This inspection was unannounced and took place on 04 and 06 July 2018. We last inspected Kelvedon House on 20 July 2016, when we rated it as ‘good.’

Kelvedon House is registered to provide accommodation for 52 people who require nursing or personal care. People who live there may have a dementia type illness or a learning disability. At the time of our inspection 49 people were living at the home. The service is delivered across three units; Park View and Jobs Way which are predominantly occupied by people who are living with dementia and the third unit which supports people who have a learning disability.

A registered manager was in place. A 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.

People were cared for by staff who were trained in recognising and understanding how to report potential abuse. Staff knew how to raise any concerns about people’s safety and shared information so that people’s safety needs were met.

People were supported by staff to have their medicines and records were maintained of medicines administered. People and relatives complimented the cleanliness of the home and staff used protective clothing when appropriate.

Staff were available to meet people’s individual needs and demonstrated good knowledge about people living at the home. Staff told us training helped them meet the specific needs of the people they supported.

Staff understood the importance of ensuring people agreed to the care and support they provided and when to involve others to help people make important decisions. The registered manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS) and had submitted the appropriate applications where they had assessed that people were potentially receiving care that restricted their liberty.

People enjoyed a choice of meals and snacks and were supported to access professional healthcare outside of the home, for example, they had regular visits with their GP and any changes to their care needs were recorded and implemented.

People were supported to enjoy a wide range of activities and were involved in their day to day care and chose how to spend their day. We saw further developments including on site reminiscence shops were planned to support people living with dementia. People were encouraged to maintain their independence.

Staff were caring and treated people with respect. We saw people were relaxed around the staff supporting them and we heard and saw positive communication throughout our inspection and saw people smiling and responding positively to staff. Staff showed us that they knew the interests, likes and dislikes of people. We saw that staff ensured that they were respectful of people’s choices and decisions.

People knew how to raise concerns and felt confident they could raise any issues should the need arise and that action would be taken as a result.

The provider had systems in place to check and improve the quality of the service provided. We saw that where areas had been identified as requiring improvement actions had been taken in response.

The registered manager was available to people, relatives and staff and supported staff to carry out their roles and responsibilities effectively, so that people received care and support in-line with their needs and wishes.

Kelvedon House is registered to provide accommodation for 52 people who require nursing or personal care. People who live there may have a dementia type illness or a learning disability. At the time of our inspection 52 people were using the service. The service is delivered across three units; Park View and Jobs Way which are predominantly occupied by people who are experiencing a dementia type illness and the LD Unit which supports people who have a learning disability.

Our inspection was unannounced and took place on the 20 July 2016. At our last inspection in July 2014 the provider was meeting all the regulations but identified that some areas in the key questions of effective and well-led required improvement. We found on this our most recent inspection the provider had made the necessary improvements.

The service had a registered manager. 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.’

We found that overall medicines were administered safely. Staff received training and had their competency assessed in relation to medicines administration. Systems were in place to protect people from abuse and harm. Staff were clear about their role in protecting people from any risks related to care delivery. Staff understood their responsibilities for reporting incidents, accidents or issues of concern. A suitable number of staff were on duty with the skills, experience and training required to meet people’s needs. Recruitment processes operated by the provider were effective.

People were supported effectively by well trained staff. Staff were provided with opportunities for developing their skills and reflecting upon their practice. New staff members were provided with a comprehensive induction. People using the service who were subject to a Deprivation of Liberty Safeguards (DoLS) authorisation were supported by staff in line with this. People’s nutritional needs were well understood and catered for. People’s health and wellbeing was monitored closely by staff and healthcare referrals were made as required to maintain their health and wellbeing.

People and their relatives were involved in planning care and making decisions. People were supported to make choices about all of aspects of daily living. Staff demonstrated kindness and understanding when supporting people. Staff were responsive to people when they were in discomfort or distress and provided them with reassurance and/or distraction. Information was freely available about how people could access advocacy support. People were encouraged by staff to try to do as much for themselves as possible, but staff were there to support them if they needed help. Staff were respectful towards people and provided any support they needed in a dignified manner. Staff had the confidence to challenge each other about dignity issues related to how they supported people.

People were encouraged to express their views and be involved in the planning of their care and support. People were supported to be as active as they wanted based on their personal choices and preferences. Care plans were detailed and demonstrated the level and type of support people required. The service had a dedicated activities coordinator who organised several activity sessions for people to be involved each day. People were supported to maintain and have regular contact with their family and friends. The provider used a variety of methods in order to listen to and learn from feedback from people. The provider acknowledged, investigated and responded to complaints in line with their own policy.

The registered manager had a good knowledge about the people using the service and their needs. Staff were well supported by the

Kelvedon House is registered to provide accommodation for 52 people who require nursing or personal care. People who live there may have a dementia type illness or a learning disability. At the time of our inspection 48 people were using the service. The service is delivered across three units, Park View, Jobs Way which is predominantly occupied by people who are experiencing a dementia type illness and the LD Unit which supports people who have a learning disability.

Our inspection was unannounced and took place on the 26 and 27 May 2015. At our last inspection in July 2014 the provider was not meeting the regulations which related to supporting workers. Evidence that we gathered during this, our most recent inspection, showed that improvements had been made.

The manager was registered with us as is required by law. 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.

People and/or their relatives told us they felt confident that the service provided to them was safe and protected them from harm. Staff we spoke with were clear about the how they could access and how to utilise the providers whistle blowing policy. The registered manager was able to demonstrate learning and changes to practice from incidents and accidents that had occurred within the service.

We observed there were a suitable amount of staff on duty with the skills, experience and training in order to meet people’s needs. People told us that were able to raise any concern they had and felt confident they would be acted upon.

People’s ability to make important decisions was considered in line with the requirements of the Mental Capacity Act 2005. However, care plans for people with Deprivations of Liberty Safeguards (DoLS) authorisations did not provide enough guidance as to how the person could be supported without restricting them unnecessarily.

People were supported to take food and drinks in sufficient quantities to prevent malnutrition and dehydration. The lunchtime experience was overall relaxed and positive for most people. People were supported to access a range of health and social care professionals to ensure their health needs were met.

Staff interacted with people in a positive manner and used a variety of communication methods to establish their consent and/or understanding. Staff maintained people’s privacy and dignity whilst encouraging them to remain as independent as possible.

Information regarding how to access local advocacy services was clearly displayed. Staff were aware of how and when to access independent advice and support for people.

People and their relatives were involved in the planning of care and staff delivered care in line with peoples preferences and wishes. Staff supported people to access support for their spiritual or cultural needs.

Information and updates about the service was made available to people and their relatives, in meetings and with the use of a number of notice boards. The complaints procedure was made available in a variety of formats to maximise people’s knowledge and understanding of how to make a complaint.

People, relatives and professionals spoke positively about the approachable nature and leadership skills of the registered manager. Structures for supervision allowing staff to understand their roles and responsibilities were in place.

Systems for updating and reviewing risk assessments and care plans to reflect people’s level of support needs and any potential related risks were not always effective. The registered manager showed us new documentation that was currently being implemented to improve and to develop more consistency in care records.

Quality assurance audits that were undertaken regularly by the provider. The registered manager had identified some of the issues we found during our inspection with records and the environment; but these had not been rectified in a timely or effective manner. The registered manager demonstrated to us that she had reported the environmental issue for several months to the provider. This meant the provider was aware but had not taken action.