This inspection took place on 20 November 2017 and was unannounced. Kenbrook is a care home with nursing. The home is owned and operated by Methodist Homes Ltd. Kenbrook is registered to provide care and accommodation for up to 51 older people who may also be living with dementia.

At our last inspection on 30 November 2015 the home met regulations and was rated good.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

Some people in the home had complex needs and were therefore unable to provide us with feedback. We therefore spent time observing interaction between people and staff. On the day of our inspection we observed people were well cared for and appeared relaxed and comfortable in the presence of care workers. We observed positive engagement between staff and people. Staff were respectful to people and showed a good understanding of each person’s needs and abilities.

People we spoke with told us they felt safe in the home and around staff and this was confirmed by relatives we spoke with. There were systems in place to keep people safe. Staff had received training on how to identify abuse and understood their responsibilities in relation to safeguarding people, including reporting concerns relating to people’s safety and well-being.

Risks to people had been assessed, updated and regularly reviewed to ensure people were safe and risks to people in relation to treatment or care were minimised.

Medicines were managed safely and staff were appropriately trained. Appropriate infection control procedures were followed to minimise the risk of spreading infection. Accidents and incidents were documented appropriately and action was taken to prevent future incidences from happening.

Staff we spoke with told us there were sufficient numbers of staff to safely meet people’s individual care needs. On the day of the inspection, we observed staff did not appear to be rushed and were able to complete their tasks. We discussed staffing levels with the registered manager and she told us staffing levels were assessed depending on people's needs and occupancy levels.

People’s needs were regularly assessed to ensure the home was able to provide treatment and care appropriate to people’s individual needs. Staff received ongoing training and spoke positively about the training they received. Regular planned supervisions and appraisals ensured staff performance was monitored. All staff we spoke with told us they were well supported by management at the home and said that morale in the home was good.

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 home operated within the principles of the Mental Capacity Act 2005 (MCA).

Where people were unable to leave the home because they would not be safe leaving on their own, the home had made applications for the relevant authorisations called Deprivation of Liberty Safeguards (DoLS).

People’s health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were documented and staff we spoke with were aware of people’s likes and dislikes and preferred routines.

People and relative’s spoke positively about the food in the home. During the inspection, we observed people having their lunch and saw there was a relaxed atmosphere. We noted that lunch on the ground floor took approximately an hour and 15 minutes and we discussed this with the registered manager. She explained t

This inspection took place on 30 November 2015 and was unannounced. Kenbrook is a care home with nursing. The home is owned and operated by Methodist Homes Ltd. Kenbrook is registered to provide care and accommodation for up to 51 older people who may also be living with dementia.

At our last inspection on 5 February 2014 the service met the regulations inspected.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (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 spent time observing interaction between people and staff. On the day of our inspection we observed that people were well cared for and appropriately dressed. People who used the service said that they felt safe in the home and around staff. Relatives of people who used the service and care professionals we spoke with told us that they were confident that people were safe in the home.

Systems and processes were in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse. Risk assessments had been carried out and staff were aware of potential risks to people and how to protect people from harm.

On the day of the inspection we observed that there were sufficient numbers of staff to meet people’s individual care needs. Staff did not appear to be rushed and were able to complete their tasks. Staff we spoke with confirmed that there were sufficient numbers of staff to safely care for people. The registered manager explained that there was flexibility in respect of staffing and staffing levels were regularly reviewed depending on people's needs and occupancy levels.

Systems were in place to make sure people received their medicines safely. Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal.

We found the premises were clean and tidy and there were no unpleasant odours. There was a record of essential inspections and maintenance carried out. The service had an Infection control policy and measures were in place for infection control.

Staff had been carefully recruited and provided with induction and training to enable them to care effectively for people. They had the necessary support, supervision and appraisals from management. Staff told us that they worked as a team and communication was good.

People’s health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were documented and staff we spoke with were aware of people’s likes and dislikes. Identified risks associated with people’s care had been assessed and plans were in place to minimise the potential risks to people. People told us that they received care, support and treatment when they required it. Care plans were reviewed monthly and were updated when people’s needs changed.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). Capacity to make specific decisions was recorded in people’s care plans.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person’s best interests. The home had made some necessary applications for DoLS and we saw evidence that authorisations had been granted. We noted that the home had eleven further applications to make and spoke with the registered manager about this. The registered manager confirmed that these applications would be made.

There were suitable arrangements for the provision of food to ensure that people’s dietary needs were met. People were mostly satisfied with the meals provided. Food looked appetising and was freshly prepared and presented well. Details of special diets people required either as a result of a clinical need or a cultural preference were clearly documented.

People and relatives spoke positively about the atmosphere in the home. Bedrooms had been personalised with people’s belongings to assist people to feel at home.

Relatives told us that there were sufficient activities available. We looked at the activities timetable and saw activities such as exercise groups, religious services, flower arranging, and music therapy. The activities coordinator explained that there was a therapeutic programme for people who were bedridden. On the day of the inspection we saw that people got involved with Christmas tree decorating.

Staff were informed of changes occurring within the home through staff meetings and we saw that these meetings occurred monthly and were documented. Staff told us that they received up to date information and had an opportunity to share good practice and any concerns they had at these meetings.

The home had carried out an annual satisfaction survey in October 2015 and were awaiting the results from the survey. We noted that the results from the last survey were positive.

There was a management structure in place with a team of nurses, care staff, kitchen and domestic staff, deputy manager and the registered manager. Staff told us that the morale within the home was good and that staff worked well with one another. Staff spoke positively about working at the home. They told us management was approachable and the service had an open and transparent culture. They said that they did not hesitate about bringing any concerns to the registered manager.

There was a comprehensive quality assurance policy which provided detailed information on the systems in place for the provider to obtain feedback about the care provided at the home. The service undertook a range of checks and audits of the quality of the service and took action to improve the service as a result. Relatives spoke positively about management in the home and staff. They said that the registered manager was approachable and willing to listen.       

We spent some time observing the interactions between staff and people who had complex needs which meant they were not able to tell us their experiences. Staff gave each person individual attention and encouraged them to be alert and aware of their surroundings.

People told us that the staff treated them with respect and were polite. One person said, “Staff are wonderful. They are always helpful and they talk to me. They make me feel wanted.”

People told us that there were a lot of entertainments and activities available. One person said, “There is lots going on. Working to make something and then displaying it, it’s worth a month of Sundays.”

Support plans provided information and guidance on each aspect of the person's personal and healthcare needs. Staff told us that they received training that supported them to meet people’s needs. We saw evidence that all staff had training in understanding dementia and in end of life care. One staff member said, “I am very well supported by my manager and the other staff. I feel part of a team.”

The results of the provider’s satisfaction survey for 2013 showed that 96% of people were happy living in the home, and 100% were satisfied overall with the quality of the service they received. One person who we spoke with said, “The facilities are first class.” Two visiting relatives told us that Kenbrook met their expectations for providing good care. One relative said, “The care couldn’t be better.”

We spoke with five people using the service during this inspection, together with three of their friends and relatives. We spoke with care and nursing staff, and to the manager of the service.

Some of the people using the service had limited communication abilities and so we could not interview them to seek their views. However, we were able to observe people's mood, their behaviour and how they interacted with staff.

Friends and relatives told us that the staff were caring, skilled and experienced, and friendly. People using the service told us that they felt well cared for and safe from harm.

We found that people using the service were being cared for by appropriately qualified and competent staff. Staff were supported in their roles by knowledgeable and experienced managers.

We saw that people's personal and health care needs were being met appropriately, and according to their support plans on the whole.

We saw that people were cared for in a clean environment and that they were protected from the risk of infection.

We saw that people were supported to eat and drink well with respect and dignity. The food looked appetising and choices were freely available. Two people told us that they enjoyed the food served and the ability to have a drink whenever they wanted.

During our visit to Kenbrook, we spent time talking to people using the service to gain their views about living in the home. Some people due to their particular needs had difficulty in telling us about their experience of living at Kenbrook, so observation was an important part of our visit.

People told us they were generally contented living in the home, they liked their bedrooms, the food was good, they chose what to eat, they had their health needs met, and had the opportunity to participate in a number of activities of their choice.

People informed us they received the care and support they wanted and needed. They told us staff listened to them and were approachable. People confirmed they felt safe living in the home and knew who to talk to if they had any worries or concerns. During our visit people showed signs of ‘well being’. They were seen to be relaxed they smiled and laughed, looked well cared for and participated in a number of activities.

Comments from people included; “It is ok here,” “I can talk to my key worker,” “Staff are ok,” “Staff listen to me,” “The staff are good,” “Most staff are all right,” “Staff help me to get washed and dressed,” “I have a key worker, who helps me” “I can talk to my key worker,” “I get help when I need,” “I see the doctor if I need to,” “I like the food, I have what I like,” “I choose what to eat,” “Staff show me the menu,” “I get up when I want,” “I feel safe,” “I have no complaints,” “I see my family,” “I like my bedroom”, “I like the shower facilities,” “My room is nice,” “We go on trips,” “I enjoyed the summer garden party,” and “I go into the garden when it is nice.”

Staff spoke of enjoying their job supporting and caring for people at Kenbrook. They confirmed there was good teamwork and they felt well supported by management staff.