Keate House is a residential care home located in the village of Lymm, Warrington. Accommodation includes 44 ensuite rooms; three lounges/dining rooms and a large conservatory. The home specialises in providing accommodation for older adults and adults experiencing different forms of Dementia. At the time of our inspection, there were 41 people living in the home.

At the last inspection on the 13 August 2015, the service was rated Good. At this inspection we found the service remained Good.

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

Staff had received training in ‘Safeguarding’ and understood how to recognise abuse and how to report concerns or allegations. Our review of rotas and discussions with people confirmed that the staffing levels were sufficient for the support which needed to be provided. The registered manager had systems and processes in place to ensure that staff who worked at the service were recruited safely. Checks included a satisfactory DBS check and two references.

Arrangements were in place to monitor the safety of the environment to ensure it did not pose a hazard to people living in the home. Medication was stored securely and administered safely by staff that had been appropriately trained. Risks were assessed to monitor people’s health and well-being and staff were provided with guidance on how to mitigate risks. Any accidents and incidents were recorded and action was taken where needed with a focus on future learning and prevention.

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.

The service operated within the principles of the Mental Capacity Act 2005 (MCA). The registered manager maintained records of Deprivation of Liberty Safeguards authorisations and we saw that they had taken action to ensure that any conditions attached to authorisations were adhered to.

People told us that consent was sought before providing care. People told us they exercised choice as to how they spent their time, what food to eat and whether to engage in activities and meetings.

We saw evidence that the registered manager maintained links with community partners such as local primary schools and Brownies to deliver a varied activity programme at the service. People also enjoyed trips out in the local community, ‘golden hour’ sessions with their keyworker and arts and crafts sessions with the organisation’s activity co-ordinator.

People were supported to maintain good health. Staff sought the input of health and social care professionals when required and made referrals to relevant professionals.

People told us they were given choice regarding meals and the majority of people enjoyed the food available at the home. Comments included, “I have my choices accommodated” and “I get pretty much what I ask for.” The chef knew and catered to, people's individual dietary needs and preferences. For example, gluten free bread was sought for one person who required a gluten free diet.

Staff were assisted to be effective in their role through induction, supervisions and an annual appraisal. Staff received training in a variety of areas including dementia, the Mental Capacity Act and moving and handling. Staff had ‘lead roles’ in areas such as nutrition and pressure area care. The lead staff member acted as a point of contact for any queries regarding their topic area and disseminated relevant information to the rest of their team. The training programme ensured that staff had the skills and knowledge to support people safely.

People we

This inspection took place on 20 October 2014 and was unannounced. The last inspection of Keate House Residential Home took place on the 1 July 2013 when it was found to be meeting all the regulatory requirements.

A registered manager was 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 and associated Regulations about how the service is run.

Keate House is a service which provides accommodation and personal care and is located in the village of Lymm. The service is registered for 48 persons which includes 44 single and two double en suite rooms; three lounges/dining rooms and a large conservatory. The home has a small unit which provides care for people living with dementia. There were 43 people living in the home on the day of our visit.

Recruitment procedures were not robust enough to fully protect people from the risk of unsuitable staff being employed. The lack of robust recruitment procedures meant that there was a risk people were being cared for by staff that may be unsuitable to work with vulnerable people. This is a breach of Regulation 21 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We were told by staff working at the home that there were two night staff on duty for 43 people. Duty rotas confirmed this was the case. The number of staff on night duty was inadequate to fully support and care for the number and dependency of people living at Keate House. This is a breach of Regulation 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.  This is because the provider had failed to ensure there were sufficient numbers of appropriately trained and experienced staff on duty at all times to meet the needs of everyone living at the home.

Care plans we looked at did not always include sufficient details to guide staff on how people should be supported. This is a breach of Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We found Keate House had a policy in place with regard to the Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act 2005 (MCA). The Mental Capacity Act 2005 (MCA) says that before care and treatment is carried out for someone it must be established whether or not they have capacity to consent to that treatment. If not, any care or treatment decisions must be made in a persons best interests. However, we found that very few of the staff had received training in this area and staff spoken with had little understanding and knowledge of how to ensure the rights of people with limited mental capacity to make decisions were respected.

The Mental Capacity Act 2005 (MCA) says that before care and treatment is carried out for someone it must be established whether or not they have capacity to consent to that treatment. If not, any care or treatment decisions must be made in a persons best interests. This lack of staff knowledge meant that the provider was not protecting the rights of people who used the service by arranging for an assessment to be carried out which would test whether or not people were being deprived of their liberty and whether or not that was done so lawfully.

This is a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We saw that care plans had been audited but when errors such as documents not being fully completed were found, it was unclear what actions were to be taken or who was to rectify the error and when. We saw an audit for incidents/accidents had been completed. The date, time and location of the accident had been recorded but there was no evidence of referrals to the falls team for advice and support. This is a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

This inspection took place over one day and during our visit we spent time in all areas of the home, including the lounges and the dining areas. We were able to observe how people’s care and support was provided. We saw good warm relationships between the people and care staff working at the home. We saw that people were treated with respect and dignity and there was good banter between the people and staff team. People in the service looked relaxed and comfortable with the staff. People we spoke with said “I’m very contented here, they are very good”.

Arrangements were in place to protect people from the risk of abuse. All the people we spoke with told us that they felt safe and well protected at Keate House Residential Home. Comments included; “Staff are good, could not get any better”.

We spoke with people who said they felt well cared for and that staff treated them with kindness. A game of bingo was taking place in one lounge but in the rest of the service people were observed to be sitting in chairs around the room, with little interaction between them.

Staff members we spoke with said that the registered manager and the proprietor were very approachable. Comments from staff members included; “It is a great place to work.” “I feel very well supported.”

The views of people and their relatives were sought so the experience of living at Keate House could be improved. Survey forms were sent to relatives to gain views and comments we saw were complimentary about the service. People we spoke with were generally positive about the care and support that was in place.

Staff were knowledgeable about the people they were supporting and how their dementia impacted on their day to day living. They had received training relevant to their roles and felt supported by the management team.

The service has a complaints procedure in place which was in the service user guide and was visible on the main noticeboard within the entrance hall. There have been no recorded complaints since our last visit.

You can see what action we told the provider to take at the back of the full version of the report.

During our visit to Keate House we saw that attention had been paid to peoples' appearance, for example, we noted that a number of ladies were wearing colour co-ordinated clothing and jewellery.

Comments such as “this place is fantastic,”home from home”l and "lovely place”were made. People spoken with said“You can’t get fed up here there is always something going on”and “Lots of things to do, I like going out.”

People were provided with a choice of suitable and nutritious food and drink. We saw that people were offered snacks and drinks through the day. People spoken with said that the food was "good and plenty of it ,"basic food but very nice, ”Oh yes the meals are really nice here” and "the food is nice."

We spoke with the staff and they had knowledge of policies in place to prevent the spread and risk of infection. People said "the staff are always cleaning" and "my room is always lovely and clean."

We reviewed a number of documents relating to the safety and suitability of the premises at Keate House and found these to be appropriate.

The people living at the home said "staff are fantastic" "staff go the extra mile" and "nothing is too much trouble for the staff."

One visiting professional said “this is a wonderful home, the care is very good and always plenty going on. Nothing is too much trouble for staff and they know the people well”

The people living at Keate House that we spoke with told us they felt involved in their care. One resident we spoke with said the staff always discussed everything with them and they could make their own choices. One person said “you can do just as you like here, it is my home.” One visitor told us “we are very happy with the care and I am always kept informed.”

All the people we spoke with said the staff treated them well and that there were enough staff to support them to fulfil their needs. Comments such as “ staff are wonderful” “staff are marvellous” “couldn’t fault them they are great” were made by people living at the home. Relatives spoken with said “ the staff are wonderful, always there for our relative and us”. “they cared for my relative like a family member all the staff are excellent”.

The staff members we spoke with were very positive about the home and the standard of support that people were receiving. Comments such as “it is a good place to work” “we get lots of training.”and “I feel supported” were made.

People spoken with told us they were happy and had no complaints or concerns. They said if they had concerns they could speak with the manager or the and one person said “ I don’t have any worries about being here but I could talk to any of the staff and they would help me”

One relative said “ this place is marvellous, I have no concerns with the care my relative receives. “

When we visited Keate House we spoke with people who live there and they told us that, “Staff always treat me with respect”; “The home is lovely and we have plenty of choice”; “The staff care for me in the way I want.”

All people spoken with said that they were aware of what was in their care plans and that the manager or senior staff spoke with them about their care on a regular basis and that they were very happy with the care and support they received. One relative said, “This place is homely. The staff are lovely and very supportive. They spoil my relative. I feel that I can go home and that my relative is well cared for. The staff don’t just look after residents they love them. The staff are also supportive of me.”

People who live at the home said, “This place is a home from home” ;“staff are really good”; “nothing is too much trouble for the staff”; “they look after you how you want”; “the staff are a really good bunch”; “The home is always spotless”; “When my relatives come the staff make them a drink and make them feel welcome”.

The people living at Keate House were asked if they felt safe at the home and if they could voice their concerns. They told us that they felt safe and had no concerns about the care and treatment they received from staff that support them. One person told us, “I feel safe and like living here”; “You can ask any staff to sort things out for you and you know it will be done. All the staff are helpful and caring.”

Resident meetings were held on a regular basis and people said they could air their views. Surveys were sent out every year and views gained were published for everyone to see. People said, “you can speak to anyone and get things sorted.” Other comments taken from surveys were, “I feel safe, I like living here.”

The inspection took place on 16 June 2015 and was unannounced. A further announced visit was made on 18 June.

The home had a manager in post who had applied to be registered with CQC. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Keate House is a service which provides personal care and is located in the village of Lymm. Accommodation includes 44 single and two double en suite rooms; three lounges/dining rooms  and a large conservatory. The home has a small unit which provides care for people with dementia. There were 43 people living in the home on the day of our visit.

At our last inspection in October 2014 we found that improvements were needed in respect of the care records, staffing numbers, staff recruitment staff training and understanding of Mental Capacity Act and DoLS and quality audits. Following that inspection the provider sent us an action plan to tell us the improvements they were going to make. At this inspection we found that the actions we required had been completed and these regulations were now met.

We spoke with people and their relatives and all were satisfied with the care and support provided and felt their individual needs and wishes were known and understood. Staff had a good rapport with people and were kind and gentle in their approaches. During the inspection we saw people were supported to be as independent as possible. We observed staff responding to people with compassion and empathy and people were seen to be engaging with staff openly.

People felt involved in the planning and delivery of their care and had opportunities to be involved in the development of the service. Staff were knowledgeable of peoples’ assessed needs and delivered care in accordance with these. People were confident approaching staff and were comfortable raising any concerns or issues they may have.

Care plans had improved so that they focused more on the individual person and had good guidance to enable all staff to care and support people as they wished.

Activities at the home had improved and were more individually focused.

Staff recruitment procedures had improved and were robust ensuring that appropriate checks were carried out before staff started work. New staff said they received a thorough induction and felt they had received appropriate training.

Improvements had been made to staffing levels and the deployment of staff so that people’s care and support needs were met promptly.

Staff were aware of how to protect people from avoidable harm and were aware of safeguarding procedures to ensure that any allegations of abuse were reported and referred to the appropriate authority. This meant that care was provided in the safest way.

There were arrangements in place to ensure people received their medicines safely and at the prescribed times. The provider had a policy to guide staff regarding the safe management of medicines.

We found the home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and staff followed the Mental Capacity Act 2005 for people who lacked capacity to make decisions for themselves.

All staff had received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.