The inspection took place on 7 June 2018 and was unannounced.

Kathryn’s House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Kathryn's House provides care for up to 29 older people, some of whom were living with dementia and some who were living with other mental health support needs. At the time of our inspection there were 20 people living at Kathryn's House.

There was registered manager in post who supported us during our inspection. 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 skilled staff available to ensure that people’s needs were met promptly and people were not waiting for their care. Safe recruitment practices were in place to help ensure that only suitable staff were employed. Staff received the induction, training and support they required to carry out their roles.

People lived in a safe, clean environment which was adapted to meet their needs. Staff were aware of safe infection control practices and systems were implemented to help reduce the risk of people developing infections. Health and safety checks were completed to ensure the environment remained safe for people. The provider had developed a contingency plan which meant people would continue to receive safe care in the event of an emergency or unforeseen event.

Staff treated people with dignity and respected their privacy. People were supported to maintain and develop their independence and where relevant other professionals were involved in supporting people to achieve their goals. People’s legal rights were protected as the principles of the MCA were followed. People were offered choices and these were respected by staff. Visitors to the service were made to feel welcome.

Risks to people’s safety were assessed and control measures implemented to keep people as safe as possible. Accidents and incidents were recorded and action taken to prevent them happening again. Staff were aware of their responsibilities in safeguarding people from abuse and any concerns were reported to the local authority. People received support to remain healthy and healthcare professionals were involved in people’s care as required. Safe medicines systems were in place and regularly monitored to ensure people received their medicines in line with prescription guidelines. People were provided with a nutritious diet and choices were available. Specialist diets were catered for and staff were aware of people’s dietary needs. Regular feedback on the food provided was sought.

People and their families were involved in the assessment process and developing care plans. Regular reviews were completed of the care people received to ensure staff had the most up to date guidance when providing people’s support. Care plans included personalised information regarding people’s communication needs, life histories and how they preferred their care to be provided. Staff were knowledgeable about people’s needs and preferences. The support people wanted when reaching the end of their life was recorded and staff understood the need to promote people’s dignity at this time. People had access to a range of activities, many of which were personalised and provided on an individual basis. People’s cultural and religious beliefs were respected.

People and staff spoke highly of the management of the service. Staff told us that they felt supported and knew that there was always someone available to help them when needed. We received positive feedback regarding the care staff from relatives a

Kathryn's House provides accommodation and personal care for up to 29 older people, some of whom were living with dementia. The home is set over three floors with access to the upper floors via a small lift. At the time of our inspection there were 18 people living at Kathryn's House.

The inspection took place on 13 April 2017 and was unannounced.

Since our last inspection a new registered manager had been appointed and was present on the day of the inspection. 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.

At our inspection in April 2016, breaches of legal requirements were found and the service was placed into special measures. We returned to the service in August 2016 and found that although some improvements had been made there were on-going concerns regarding the service people received. We undertook a further inspection in December 2016 and found the improvements previously made had not been sustained and identified nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was a lack of management over-sight of the service, sufficient staff were not deployed to meet people’s needs, people did not always receive safe care and staff were not aware able to demonstrate their understanding of safeguarding. The training staff received was not effective in supporting them in their role and staff did not receive supervision. People did not always receive care in line with their needs, there was a lack of activities which took into account people’s interests and people’s legal rights were not protected. As a result of this Kathryn's House remained in special measures.

We undertook this inspection to check that the provider had taken action to meet their responsibilities. We found that significant improvements had been made in all areas and no breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found. The rating for the service remains as requires improvement to ensure that the changes in the care people receive and the governance of the service are sustained and embedded in to practice. However, due to the extent of the improvements made in responding to people’s individual needs and the personalised care people are now receiving the service has been rated as good in the responsive domain.

Risks to people’s safety and well-being were assessed and control measures were in place to help minimise risks. Staff were aware of how to support people to manage risks safely. Accidents and incidents were recorded and monitored to identify any trends and minimise the risk of them happening again. Staff were aware of their responsibilities in safeguarding people from potential abuse and any concerns were appropriately reported. The provider had a contingency plan in place to ensure that people’s needs would continue to be met in the event of an emergency or if the building could not be used.

There were sufficient staff deployed to meet people’s needs safely. People’s needs were responded to in a timely manner and staff had time to spend with people. Staff received regular training and supervision to ensure they had the skills required to meet people’s needs. Training was provided in line with the learning needs of staff to ensure their understanding. Safe recruitment processes were in place to ensure people received support from suitable staff.

Safe medicines practices were practised and people received their medicines in accordance with their prescriptions. Staff competency in managing medicines was assessed and regular medicines audits were completed. People’s healthcare needs were known to staff and appropriate referrals were made to healthcare professionals wher

Kathryn's House provides accommodation and personal care for up to 29 older people, some of whom were living with dementia. The home is set over three floors with access to the upper floors via a small lift. At the time of our inspection there were 24 people living at Kathryn's House.

The inspection took place on 8 December 2016 and was unannounced.

At our inspection in April 2016, breaches of legal requirements were found and we took enforcement action against the provider. We issued warning notices in relation to safe care and treatment, person centred care and good governance. As a result of our concerns Kathryn's House was placed into special measures. The provider wrote to us to say what they would do to meet legal requirements. We undertook a further inspection in August 2016 to check the provider had taken action to meet the regulations. We found the provider had made some improvements in the quality of people received. However, these were not sufficient as the care people received was not always safe, staff were not able to demonstrate their understanding of safeguarding, people did not always receive care in line with their needs, there was a lack of activities which took into account people’s interests and the provider had not ensured that quality assurance systems were in place. There were continued breaches because the provider had failed to take proper action. As a result of this Kathryn's House remained in special measures.

We undertook this inspection as a result of receiving concerns regarding people’s care and to check that the provider had taken action to meet their responsibilities. We found that previous improvements made had not been sustained and that there were on-going concerns regarding the care and treatment people received.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager is responsible for the day to day management of the home and was available throughout the inspection.

There was a continued lack of managerial oversight within the service. The provider and registered manager had not identified shortfalls with the care people received or poor practices in staff performance. There was a lack of understanding with regard to the responsibilities as registered persons. The provider had failed to ensure that the CQC had been notified of significant events at the service.

Risks to people’s safety were not adequately identified and addressed. Accident and incident forms were not always completed in detail and were not analysed to minimise the risk of reoccurrence. Sufficient staff were not always deployed to meet people’s needs and the minimum staffing levels determined by the provider were not always met. Staff had failed to identify safeguarding concerns and ensured that these were reported to the relevant authorities.

Staff had not received training in relation to people’s specific needs including supporting people living with dementia and other mental health conditions. Staff had received some training to support them in their role but were unable to demonstrate their understanding in practice. The provider had failed to ensure staff received effective, on-going supervision which monitored their skills and practice. Staff told us they felt supported by the registered manager.

People’s legal rights were not protected as the principles of the Mental Capacity Act 2005 were not followed. Capacity assessments had been completed in relation to a number of restrictions but had not been shared with staff. There were capacity assessments completed in relation to locked doors and DoLS applications had not been submitted to the local authority.

People’s nut

Kathryn's House provides accommodation and personal care for up to 29 older people, some of who may be living with dementia. At the time of our inspection there were 26 people living at Kathryn’s House. The home is set over three floors with access to the upper floors via a small lift. At the time of our inspection there were 26 people living at Kathryn’s House.

The inspection took place on 19 August 2016 and was unannounced.

At our inspection in April 2016, breaches of legal requirements were found and we took enforcement action against the provider. We issued warning notices in relation to safe care and treatment, person centred care and good governance. As a result of our concerns Kathryn’s House was placed into special measures. The provider wrote to us to say what they would do to meet legal requirements.

We undertook this inspection to check that they had followed their plan and to confirm that the service was meeting legal requirements. We found the provider had made some improvements however sufficient improvements had not been made to meet the requirements of the Health and Social Care Act 2008 (Regulated Activities) 2014. There were continued breaches during this inspection because the provider had failed to take proper action. As a result of this Kathryn’s House remains in special measures.

Risks to people’s safety were not always identified and adequately controlled. Staff were not aware of risks to people’s safety and well-being and records were not completed to provide guidance. Care plans were not seen by staff and some people did not have care plans in place to guide staff in providing safe care. Staff were not able to demonstrate their responsibilities regarding safeguarding people from abuse. Risk assessments relating to people’s nutritional needs were not completed and referrals were not always made when concerns were identified. People’s needs were not always assessed prior to them moving into the service and staff were not given guidance regarding their needs. Care was not always provided in accordance with people’s individual needs. After the inspection the provider informed us that full risk assessments and care plans were now in place for people and that staff had now received training to ensure that people were kept safe.

People medicines were not managed safely and records were not accurately maintained. We found gaps in the recording of people’s medicines and safe procedures were not followed.

Information relating to the evacuation of the building in an emergency had been completed but staff had not been made aware of how to access this information.

There were sufficient staff available to meet people’s needs although staff were not always deployed appropriately. Staff were not provided with guidance on the staffing levels needed within the communal areas of the home which placed people at risk. However since the inspection the provider has assured us they have changed how staff are deployed to assist everyone that needs help with their meals so people are not waiting. New staff were subject to recruitment checks to ensure that they were suitable to work in the service.

People’s rights were not protected as the Mental Capacity Act 2005 (MCA) was not always followed. This meant that people may be subject to restrictions which had not been legally authorised. The registered manager and staff were unable to demonstrate their understanding of their responsibilities in this area. Assessments of people’s ability to make day to day choices had been completed but not shared with the staff supporting them.

Activities were not planned in accordance with people’s preferences and were not observed to engage people.

There was a lack of effective leadership of the service and systems were not in place to ensure that the service would operate smoothly in the absence of the registered manager. Although there were some improvements in the way the quality of the service was assessed and monitored con

The inspection took place on the 18 and 21 April 2016 and was unannounced.

Kathryn's House provides accommodation and personal care for up to 29 older people, some of who may be living with dementia. At the time of our inspection there were 26 people living at Kathryn’s House. The home is set over three floors with access to the upper floors via a small lift.

There was a registered manager in place. 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.

Where risks were identified suitable risk assessments and control measures had not been implemented. Unsafe moving and handling practices were used and people did not receive support and reassurance during times of high anxiety.

Effective infection control systems were not in place and guidance was not available for staff. The home had a policy in place regarding safe laundry processes. However this was not followed and laundry procedures put people at risk of infection. The home was clean and maintained to a good standard.

Safe medicines processes were not always followed. Protocols were not in place for the administration of ‘as required’ medicines and unsafe administration practices were observed. People received their medicines according to the prescribed guidelines and medicines were stored securely.

Staff did not understand their responsibilities under the Mental Capacity Act (MCA) and had not received training in this area. We saw no evidence of mental capacity assessments in people’s care files. The registered manager told us they were aware this was an area which required work.

Staff had not received effective training to undertake their roles and responsibilities. There were a large number of gaps in training records. Staff received supervisions in groups and did not meet with their manager individually to assess their progress and skills.

People were not always supported with their food in a safe way and people did not have a meaningful choice of food or drinks. The food provided looked appetising and portion sizes were good.

People were not supported in a caring and respectful manner. We found that people were being woken and supported to get ready for the day at an unreasonable time. People did not receive appropriate care with regard to their continence needs and continence aids were not provided at night. This meant people were left in wet and soiled beds until staff next checked if they required support.

Staff did not always speak to people in a caring and respectful manner although we also saw some positive interactions between people and staff where care was provided in a gentle and reassuring way.

Care plans were not completed in a timely and effective way. A number of people did not have care plans in place and plans were not adapted when people’s needs changed.

People did not have access to a range of activities in accordance with their individual needs and preferences. Relatives told us they would like to see more activities for people.

The service did not undertake regular audits to monitor the quality and effectiveness of the service and there was a lack of managerial oversight. Relative satisfaction questionnaires were completed annually although action plans were not implemented to ensure comments were acted upon. Records within the service were not always accurately maintained.

There were sufficient staff deployed in the home. Appropriate recruitment checks were undertaken when new staff were employed to ensure they were suitable to work with people living in the service.

People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them.

People’s privacy was respected. Staff were seen to knock on pe

We found that staff at Kathryn's House respected and involved people who used the service in the planning and delivery of care and support. One person we spoke with about meetings to which residents were invited told us “Quite a lot of us go to the meetings and they are held quite regularly. We are able to tell the manager what we think and they do listen.” People's plan of care reflected their wishes in the way that care was planned and delivered.

People who used the service experienced effective safe and appropriate care treatment and support. People were fully assessed prior to joining the service and regularly thereafter. Care plans were detailed and ensured that the welfare of people was protected. Staff treated people with respect and, through the provision of policies and procedures, people's welfare and safety was assured.

People who used the service were protected from abuse because staff had received appropriate training and were able to recognise abuse if it occurred. During our visit we spoke with people who used the service and staff. One person told us “Oh yes, I don’t have any worries. They always look after me.”

The service was clean and hygienic and the risk of infection was minimised by the presence of policies and procedures and relevant guidance. We saw that the home was well maintained and clean. Portable equipment and appliances were also clean and hygienic.

Records kept by the service were comprehensive, appropriate and securely stored.

We inspected Kathryn's House as part if our planned schedule of inspections. The inspection was unannounced which meant that the provider did not know we were going to visit.

At the time of our inspection there were 25 people accommodated at Kathryn's house.

During our inspection we looked to see how the service involved people in making choices and decisions about the care, support and daily life. We found that the provider couldn't evidence in all cases how people were included in important decisions about their life.

We saw that care records and risk assessments that contained important information about how people's care should be delivered and how they should be protected from the risk of harm, were not up to date, or in place for some people. We also saw that people's records and personal information was not always secured.

We saw that medication administration and storage arrangements were suitable and that staff had received appropriate training to administer medication safely.

We looked to see if there were enough suitably trained staff to meet people's needs. Training records showed that people had received the training they needed.

The registered manager told us that complaints were taken seriously. A relative told us that they didn't have any complaints.