Keller House provides personal care and accommodation for up to 15 older people living with a dementia type illness. There were five people living with dementia in the home during the inspection and they all needed assistance with looking after themselves; including support with personal care, meals and moving around the home.

We carried out an unannounced comprehensive inspection at Keller House Residential Care Home on the 24 Mach 2015 where we found improvements were required in relation to safe care and treatment and person centred care, staff training, record keeping and quality assurance.

This was an unannounced inspection, which was carried out on 26 July 2016, to check that the provider had made improvements and to confirm that legal requirements had been met. We found improvements had been made, but additional work was required to ensure the provider was meeting the regulations.

At the time of this inspection the local authority had an embargo on admissions to the home pending improvements to the delivery of care and support needs for individuals and record keeping.

The registered manager was present during 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.

Quality assurance and monitoring systems were in place and the registered manager said audits were used to review all aspects of the services provided, although we found these were not as effective as they should be. For example, they did not identify the concerns we found with regard to medicines.

Medicines were managed and given out safely. However, systems for recording additional prescribed medicines and ensuring medicine administration records (MAR) were completed appropriately were not in place.

Staff understood people’s needs and provided the support and care they wanted in a kind and patient way. Risk assessments had been completed to identify where people may be at risk. Staff demonstrated a clear understanding of the steps that were in place to ensure risk to people was reduced, whilst enabling them to make choices and be as independent as possible.

Staff had attended relevant training, including safeguarding training, and relevant policies were in place. Staff had a clear understanding of types of abuse and what action to take if they had any concerns.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The management and staff had attended training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and were aware of current guidance to ensure people were protected. DoLS applications had been requested to ensure people were safe and advice had been sought to from the local authority.

People were assessed before they moved into the home to ensure staff could meet their needs and care plans were developed for this information. Staff said they had read these, they felt they had a good understanding of people’s needs and provided the support and care they wanted in a kind and patient way. Care plans were reviewed and people and their relatives were involved in discussions about the care and support provided.

People said the food was very good, choices were provided and drinks and snacks were available throughout the day. Systems were in place to monitor the amount people ate and drank, to ensure they had a nutritious diet, and staff contacted the GP if they had any concerns.

There were enough staff to provide the support people needed and the recruitment procedures ensured only suitable people worked at the home. There was a relaxed atmosphere in the home, people said they were comfortable and relatives were confident that if they had any concerns the

Keller House provides accommodation and care for up to 15 older people living with a dementia type illness and who require assistance with daily living. There were 10 people living at the home on the day of the inspection.

The home was run by a registered manager who was present during 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.

When we inspected this service on 28 October 2013 we asked the provider to make improvements to the policies and procedures with regard to complaints. At the last inspection on 27 August 2014 we looked at complaints and the relevant policies and procedures and consequently made compliance actions for management of medicines and complaints. The provider sent us an action plan and said they were compliant by October 2014; we found these were met at this inspection.

This inspection took place on the 24 March 2015 and was unannounced.

Risk assessments had been completed as part of the care planning process. We found they had not all been reviewed on a regular basis and people’s needs were not always assessed, reviewed and updated as they changed.

We found there were not always enough staff to meet people’s needs and a system to determine appropriate staffing levels was not in place, which meant people had to wait for staff to assist them.

Not all staff had attended essential training, such as supporting people living with dementia.

Recruitment procedures were not robust, as all the relevant information had not been collected before staff were employed to work at the home. The systems used to assess and monitor the services provided were not effective.

There were systems in place for the safe management of medicines, and people had access to external healthcare professionals as required. Staff had attended safeguarding training and had a good understanding of abuse and how to protect people.

Staff had an understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, and ensured people were enabled to make decisions about the care and support provided.

The atmosphere at the home was relaxed and comfortable; people were treated with respect and relatives and friends were welcome at any time.

There was an open management structure at the home and staff felt supported by the registered manager.

We found a number of breaches 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 this report.

At our previous inspection we found that the home did not have an effective complaints policy or procedure in place, to enable people to raise concerns and for them to be investigated appropriately. Following the inspection the provider advised us they had taken action and the issues had been addressed. Evidence gathered at this inspection showed that although some changes had been made the provider was not compliant.

We spoke with three of the people who lived at the home. However, some people were not able to tell us about their experiences of living at Keller House, because of their complex needs. People told us they were comfortable and that they had nothing to complain about. One person said, “Everything is very good here. The staff look after us and there is nothing to complain about. I could talk to the staff if I wanted to”.

We spoke with the manager, the deputy manager and two care staff. We looked at the complaints policies and procedures, the complaints records and the medication records and care plans of the people concerned.

We considered our inspection findings to answer 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?

Is the service safe?

We found that during our inspection the service was safe. We saw that people were relaxed and comfortable sitting in the lounge, or walking around the home. Staff said they had a good understanding of people needs, and demonstrated how they provided the support that people wanted.

Systems were in place to ensure the management and staff learned from the complaints and concerns raised, and some of the issues identified at the last inspection had been addressed.

Is the home effective?

We found that during our inspection the service was effective. People’s health and social care needs had been assessed, and they had been involved in this process, with the support of relatives or representatives.

Is the service caring?

We found that during our inspection that the service was caring. We saw that people were supported by kind, patient staff.

Is the service responsive?

We found that during our inspection that the service was responsive. We saw evidence that when people had raised concerns the manager and staff responded.

Is the service well-led?

We found during our inspection that the service was well led. Staff we spoke with were clear about their roles and responsibilities. They said they were able to talk to the management if they had any concerns, and felt very well supported by the manager and senior staff.

We used a number of different methods to help us understand the experiences of people using the service because people using the service had complex needs which meant they were not able to tell us their experiences. We spent time observing care and how staff interacted with people. We spoke with people's relatives who were visiting the home. We spoke with staff and looked at some records.

We saw that staff knew people well and had a good understanding of people's needs. Care plans were in place and these reflected the assessed needs of people. Staff knew what abuse was and what to do if it was suspected. There were sufficient numbers of staff with the appropriate skills to meet the needs of people using the service. There was a complaints procedure in place, however the systems in place to manage complaints did not ensure complaints were fully investigated or resolved to the satisfaction of the person making the complaint.

We used a number of different methods to help us understand the experiences of people using the service, because some of the people had complex needs which meant that they were not always able to tell us their experiences. We observed staff supporting people living in Keller House, and we looked specifically at the systems in place for monitoring the quality of the support and care provided by the service.

We found that the service monitored quality in a number of ways. They obtained feedback from people who used the service and their relatives using questionnaires. The comments we saw were positive and included, ‘very clean and homely’ and we are ‘quite happy’ with the support.

A number of audits had been introduced and these included the management of medicines, staff training, care plans and suitability of the environment. We found that the audits were carried out regularly.

We spoke with the manager who said that the quality monitoring system enabled them to identify where changes were needed. They also highlighted positive feedback, from people who used the service, their relatives and the staff.

We spoke with three people who used the service and they were looking forward to the Christmas festivities. They made no specific comment about how the service monitored the quality of the care and support provided.

We used a number of different methods to help us understand the experiences of people using the service because some of the people using the service had complex needs which meant that they were not able to tell us their experience.

We observed staff supporting people living in Keller House, we looked at documents and spoke to visitors, the care staff, manager and provider.

People who were able to told us that they were comfortable and that the staff were very good.

Not all of the people using the service were able to tell us about their experiences in the home. Those who could told us, “I am happy here”. Visitors told us they were happy with the home and the care provided. One relative told us that “staff are very good I am more than happy with the care here”.