically on Boxing Day 2015. People living in the home and their relatives told us there had not been any one with overall management authority in the home or easy access to managers who were on call for the service and that there was no one coordinating overall staffing deployment. We had seen that there was an on call contact list available for management cover over the Christmas period but relatives told us that the number given as first point of call was not always being answered. People living on the nursing unit and their relatives told us that a lack staff availability and management presence had impacted negatively upon the care and support on Boxing Day. For example, on the nursing unit one person told us that there had not been staff available to help them get up, washed and dressed until 3pm that afternoon. They told us this was not their choice. We issued a warning notice in relation to the breach of the regulation that required the registered provider to make improvements to ensure there were always sufficient competent and experienced staff in a management position or with delegated responsibility to make sure that the service was being run to meet the requirements of the regulations.
People also told us that they believed that the staff on duty had worked hard to try to meet their needs and were helpful and supportive. We were given examples of how staff had worked hard to make sure that everyone enjoyed Christmas Day and that there were entertainments and a festive atmosphere with the same level of staffing as Boxing Day. Rotas were provided to us and staff we spoke with, people living in the home and their visitors told us that staff in the home had been moved around the units and had worked additional hours to make sure people’s needs were met and adequate staff were in place. We were told by some people staff were available for them to be able to take part in and enjoy the day as they wanted and one person told us they "could not fault it". The management team had undertaken an investigation as to what might have caused such differing experiences over the two days when staff levels had been the same.
Kendal Care Home provides nursing and residential care for up to 120 older people, some of whom are living with dementia. The home is on three floors and has a passenger lift for access to these. The ground floor is a residential suite, the first floor is a general nursing suite and the second floor is a suite for the nursing care of people living with dementia. All the bedrooms in the home are for single occupancy and have ensuite toilet and shower facilities. Each of the three units have their own communal dining and lounge areas and there is a cinema room for people to use. The home is set back from the main road, with level access grounds and ample car parking for visitors.
The service did not have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The home had not a registered manager in post since March 2015. One manager had left before registering with CQC. Another manager had since been recruited and was on duty during some visits but had yet to register with CQC. This lack of management stability and continuity had significantly impacted upon the progress in implementing changes and improvements in the service.
This report only covers our findings in relation to the warning notice and the concerns raised about staffing and management availability. We have not revised the rating overall. We will review our overall rating for the service at the next comprehensive inspection of the service. You can see what action we told the provider to take at
the back of the full version of the report.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Kendal Care Home on our website at www.cqc.org.uk.
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This unannounced inspection of Kendal Care Home took place over two days on 30 September and 6 October 2015. During our previous inspections on 8, 9 and 12 February 2015 we found the service was not meeting all the regulations.
This was because at our inspection on 8, 9 and 12 February 2015 there was not verifiable evidence that all staff in the home had received induction training and appropriate training for their roles. Care plan assessments did not always reflect a person-centred strategy and changes were not always reflected in care plans. The registered provider had not made sure that all aspects of service provision and record keeping were being regularly monitored for effectiveness.
We also carried out a focussed inspection on 2 June 2015 following concerns raised by other agencies and individuals in relation to the levels of suitably qualified staff being deployed in the home to meet people’s needs. We found on the day of our visit, 2 June 2015, that there was an adequate level of staff on duty to provide basic personal and nursing care. However the nursing support available to people did not reflect an emphasis on person centred nursing care but more on completing nursing care tasks.
Following the inspection on 2 June 2015 the registered provider wrote to us and gave us an action plan saying how and by what date they intended to improve training provision and recording, care planning and person centred care. At the inspection on 30 September 2015 we found that the care plan assessments and reviews of assessments to help ensure that people received care that met their needs were still not satisfactory. We also found that the registered provider had not made sure that all aspects of service provision and record keeping were being regularly monitored for effectiveness. Staff training was being better organised and monitored but some staff still lacked appropriate training and support for their roles. Whilst we could see changes had begun to improve service provision in these areas they had yet to be fully effective.
At this inspection we also found that there were others breaches of regulations that had an impact on people living in the home. These were in medicine management, recruitment of staff, making sure that care planning was person centred and that all needs had been assessed and risks well managed. We found that systems had not always been effective in making sure people’s nutrition and hydration needs were well monitored and not all records required by regulation were up to date. We found that a systematic approach to determining the range of skills needed and gender mix of staff on duty to meet people’s preferences and needs not always being used. Agency staff were being brought in to try to maintain staff numbers. Some agency staff had not been well supported in their roles and responsibilities in the home
Kendal Care Home provides nursing and residential care for up to 120 older people, some of whom are living with dementia. The home is over three floors and has a passenger lift for access to these. There are three suites in the home and all the bedrooms are single occupancy with ensuite facilities. Each of the three units has communal dining and lounge areas. There is a cinema room for people to use. The home is set back from the main road, with level access grounds. There is ample car parking for visitors. During our inspection there were 75 people living there.
The service did not have a registered manager in post at the time of this inspection or at the time of our inspection in February 2015. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered manager had resigned from their post in March 2015 and their replacement left in August 2015 before registering with CQC. The registered provider is currently trying to recruit a suitable person for this post.
We found that on the residential unit people has some very positive things to say about the way the unit was run, the unit manager and their care and support. The two other units where there was nursing care provided for people, some of whom were living with dementia, were perceived less positively by relatives. They told us about the lack of leadership and management on the units and the frequent use of agency staff who did not know people well.
We found that the registered provider had started to make improvements in providing a consistent training programme for staff and providing mandatory training. However we found that training for specific roles and responsibilities was not consistent for all care and nursing staff to support them to safely effectively fulfil the requirements of their roles. This was evident because staff had not worked within the requirements of the Mental Capacity Act 2005.
We found that the management of medicines in the home did not always follow policies and procedures and current best practice and medicines were not always given as prescribed by the doctor. Most of the people we looked at had photographs and their allergies recorded on their medicines records which reduces the risk of medicines being given to the wrong person or to someone with an allergy and is in line with current guidance.
The systems used to assess the quality of the service had not identified all the issues that we found during the inspection. Whilst we found that some aspects of the quality monitoring processes were being done well others were less well monitored. The standard of some clinical record keeping was not adequate. The registered provider had not ensured that an effective system was in place to make sure the nutritional and hydration needs of people were accurately recorded and monitored. We also found that care and risk assessments had not always been reviewed and updated.
We found that people living at Kendal Care Home were able to see their friends and families as they wanted and go out when they wanted with them. There were no restrictions on when people could visit them. We could see that people who were able to made day to day choices about their lives in the home and were able to follow their own faiths. People living there and visiting relatives told us that staff were polite and caring and “Work extremely hard”.
We have made a recommendation about making sure confidential health checks were carried out with people before they started work. Confidential health questionnaires help the registered provider to support physical or mental health conditions which are relevant to a person’s capability for the role.
You can see what action we told the provider to take at the back of the full version of the report.
This unannounced inspection of Kendal Care Home took place over two days on 30 September and 6 October 2015. During our previous inspections on 8, 9 and 12 February 2015 we found the service was not meeting all the regulations.
This was because at our inspection on 8, 9 and 12 February 2015 there was not verifiable evidence that all staff in the home had received induction training and appropriate training for their roles. Care plan assessments did not always reflect a person-centred strategy and changes were not always reflected in care plans. The registered provider had not made sure that all aspects of service provision and record keeping were being regularly monitored for effectiveness.
We also carried out a focussed inspection on 2 June 2015 following concerns raised by other agencies and individuals in relation to the levels of suitably qualified staff being deployed in the home to meet people’s needs. We found on the day of our visit, 2 June 2015, that there was an adequate level of staff on duty to provide basic personal and nursing care. However the nursing support available to people did not reflect an emphasis on person centred nursing care but more on completing nursing care tasks.
Following the inspection on 2 June 2015 the registered provider wrote to us and gave us an action plan saying how and by what date they intended to improve training provision and recording, care planning and person centred care. At the inspection on 30 September 2015 we found that the care plan assessments and reviews of assessments to help ensure that people received care that met their needs were still not satisfactory. We also found that the registered provider had not made sure that all aspects of service provision and record keeping were being regularly monitored for effectiveness. Staff training was being better organised and monitored but some staff still lacked appropriate training and support for their roles. Whilst we could see changes had begun to improve service provision in these areas they had yet to be fully effective.
At this inspection we also found that there were others breaches of regulations that had an impact on people living in the home. These were in medicine management, recruitment of staff, making sure that care planning was person centred and that all needs had been assessed and risks well managed. We found that systems had not always been effective in making sure people’s nutrition and hydration needs were well monitored and not all records required by regulation were up to date. We found that a systematic approach to determining the range of skills needed and gender mix of staff on duty to meet people’s preferences and needs not always being used. Agency staff were being brought in to try to maintain staff numbers. Some agency staff had not been well supported in their roles and responsibilities in the home
Kendal Care Home provides nursing and residential care for up to 120 older people, some of whom are living with dementia. The home is over three floors and has a passenger lift for access to these. There are three suites in the home and all the bedrooms are single occupancy with ensuite facilities. Each of the three units has communal dining and lounge areas. There is a cinema room for people to use. The home is set back from the main road, with level access grounds. There is ample car parking for visitors. During our inspection there were 75 people living there.
The service did not have a registered manager in post at the time of this inspection or at the time of our inspection in February 2015. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered manager had resigned from their post in March 2015 and their replacement left in August 2015 before registering with CQC. The registered provider is currently trying to recruit a suitable person for this post.
We found that on the residential unit people has some very positive things to say about the way the unit was run, the unit manager and their care and support. The two other units where there was nursing care provided for people, some of whom were living with dementia, were perceived less positively by relatives. They told us about the lack of leadership and management on the units and the frequent use of agency staff who did not know people well.
We found that the registered provider had started to make improvements in providing a consistent training programme for staff and providing mandatory training. However we found that training for specific roles and responsibilities was not consistent for all care and nursing staff to support them to safely effectively fulfil the requirements of their roles. This was evident because staff had not worked within the requirements of the Mental Capacity Act 2005.
We found that the management of medicines in the home did not always follow policies and procedures and current best practice and medicines were not always given as prescribed by the doctor. Most of the people we looked at had photographs and their allergies recorded on their medicines records which reduces the risk of medicines being given to the wrong person or to someone with an allergy and is in line with current guidance.
The systems used to assess the quality of the service had not identified all the issues that we found during the inspection. Whilst we found that some aspects of the quality monitoring processes were being done well others were less well monitored. The standard of some clinical record keeping was not adequate. The registered provider had not ensured that an effective system was in place to make sure the nutritional and hydration needs of people were accurately recorded and monitored. We also found that care and risk assessments had not always been reviewed and updated.
We found that people living at Kendal Care Home were able to see their friends and families as they wanted and go out when they wanted with them. There were no restrictions on when people could visit them. We could see that people who were able to made day to day choices about their lives in the home and were able to follow their own faiths. People living there and visiting relatives told us that staff were polite and caring and “Work extremely hard”.
We have made a recommendation about making sure confidential health checks were carried out with people before they started work. Confidential health questionnaires help the registered provider to support physical or mental health conditions which are relevant to a person’s capability for the role.
You can see what action we told the provider to take at the back of the full version of the report.
We carried out an unannounced comprehensive inspection of this service on 8, 9 and 12 February 2015 at which breaches of legal requirements were found that had an impact on people living in the home. This was because the registered provider had not always made sure there was the right mixture of staff skills and experience on all shifts or that training and staff support was monitored so people could be sure staff had the right skills and experience to support them.
Following the comprehensive inspection in February 2015 the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. They sent us an action plan setting out what they would do to improve the service and meet the requirements in relation to the breaches and when this would be completed by.
After the inspection in February 2015 we received concerns from other agencies and individuals in relation to the levels of suitably qualified staff being deployed in the home to meet people’s needs and to provide individual support where it was needed. As a result we undertook a focused inspection on 2 June 2015 to look into those concerns. This report only covers our findings in relation to staffing. We have not revised the rating for this key question as it would require a longer term track record of consistent good practice across all aspects of the safe domain. We will review our rating for safe at the next comprehensive inspection.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Kendal Care Home on our website at www.cqc.org.uk
Kendal Care Home provides nursing and residential care for up to 120 older people, some of whom are living with dementia. On the day of the inspection there were 82 people living there.
The home is on three floors and has a passenger lift for access to these. There are three suites in the home for people needing nursing care, residential care and for people living with dementia. All of the bedrooms in the home are for single occupancy with ensuite shower and toilet facilities. All the three suites had communal dining and lounge areas for people to use. There is a cinema room for people to use. The home is set back from the main road, with level access grounds. There is ample car parking for visitors.
The service did not have a registered manager in post at the time of this inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered manager had resigned their post in March 2015. The registered provider had since recruited a suitable person who was in post and in the process of registering as the manager with CQC.
We found on the day of our visit, 2 June 2015, that there was an adequate level of staff on duty to meet minimum requirements and provide the personal and nursing care and support people needed. However at times the nursing support available to people did not reflect an emphasis on person centred nursing care but more on completing nursing care tasks.
We found that staff and the new manager were working hard to try to maintain a safe service and to recruit and retain suitable staff. We could see that the use of agency staffing was decreasing.
This unannounced inspection took place over three days on 8th, 9th and 12th February 2015.
At our previous inspection on the 13 October 2014 we found that the provider was still in breach of regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 because medicines were not being managed safely.
We took enforcement action and issued a warning notice to the registered provider and registered manager that required them to make immediate improvements in relation to the way medicines were managed and monitored. The registered provider wrote to us and gave us an action plan saying how and by what date they intended to improve the way medicines were managed in the home. They planned to clarify arrangements for medicines supply for residents admitted to the service, review the administration of medicines to ensure that this was timely, improve record keeping and to provide staff training and assess competencies in the task of medicines administration.
We had also inspected Kendal Care Home on 7 January 2015 in response to a whistle blower raising concerns over staffing levels in the home. At the time we visited we found that the service was appropriately staffed to meet the needs of the people using the service. At this inspection on we found that the registered provider had made the improvements needed to meet the requirements of the warning notice issued to them. We found that medicines were being kept and administered safely in the home and storage was clean, tidy and secure so that medicines were fit for use. All of the people we spoke with who lived in the home told us that they felt safe living there.
However at this inspection we found that there were others breaches of regulations that had an impact on people living in the home.
Kendal Care Home provides nursing and residential care for up to 120 older people, some of whom are living with dementia. On the day of the inspection there were 73 people living there. The home is over three floors and has a passenger lift for access to these. There are three suites in the home and all the bedrooms are single occupancy with ensuite facilities. Each of the three suites has communal dining and lounge areas. There is a cinema room for people to use. The home is set back from the main road, with level access grounds. There is ample car parking for visitors.
The service did not have a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered manager had recently resigned their post. The registered provider told us that they had recruited a suitable applicant who would have to register with CQC when they took up the management post.
The service has long standing difficulties with recruiting suitable staff and we saw that staffing and skill levels could still fluctuate, despite the use of agency staff. People living there could not be certain staff levels and skill mixes could be sustained in the long term to make sure there were always enough skilled staff to support and care for them.
The service was not being effective as records that we saw indicated that areas of staff training were not up to date or organised for renewal, although this need had been identified. Records did not provide evidence that both permanent and agency staff had also had training and formal supervision that was relevant to their roles and duties in the home.
We found that care assessments for some people living there had not been updated to provide a person-centred strategy to ensure appropriate support and use of medicines during end of life care.
The service was not being consistently well managed. We saw the systems used to assess the quality of the service were not always identifying quality issues. The management of the service had changed again as the registered manager had resigned so a deputy was running the service until the new manager took over.
We have made a recommendation about recruiting suitable staff to permanent roles so that a stable and skilled workforce can be maintained.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to staff training, skills, care assessments and not monitoring the quality of service provision well enough. These regulations correspond to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We also found a breach of the Care Quality Commission (Registration) Regulations 2009 because the provider did not have a registered manager in place at the service.
The registered provider had systems in place to make sure people living there were protected from abuse and avoidable harm. They also had safe systems for recruitment to make sure the staff taken on were suited to working there.
The environment of the home was welcoming and the communal areas were decorated and arranged to make them homely and relaxing. Where people were living with dementia there was highly visible signage to show people what different areas of the home were for. This supported their independence.
People knew how they could complain about the service they received and were confident that action would be taken in response to any concerns they raised.
People we spoke with who lived in the home told us that they made decisions about their daily lives. All the visitors we spoke with told us that staff made them welcome when they came to visit or when they wanted to speak with them. We saw that people who needed support to eat and drink received this in a supportive and discreet manner.
The service followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards. This helped to protect the rights of people who were not able to make important decisions themselves. The service worked with health care professionals and external agencies to provide appropriate care to meet people’s physical and emotional needs.
You can see what action we told the provider to take at the back of the full version of the report.
We spoke with the manager and deputy manager, nursing and care staff and ancillary staff working in the home and observed staff deployment and interactions with the people living there. Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with the management and staff and looking at records and duty rotas.
We considered our inspection findings to answer the questions we always ask:
' is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well-led?
This is a summary of what we found. If you want to see the evidence that supports our summary please read the full report.
Is the service safe?
Agency staff were still working in the home because there had been a shortage of care and nursing staff at times. However the same agency staff had been working in the home for several months and so had got to know the service. The levels of staff we found during our visit and the rotas we looked at indicated that nursing and care staff levels and skill mix were being maintained. Staff told us they found the staffing improved and raised no concerns with us about this.
There were sufficient domestic and catering staff available to provide the support needed in these areas and maintenance staff to maintain the environment. Additional staff were being recruited on an on going basis for nursing and care roles, activities coordination and maintenance to provide support across the home.
Is the service effective?
The steps the registered provider and manager had taken to review and alter procedures around admission had improved the process for the people coming into the home. Admissions were better planned and organised taking into account staffing levels.
Is the service caring?
We observed that there were sufficient staff available to care and support people.Staff were respectful and gave encouragement and prompting when supporting people, for example with their meals and drinks.
Is the service responsive?
Changes had been made to the way admissions were organised so that staff could follow up any issues and get the medicines and equipment people needed before they came in to help ensure their needs could be met on arrival.
Is the service well-led?
The staffing levels in the home had been affected by shortages and sickness. In response to this the registered provider had put interim contingency plans in place using agency staff to maintain better staffing. Management was more stable in the home and staff said this had been an improvement. The registered manager was actively recruiting staff to provide care and support.
' is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well-led?
This is a summary of what we found. If you want to see the evidence that supports our summary please read the full report.
Is the service safe?
We looked at how medicines were being managed in the home. We found that people had been prescribed medicines to be taken when required and we found that medicines prescribed in this way did not have any information available to guide staff as to how to give them. We found there was no information recorded to guide staff which dose to give when a variable dose was prescribed. It was important that this information be recorded to ensure people were given their medicines safely and consistently at all times.
Is the service effective?
We also saw that some medicines were unavailable for administration and a third one ran out on the day of our visit. It was important that arrangements were in place to ensure that all medicines were available for administration when people were living in the home to meet their medication needs
Is the service caring?
We saw that the nurse administered medication to people in a kind and respectful manner.
Is the service responsive?
We found that one person was prescribed Insulin, however there was no information recorded as to how often to monitor their blood sugars which are taken in order to check it is safe to administer the prescribed dose of insulin.
Is the service well-led?
Record keeping was not consistent with regard to medicines. We saw that the provider did regular audits of medication to identify concerns in order to protect people from harm. However, the audits had not noted and addressed the concerns we found during the inspection.
We found sufficient numbers of staff on duty to meet people's needs and keep them safe. We saw that there were arrangements in place to maintain staffing levels, which allowed the manager to respond to unexpected changes through sickness or sudden absence.
We considered our inspection findings to answer the questions we always ask:
' is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well-led?
This is a summary of what we found. If you want to see the evidence that supports our summary please read the full report.
Is the service safe?
CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We looked at the records of applications that had been correctly submitted and these were in order. The service had appropriate policies and procedures in place in relation to this and also regarding the Mental Capacity Act 2005.
We found that the appropriate processes had been followed with records of people's best interests, mental health and mental capacity assessments by appropriate medical, health and social care professionals. This was to help make sure that people's human rights were respected and taken into account.
We checked the personnel record files for recently recruited staff and the information held on agency staff. We found that appropriate checks were made as part of the recruitment process. These included a check to ensure each of those who applied for a position was suitable to work with vulnerable people before they started working at the home.
We found that there had been staff shortages and the service had used agency staff to maintain staffing levels as an interim measure. A longer term recruitment and retention strategy had been implemented as well.
We found that appropriate arrangements were not in place in relation to the recording of medicines. We saw that medicines were not always kept or administered safely. We saw medicines that were left unattended and insecure on a number of occasions during the medicines round with risk to people from unauthorised access. We found a large quantity of medicines that were no longer required that had not been disposed of in a timely manner. This increased the risk of medicines being put back into use inappropriately or being mishandled and diverted.
The service did not have a registered manager in post. However a new manager had been recruited and was in the process of registering with the CQC.
Is the service effective?
We found that the provider had procedures in place for obtaining valid consent and what people's wishes were if their health deteriorated. Attention was being paid to making sure that people were being supported to give consent or make decisions about their care and treatment.
We found that a review was underway in regard to decisions made around resuscitation. The review being carried out was to improve the recording and accuracy of information and make sure that where people lacked capacity to make a decision their rights were upheld.
Is the service caring?
We saw that care and nursing staff gave encouragement when supporting people. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.
We observed that staff interacted with people in a positive and supportive way.
Is the service responsive?
Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes.
We saw people were able to follow their own faiths and attend religious services if they wanted to.
Is the service well led?
Quality assurance processes were in place. The provider did regular audits of medicines handling to identify concerns in order to protect people from harm. However, these assessments and audits had not identified the medication shortfalls found at this inspection.
The service did not have a registered manager in post when we visited. However the new manager had been recruited, was in post and applying for registration with CQC. They demonstrated a good understanding of procedures regarding deprivation of liberty.
Below is a summary of what we found. The summary is based upon our observations, discussions with people using the service, their relatives and the staff supporting them and from looking at the records held in the home. We also observed the interactions between people living there and the staff supporting and caring for them. We used the 'Short Observational Framework for Inspection' (SOFI) to help us do this. SOFI is a specific way of observing care to help us understand the experiences of people who could not easily talk with us.
If you want to see the evidence that supports our summary please read the full report.
Is the service safe?
At a previous inspection we found concerns with the home's arrangements for managing medicines. We found that improvements had been made to make sure that people living in the home were given their medicines safely. We spoke with two people living in the home about their medicines. They both said that they received their medicines at the times they needed them and said staff were supportive and caring.
The provider had contingency plans in place for dealing with foreseeable emergencies. A member of the management team was available on call in case of emergencies. There were enough staff on duty to meet the needs of the people living at the home and we saw that staff treated the people living there with respect and promoted their dignity.
Staff personnel records did not contain all the information required by the Health and Social Care Act 2008. This meant the provider could not demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home. A compliance action has been set for this and the provider must tell us how they plan to improve.
CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place.
Is the service effective?
People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. Staff had received training to meet the needs of the people living at the home.
People's health and care needs had been assessed with them and/or their families. Risks to their health and wellbeing had been assessed and plans put in place to manage them. Specialist dietary, mobility and equipment needs had been identified in care plans and action taken to meet them.
We found that the provider had procedures in place for obtaining valid consent and evidence of power of attorney and assessing mental capacity however this important information was not evident in practice within people's care files. This meant that staff did not have prompt access to accurate information on who had legal authority to make decisions on people's behalf. It also meant capacity was not always assessed according to legislation. We found that the information on file for decisions made around resuscitation were not of a consistently good standard.
People's different needs were taken into account with the layout of the home and the signage used to promote their understanding and independence.
Relatives we spoke with confirmed there were a range of activities for people to take part in and that the visiting times were flexible.
Is the service caring?
People were supported by suitably trained and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. A visitor told us they had moved their relative from another home and said "It has been a good move, the care has been good and the staff have really helped her to settle in'. They also told us that their relative had more activities to choose from and 'more mental stimulation here'.
From our observations and what people told us we found that people's preferences, interests and personal wishes were discussed with them and recorded. We were told that staff were 'polite' and 'cheerful' and listened to what they had to say.
Is the service responsive?
People's needs had been appropriately assessed before they moved into the home. People told us they had key workers and also about the 'service user of the day'. This programme focused upon a different person each day and ensured that all care files, and risk assessments were reviewed.
Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.
Is the service well-led?
Quality assurance processes were in place and people told us they were asked for their feedback on the service they received and that they had also filled in a customer satisfaction survey. The staff said the management team was supportive and held regular meetings to promote good communication. Staff told us they were given regular supervision and the opportunities to train and develop professionally.
The service worked well with other key organisations, including the local authority and safeguarding teams. This approach helped to support care provision and service development.
Overall, we found that medicines were not managed in a safe way. Whilst people who we spoke with were mostly happy with the way their medicines were managed, we saw that medicines were not handled properly.
From our observations and conversations with people living there we found they were able to follow their own interests and take part in social activities. We saw that people were comfortable with the staff on duty. We were told that staff were "Very kind' and also 'patient'. We found that staff knew the people who lived there well and were familiar with their conditions and needs.
People told us they 'liked' and 'enjoyed' the food provided and that they had a choice. We saw that the menu was varied and that people had their weights monitored.
There were systems in place to recruit and train staff. Some staff still needed some important training and this was being organised to make sure they were fully prepared for their roles. Staff levels and the way staff were used was also being reviewed by the new manager. This was because there were times when there were not enough of the right staff available to meet people's needs promptly. People told us that they often had to wait for help when they rang their call bells, but that staff did "eventually" come. This meant people may not get the right help they needed and in a timely way and that could affect their care and welfare.
Everyone living in the home had a care plan in place that had information about them and what help and support they needed. However some assessments of risk in care plans, for example, the risk of falling had not always been completed and instructions had not always been followed in practice by staff. If care plans did not give and accurate reflection of the care people needed they might be at risk of getting inappropriate care and treatment.
The provider had systems for getting people's views and monitoring the quality of the services provided but these had not been followed fully in practice. We saw that people had not had any meetings to allow them to give their views and affect the running of their home. We also saw that the systems to check or 'audit' the quality of care in the home had not been carried out as they should be. This can affect the safety and quality of care provision. There was a new manager in post and they were working to find the problems and address them.