Kenilworth care home in Loftus, Redcar and Cleveland provides accommodation for up to 20 older people who require personal care. At the time of inspection, there were 19 people using the service.

At our last comprehensive inspection we rated the service as good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this comprehensive inspection we found the service remained good.

People were safeguarded from the risks of abuse. Staff understood and managed the risks to people to make sure they remained safe, however records relating to risk needed to be improved. Staff did not always recognise the risks posed from the environment. We asked the registered manager to take action to ensure the kitchen door always remained closed because the cooker was next to the door where people and staff regularly passed. A cooling fan was put in place to protect staff from excess heat in the kitchen. Staff followed infection prevention and control procedures and the registered manager took action to put toilet roll holders in place when we asked them to during inspection. Recorded water temperatures showed they were above safe temperature limits without action taken to address this. No harm had come to anyone as a result of these risks to the environment.

Accidents and incidents were recorded and analysis carried out. Certificates to maintain the safety of the building were up-to-date. Fire safety checks had been completed regularly. Staff were recruited safely and there were enough staff on duty at all times. Good systems were in place to manage people’s medicines. There was evidence that lessons had been learned when incidents had taken place.

Detailed assessments were carried out before people moved into the service. People were supported with their health care needs and care records detailed guidance from health professionals. People were involved in planning menus and referrals for nutritional support were made when needed. Staff were supported by way of induction, supervision, appraisal and training.

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 environment was in need of updating. Some improvements had been carried out and an improvement plan was in place.

People told us they were cared for by staff who knew them well. Nothing was too much trouble and their privacy and dignity had always been maintained. Although the care records did not detail people’s involvement in their care, people told us they had been involved in planning and reviewing their care. Care records detailed people’s communication needs and information was given in people’s preferred formats.

Staff provided person-centred care to people which supported them to be as independent as they could be and to live fulfilled lives. Care records supported staff to do this. An activities co-ordinator supported people with activities of their choice and people were complimentary about these. Everyone we spoke with knew how to make a complaint and told us they had confidence that appropriate action would be taken to address their complaint. No-one was receiving end-of-life care.

People and staff were very supportive of the registered manager and of each other. They all worked together to deliver safe care to people. Feedback had been sought via meetings and surveys. The auditing process had been reviewed and more robust audits had been put in place. The provider regularly visited the service and sought feedback from people and staff during this time. Action plans were in place to continue to develop the service. The

This inspection took place on 22 March and 7 April 2016. The first day was unannounced which meant the registered provider and staff did not know we would be visiting the service.

At the last inspection on 27 April and 1 May 2015 we found the service was not meeting all the requirements of the Health and Social Act 2008. There were gaps in the records for maintenance, planned fire drills and health and safety records. There was no evidence that checks of emergency call bells and water temperatures had been carried out. Personal Emergency Evacuation Plans (PEEP) for people living at the home were not up to date. Staff training, supervision and appraisals were not up to date. Meetings for people, their relatives and staff had not taken place. Records of quality assurance visits by the registered provider were limited and no action plans had been produced where changes needed to be made. Some audits were not in place where needed. Some records looked at were inaccurate or incomplete.

Kenilworth care home provides care and support for up to 20 people in Loftus and is located off the main high street. At the time of inspection, there was 20 people living at the service. The service is set in its own grounds with gardens and there is parking available on-site.

The registered manager had started at the service as a care assistant and had worked their way up to manager before applying to become registered manager in 2010. 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.

Safeguarding alerts had been made when needed. Staff understood the procedure they needed to follow if they suspected abuse might be taking place.

Risk assessments were in place for people who needed them and were reviewed regularly. Staff understood that people could take reasonable risks.

Staff were recruited safely. There were sufficient staff on duty to provide appropriate care and support to people. The management team was also on-call out of hours to support staff.

Medicines were managed safely. Staff understood the requirements of managing medicines safely and followed procedures to make sure people had the medicines they needed.

Certificates were in place to ensure the safety of the service and the equipment used. Maintenance and fire checks had been carried out regularly by the service.

Supervision, appraisal and training was up to date and staff told us they felt supported. People told us they felt staff had the knowledge and skills needed to care for them.

People spoke positively about the nutrition and hydration provided at the service. Staff understood the procedures they needed to follow if people became at risk of malnutrition or dehydration.

Some people had Deprivation of Liberties Safeguards in place to keep them safe. The service followed the correct procedure to make sure this process was carried out appropriately and in the best interests of people.

Each person was involved with a range of health professionals and this had been documented within each person’s care records. From speaking with staff we could see that they had a good relationship with the health professionals involved in people’s care.

The service was spacious and people told us they could spend time in private or with other people. People had spacious bedrooms which included their personal possessions.

People spoke positively about the care and support they received from staff. They told us staff always had time for them and felt listened to.

Some people were involved in their care and made decisions about their care. Other people told us they did not want to be involved in planning their own care; they told us they were confident that staff would provide the care an

This inspection was carried out to check that Kenilworth Care Home had addressed concerns identified at a previous inspection on 10 June 2013 regarding outcome 9, management of medicines. At this inspection we found they were now compliant with this outcome therefore four additional outcomes were reviewed during the inspection visit.

People who used the service expressed satisfaction with the care and service they received. One person told us, “You do get well looked after, it’s all very good.” They also said, “The staff are very pleasant.” A relative we spoke with told us, “Everything is fine, they look after mam well.”

There was a friendly and relaxed atmosphere between people living and working at the home. We observed staff interacting well with people and supporting them, which had a positive impact on their wellbeing. We saw that staff worked in collaboration with other health and social care professionals.

Staff responded quickly when people called for help and people were provided with the care they needed.

We found that people lived in an environment that was homely and clean.

Processes for the administration and management of medicines were being followed.

We spoke with one person about their medicines. They were happy that care staff looked after her tablets and said that she got her medicines ‘at the right time.’ However when we asked this person, who was prescribed one inhaler ‘when required’ she was unsure how often she could use it.

Overall we found medicines were not always safely handled and improvements are needed.

Our inspection at Kenilworth Care Home on 8 November 2012 was carried out to check that they had addressed concerns identified at a previous inspection on 29 August 2012 with outcome 21, Records. We found that they were now compliant with outcome 21 and therefore five additional outcomes were reviewed during the inspection visit.

People who used the service expressed satisfaction with the care and service they received. One person told us; “The lasses are lovely, they can’t do enough for you.” Another person told us; “The girls are lovely, they look after me well.”

One of the relatives we spoke with told us; “It’s a friendly, homely place.”

We observed staff interacting well with people and supporting them, which had a positive impact on their wellbeing.

We found that arrangements were in place to ensure people’s nutrition and hydration needs were met.

We found processes for the administration and management of medicines were not always been followed.

There were appropriate arrangements in place for the recruitment of staff.

The home had a complaints procedure in place and this was accessible to people and their relatives.

We found that people's care records were kept up to date and contained required information.

During the inspection we spoke with four people that used the service. People who used the service expressed satisfaction with the care and service that they received. One person told us “It’s lovely here, all the staff are brilliant.” Another person told us “I am happy here and I get well looked after.”

We saw that staff interacted well with people living at the home and they provided support and encouragement in a sensitive and dignified manner. The atmosphere in the home was relaxed and staff frequently smiled at people. Staff got down to eye level, spoke clearly and at a steady pace so people could understand them. People who used the service were observed to be well presented and were dressed appropriately.

We found that people's views were taken into account in the assessment and care planning process. Staff were receiving regular supervision. We also found that some assessments and care plans were not being evaluated regularly and plans were not always developed to meet people’s identified needs.

People told us what it was like when they first arrived at the home. People said “I’ve been here 11 months and I settled in straight away”, “It took me a while to settle in but I like it now”, “I didn’t want to come, but it’s nice here." and “I really like my room, I was lucky to get it; nearly everything in here is mine.”

People told us that “the staff work hard”, “I get well looked after, well fed, a clean room and clean sheets on the bed, I can’t ask for more.”, “I’ve had a good life and this is the icing on the cake, being so well looked after.”, “The food and everything is good”, “we’re all looked after” and “it’s been a good day today.”, “I hope every old person’s as lucky as I am.”, “You can ask the staff for anything, you just ring the buzzer and they come straight away and they look after all your little needs.” and “I’ve no complaints but if I did I wouldn’t worry about taking it through the proper channels.”

People told us about the things they like to do, for example “I like to read”, “I get the newspaper daily”, “I played bowls today and dominoes yesterday” and “I can read and watch TV.” and “I’ve got family and friends and they come to visit me lots and take me out."

This was an unannounced inspection which was carried out over two days on 27 April 2015 and 1 May 2015.

We previously inspected Kenilworth Care Home in May 2014. At that inspection we found the service was meeting all of the essential standards that we assessed.

Kenilworth Care Home provides accommodation for up to 20 people who need help and support with their personal care. The home is a two storey Victorian house with a purpose built single storey extension. There is a stair lift to assist people to get to the upper floors. At the time of our inspection there were 18 people living at the home.

The home had a registered manager in place. 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. The registered manager had worked at Kenilworth Care home for many years prior to becoming registered manager.

People living at service spoke positively about the care and support which they received from staff. They told us they felt safe. All staff at the home had not undertaken training in Safeguarding adults. They had some understanding about the types of abuse but were not always clear about the principles and processes of safeguarding.

People were cared for by sufficient numbers of experienced staff. Robust recruitment procedures were in place and appropriate checks had been undertaken before staff began work.

Through our observations of staff providing care and support to people, we could see that staff knew people well. Staff were easily able to engage people in conversation. They were respectful to people when they provided care and they ensured people’s privacy and dignity were maintained.

We saw that medicines were administered correctly. There were protocols in place for managing medicines and for when required medicines (PRN). We did find medication records for PRN medications were not always person-centred.

Some staff had been trained in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Not all staff including the management team we spoke with were knowledgeable about the procedures which they needed to follow should an application needed to be made. This meant that people may not be safeguarded when they needed to be and their human rights respected.

During our inspection we saw that people had contact with their relatives and friends both in the home and out in the community.

Care plans were personalised and contained the information they needed. Care and support was delivered to people in line with their care needs. Care records detailed the information needed to tailor care to people’s specific needs. People were not involved in the development and review of their care plans.

People had regular access to health professionals and were supported to have regular health checks. When people were required to go to hospital they were supported by their relatives or staff.

People had access to regular food and hydration in sufficient quantities. People had choice over meals and these could be changed if people wanted something different.

Everyone we spoke to were aware of how to make a complaint. Staff were knowledgeable about the action they needed to take following a complaint. Everyone we spoke to felt able to speak to the registered manager and did not raise any complaints or concerns about the service.

People we spoke with told us the registered manager was regularly on duty and made a point of coming to see them each day. Everyone we spoke with at the service told us the registered manager was accessible and they felt able to discuss any issues or concerns which they had with them.

Staff had not received regular training to help them to perform their roles and to increase their knowledge. Staff had not received an appraisal over the last year and supervisions were not up to date. This meant that staff were not supported to carry out their role and regular monitoring was not place.

Health and safety checks and certificates were not up to date. We found some certificates had expired. There were gaps in some records so we could not be sure if some checks had been carried out and personal emergency evacuation information was out of date.

The service was very clean and tidy. People we spoke to told us this was always the case. Staff had access to personal protection equipment (PPE) such as gloves and aprons. Staff we with confirmed they always had enough PPE.

Procedures were not in place to monitor the quality of the service. Regular audits were not carried out. The registered manager did not seek out the views of people at the service or staff.

We found breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to checks of the building and equipment needed to support people, training, supervision and appraisal and methods used to monitor the quality of the service. You can see what action we told the provider to take at the back of the full version of this report.