This inspection took place on 21 February 2019 and was unannounced.

Kemp Lodge is registered to provide nursing and personal care for up to 38 people. At the time of the inspection there were 15 people living at the service. A large proportion of people had already left the service or were in the process of moving to alternative accommodation. Kemp Lodge is a purpose built single story building consisting of three units and provides care to adults with nursing and personal care needs. The service is set in pleasant grounds in a residential suburb of Liverpool.

Kemp Lodge is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of our inspection a registered manager was in post. A registered manager is a person who has registered with 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.

We inspected the service against two of the five questions we ask about services: is the service safe and is the service well led. This is because at the last inspection, the service was not meeting some legal requirements.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating for this inspection.

This inspection was done to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection on 12 December 2018 had been made, when the service was rated as ‘Requires Improvement.’ This is because breaches of legal requirements were found in relation to ‘Safe Care and Treatment,’ ‘Safeguarding’ and ‘Good Governance,’ which are breaches of Regulation 12, 13 and 17 of the Health and Social Care Act (Regulated Activities Regulations) 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

Services rated as ‘Requires Improvement’ will be inspected again with 12 months. Prior to our inspection in December 2018, the registered provider had applied to CQC to remove the location and the service was due to close in February 2019. However, the provider had recently extended the date for closure until June 2019. Given that the service was due to remain open later than originally planned, we decided to conduct a focused inspection. We needed to consider any current risks and how the provider has mitigated them appropriately and the impact on people using services and whether the provider remains in breach of requirements.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe and well-led. At this inspection, we checked to see whether the provider had acted on our findings from the last inspection and what action had been taken to resolve them.

When we completed our previous inspection, we found concerns relating to ‘Safe care and treatment’ and ‘Good governance.’ This was because systems in place to manage topical medication, thickening agent and PRN medication (as and when required medication) were not being properly managed and systems to manage the quality and safety of the service were not always effective. This was a breach of Regulation 12 and 17 of the Health and Social Care Act (Regulated Activities Regulations) 2014.

At the last inspection, we looked at safeguarding records and found that the service did not always appropriately identify safeguarding concerns and notify us of concerns. T

This inspection took place on 12 December 2018 and was unannounced.

Kemp Lodge is registered to provide nursing and personal care for up to 38 people. At the time of the inspection there were 20 people living at the service. The registered provider had recently applied to CQC to remove the location and the service was due to close in February 2019. At the time of our inspection, a large proportion of people had already left the service or were in the process of moving to alternative accommodation.

Kemp Lodge is a purpose built single story building consisting of three units and provides care to adults with nursing and personal care needs. The service is set in pleasant grounds in a residential suburb of Liverpool.

Kemp Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of our inspection an assistant service manager was in post. This was because the registered manager had transferred to another service. A registered manager is a person who has registered with 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.

At the previous comprehensive inspection which took place in December 2017, the service was rated as ‘Requires Improvement.’ We found the registered provider was not meeting legal requirements in relation to ‘Safe, care and treatment’ and ‘Good governance.’

At this inspection, we found the service continued to be in breach of ‘Safe, care and treatment’ and ‘Good governance’ which are breaches of Regulation 12 and 17 of the Health and Social Care Act (Regulated Activities Regulations) 2014. This was because systems in place to manage topical medication, thickening agent and PRN medication (as and when required medication) were not being properly managed and systems to manage the quality and safety of the service were not always effective. We also identified a breach of Regulation 13 in relation to the management of safeguarding incidents.

We found that topical medicines were not always administered to people as prescribed. Topical medicines are medicines which are usually applied to the skin such as creams, gels and ointments.

We also found that the use of thickener in fluids was not recorded on people’s fluid input charts. Thickener is a prescribed product and is used to reduce the risk of choking for people with swallowing difficulties. This placed people at risk as records did not indicate the quantity of thickener people had received in their fluids.

We looked at the management of PRN medication. We found that for some people who were on PRN medication (such as pain relief), there was not always sufficient information recorded in their PRN protocols. This meant that people were at risk of not receiving medication when needed and in line with best practice.

We looked at daily charts and records and found that they had not been completed as rigorously as they should. Support was not being provided and did not follow guidance detailed in people’s plans of care. This meant that people were not receiving the care and support they required.

We looked at safeguarding records and found that the service did not always appropriately identify safeguarding concerns and notify CQC accordingly. This meant people were exposed to the risk of actual or potential harm.

We looked at systems to manage the quality and safety of the service and found they were not always effective. Although we saw evidence that the service carried out regular audits and had identified issues, it was not always recorded as to what action had been taken and by who. In some instances, action plans had n

This inspection took place on 6 and 12 December, 2017 and was unannounced.

Kemp Lodge is a large care home, registered to provide general nursing and personal care for up to 38 people. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of the inspection there were 22 people living at the home. The home is a purpose built facility with all accommodation located on the ground floor. There were well maintained gardens to the rear of the building and a number of car parking spaces at the front.

At the time of the inspection 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.

At the previous comprehensive inspection which took place in May 2017, the home was rated as ‘Inadequate’ and placed in ‘Special Measures’. We found the registered provider was not meeting legal requirements in relation to safe care and treatment, need for consent, receiving and acting on complaints, good governance and staffing.

Services in 'Special Measures' are kept under review and inspected again within six months. The expectation is that providers who have been providing ‘Inadequate’ care should have made significant improvements within this timeframe. If not enough improvements are made and 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.

Following the previous inspection the registered provider submitted a number of action plans which outlined how they were improving the standards of care and quality of service. During this inspection we checked to make sure that the provider had made enough improvements to meet their legal requirements.

During this inspection we found a number of improvements had been made however the registered provider was found to be in breach of ‘Good Governance’ and ‘Safe care and Treatment’.

We reviewed a number of care records for the people who lived at Kemp Lodge and found that care plans and risk assessments were being regularly reviewed however there was still some inconsistent information found in different assessments and clinical processes were not being completely adhered to. This meant that the delivery of the care being provided was not always being safely monitored or reviewed, meaning that people were exposed to unnecessary risk.

Medication processes and systems had generally improved although we did identify some examples where further improvements needed to be made. Prescribed medicated creams were not always being applied as staff had been instructed. This meant that people were not always receiving a safe level of care in relation to the medications which they were being prescribed.

During this inspection, we did identify improvements which had been made in relation to the overall governance of the service although it was still evident that further systems and processes needed to be implemented and maintained in order to improve the standard and delivery of care which was being provided.

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

There was an activities co-ordinator in post at the time of the inspection. The activities co-ordinator was responsible for organising a range of different activities for residents to involve themselves in. The feedback we received about the range of different activities from both relatives and residents was

The inspection took place on Wednesday 17 and Thursday 18 May, 2017 and was unannounced.

Kemp Lodge is a large care home, registered to provide general nursing and personal care for up to 38 people. At the time of the inspection there were 27 people living at the home. The home is a purpose built facility with all accommodation located on the ground floor. There were well maintained gardens to the rear of the building and a number of car parking spaces at the front of the home.

At the time of the inspection there was no 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.

At the previous comprehensive inspection which took place in November, 2014 the home was rated ‘Good’ across all areas. During this inspection we found a number of concerns and identified a number of breaches in regulation. These included Regulation 11 ‘The need for consent’, Regulation 12 ‘Safe care and treatment’, Regulation 16 ‘Receiving and Acting on complaints’, Regulation 17 ‘Good Governance’ and Regulation 18 ‘Staffing’. During the inspection we found that people’s safety was being compromised in a number of areas.

We found that assessments and care planning for some people had not been updated and implemented to ensure care was safe and reflected people’s changing needs. The risk of not updating major changes to people’s care plans is that new staff might be unaware of their changed care needs and there is an increased risk that specific areas of care might not be effectively monitored and reviewed, exposing people to unnecessary risk.

We found that there was a lack of support for staff to fully develop their skills and knowledge to effectively and safely manage aspects of both personal and clinical care.

Staff were not always familiar with the support needs of the people they were caring for. There was often conflicting information being provided in care records and there was no consistency with the care being provided.

Accidents and incidents were routinely recorded on an internal database system however there was little evidence to suggest they were being communicated amongst the staff team. Not all staff were made aware that accidents and incidents that had occurred and ‘lessons learnt’ from analysing the accidents/incident information was not being shared with staff to improve practice.

The concerns we identified are being followed up and we will report on any action when it is completed.

There was little evidence to suggest the home was operating in line with the principles of the Mental Capacity Act, 2005 (MCA) Mental capacity assessments were completed, though they were not always completed accurately. Best interest did not clearly reflect that relevant people had been involved in making those decisions. People’s consent was not always gained in line with the principles of the MCA.

You can see what action we took at the back of this report.

People’s day to day support needs were not being met. External healthcare professional referrals were not taking place when requested and guidance and advice which was provided by external health professionals was not being acted on. Care records contained conflicting information and staff were not always following the most up to date healthcare reviews.

During the inspection a number of care records were reviewed and it was evident that care plans were often pre-populated and were not individual to that person.

Staff morale appeared to be subdued due to number of recent changes in management. It was evident throughout the inspection that there was a divide in the staff team, communication was poor and the lack of consistent leadership and management was impacting on all areas of safe

This unannounced inspection of Kemp Lodge Care Home took place on 18 November 2014.

Located in a residential area and near to local facilities, Kemp Lodge Care Home is registered to provide general nursing care for up to 38 people. Thirty four people were living at the home at the time of our inspection. It is a purpose built facility with all accommodation located on the ground floor. There are a number of car parking spaces adjacent to the home.

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 2008 and associated Regulations about how the service is run.

People said they felt safe living at the home and were supported in a safe way by staff. Staff understood what abuse was and the action they should take to ensure actual or potential abuse was reported.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. People and their families told us there was sufficient numbers of staff on duty at all times.

Our review of a selection of care records informed us that a range of risk assessments had been undertaken depending on people’s individual needs. Some of the people living at the home used bedrails and a detailed risk assessment had been undertaken for all the people who used this equipment in order to establish if it was safe for them to use.

People told us they received their medication at a time when they needed it. We observed that medication was administered to people in a safe way.

The building was clean, well-lit and clutter free. Measures were in place to monitor the safety of the environment.

Families we spoke with told us the manager and staff communicated well and kept them informed of any changes to their relative’s health care needs. People said their individual needs and preferences were respected by staff. They were supported to maintain optimum health and could access a range of external health care professionals when they needed to.

People spoke highly of the meals and the general meal time experience. They told us the food was very good and they got plenty to eat and drink.

People and families described management and staff as caring, considerate and respectful. Staff had a good understanding of people’s needs and their preferred routines. We observed positive and warm engagement between people living there and staff throughout the inspection.

Staff told us they were well supported through the induction process, regular supervision and appraisal. They said they were up-to-date with the training they were required by the organisation to undertake for the job.

Although the paperwork showed some inconsistencies, from our conversations with people, families and staff we were assured that the home adhered to the principles of the Mental Capacity Act (2005).

The culture within the service was and open and transparent. Staff, people living there and families said the registered manager was approachable and inclusive. They said they felt listened to and involved in the running of the home.

Staff were aware of the whistle blowing policy and said they would not hesitate to use it. Opportunities were in place to address lessons learnt from the outcome of incidents, complaints and other investigations.

A procedure was established for managing complaints and people living there and their families were aware of what to do should they have a concern or complaint. We found that complaints had been managed in accordance with the complaints procedure.

Audits or checks to monitor the quality of care provided were in place and these were used to identify developments for the service.

In the course of our inspection, we were able to spend time talking with four people who were being cared for at the home. They all told us they liked the home and that their care was good. We asked one person to explain to us why they thought the care they received was good. This person told us 'I know who the nurse is who looks after me, and I know the names of the carers that help me when I need it.'

We spent some time observing people in the dining area and could see there were sufficient numbers of staff present to assist people with their meals, if they required help. We asked one relative who was spending lunch time with their family member if they thought people had enough support when taking meals. This person told us "[Family member's name] only eats small amounts so I come down everyday to encourage [name] to eat. The staff wouldn't be able to spend as much time as I do, doing this. They do help, but I can come each day to do it."

We found that people who used mobility aids had access to this equipment. Where a person had been assessed for a walking frame, this had been ordered for the person and was labelled as belonging to them. When equipment was serviced or repaired, this was done by a specialist company.

We found that when a person was transferred to hospital, or attended a specialist clinic for consultation, all information about the person was made available to other clinicians without delay.

The home had systems in place to monitor the quality of service provided.

During our inspection, we were able to speak with people living at the home and their relatives. We spent time in one of the lounge areas, where people were receiving visitors. We spoke with one person, asking them about how they were cared for, whether they were happy with how the staff cared for them, and if there was anything that they would like to be done differently. This person told us "The staff are fantastic; I'm very happy. These girls [staff members] keep me busy. I can do what I want and I'm very happy." We spoke with this person's relatives, asking them if they were made welcome when they visited, if they were happy with how their family member was cared for, and how they well they thought their family member had settled in at the home. We were told: "The staff are marvellous, they really, really can't do enough for [family member's name]." The relatives we spoke with told us that their family member looked well, was happy and contented, and they could visit at any time. They also commented on the quality of care delivered, saying that they knew everything was explained to their family member, so they did feel that daily events were not beyond their control, and that staff listened to what people said.

At the time of our visit, people were engaged in various activities and we observed staff caring for people in a warm, friendly and respectful manner.

Staff were at all times respectful of residents and delivered care in a professional manner, respecting wishes of residents and encouraged them to become actively involved in day to day life of the home.

People spoke well of the staff and the levels of care provided. A resident said "I am happy here; they take care of me and know how I like things done. My family can visit when they like which is good because they have to go to work." The relative of a resident we spoke with described the care as being "Very good...there are three girls who she is particularly fond of and who care for her - they are lovely and I get on well with them all."

We were also able to see evidence of improvements in response to comments or complaints from relatives of residents.

The home also took steps to make all communal spaces social spaces - e.g.the use of the wide corridors, by placing couches against walls, which encouraged residents to stop and chat with each other. Although the home was a busy place, everybody took the time to stop and talk to residents - this was true of cleaners, catering staff and managers, as well as the carers and nursing staff. The decor was bright and friendly and residents were free to move about as they wished. The people we spoke with said that they were happy with the care they received. When we spoke with relatives, they told us that they had confidence in the level of care provided and that their loved ones were well looked after.

We observed part of a medication round and saw that nurses followed good practice guidelines for handling medicines and talked to people in a professional and kind way.

One person told us, The nurses are my angels, they look after my medicines…well, they just look after me, I’m very happy”. Another person said, “I always get my tablets at the right time and I can just ask if I need anything or if I don’t feel well – I’ve no problems”.

Generally they spoke positively about how staff included them in the care and confirmed that staff asked for their consent to care and treatment as required on a daily basis. People were generally fully aware about visiting health care professionals and their role in the care. This helped confirm that the home is good at explaining and involving the person in any decisions made about planned treatment.

We spoke with a person who explained they had shared a room until recently with another person and this had been for a protracted period. We could find no evidence of people consenting to this in their care record. The manager could also not direct us to a company statement or policy on this. Currently the home has seven shared rooms so this is quite an issue. We have made an improvement action for the home to address.

We spent some time observing the care and talking to people living in the home. We saw staff attending to people in wheelchairs and assisting people to feed. One person told us about the care they received on a daily basis and thought that staff were ‘very good and kind’. Generally people were relaxed and talked freely. One person was clearly not well but told us they had had a medical review the day before and staff were on top of all care needs.

We spoke with visitors who said that they are always kept informed about any changes in the care and any events such as a medical review would be communicated very quickly. This shows that the home is responsive to people’s care needs.

We have had previous concerns that the home has found it difficult to meet specific nursing care interventions consistently and have not always been appropriate or timely in their management. For this visit we looked in some detail at the care of a person with very acute and complex care needs and saw that the overall care was well monitored and care records helped to evidence appropriate ongoing care.

We received some feedback from a recent safeguarding investigation into a person who had a pressure sore in the home. Overall care of the person had been found to be satisfactory in terms of wound management. The outcome for the person was good in that the wound has healed. We discussed the ‘action plan’ devised by the home following our last visit and saw that the main aims seemed to have been met in that the care is now more consistent.

We spoke with people living at Kemp Lodge who said that they felt staff were competent and able to deliver care needs effectively. They feel that staff approach care confidently and work as a team. This helps to provide a feeling of security for people that their care needs can be met.

We spoke with a number of people who live in the home and discussion referred to their views on being supported to consent to care and treatment. Generally they spoke positively about how staff included them in the care and confirmed that staff asked for their consent to care and treatment as required. For example, staff always conferred regarding the use of the hoist and fully explained the procedure. One relative said that staff conferred with them about a recent referral to the GP as a visit was needed.

We saw one person and staff had acted in the person’s best interest and secured a safety belt so that the person was maintained safely in a chair. This raised issues around restraint of people. Supporting assessments and records did not reflect any decision making process which took into account the person’s lack of ability to make their own decisions or who was acting on their behalf. This is a concern because it is important that people’s rights are protected in such circumstances and the service can show due process has been followed.

We had some concerns expressed by the social service safeguarding team about some aspects of the care at Kemp Lodge. This followed two complaints by relatives of people living in the home; one around the care of a person with diabetes the other a person who had a urine infection. Both were concerned about the ability of nursing staff to identify appropriate interventions at times of acute illness.

When we visited the home we looked in detail at some of the people who have ongoing medical needs and how these are assessed and monitored. We also spent some time observing the care and talking to people living in the home.

Overall we found the general ongoing monitoring of peoples health care was appropriate although we have highlighted some areas of concern that the service needs to address to ensure consistency. Those people we spoke to on the day of the site visit said that staff were very competent when carrying out care and using equipment. People looked clean and were appropriately dressed showing that staff paid good attention to standards around personal hygiene. We spoke with one person who said ‘The staff look after me very well. There’s plenty of staff about – I only have to call them’. All people spoken with were very happy with the ongoing medical care and felt reassured by the visiting visits by a GP twice weekly.

People spoken with said that meals provided were good and there was a choice available. We saw plenty of staff available at meal times to support people.

We spoke with people on the site visit who either live in the home or their visitors. None of the people we spoke with had any issues with the way medication was managed.

We had some complaints prior to our visit about areas of specific care and this raised questions about some of the ongoing competencies of trained nursing staff. We spoke with people living at Kemp Lodge on the day of the site visit who said that they felt staff were competent and able to deliver care needs effectively. We have some minor concerns about specific training and updates for nurses and these are addressed in the report.