This comprehensive inspection took place on 21 and 22 May 2018 and was unannounced.

The last comprehensive inspection took place in May 2017. The service was rated requires improvement in the key questions is the service safe and well led? and overall. We found one breach of regulations relating to safe care and treatment for which we served a warning notice on the provider. This was because they did not always administer medicines as prescribed and staff medicines competency assessments were not recorded at the time of the inspection. We asked the provider to make the necessary improvements by 7 July 2017.

On 31 August 2017, we carried out a follow up inspection to check that improvements to meet legal requirements planned by the provider after our May 2017 inspection had been made. We inspected the service against two of the five questions we ask about services: is the service safe and well led? This is because 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. On 31 August 2017, we found the provider was meeting the regulation relating to safe care and treatment

However, at the inspection on 21 and 2 May 2018, we found the provider was again not fully meeting the regulations relating to safe care and treatment and good governance.

Kenilworth Nursing Home is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Kenilworth accommodates a maximum of 40 people. At the time of the inspection, 30 people were using the service. The maximum of 40 people is if people are sharing double rooms and the provider was actively moving people to single rooms as they became available.

The service is family run as a partnership and the registered manager is one of the partners. 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.

During the inspection we found medicines management was inconsistent and audits did not always identify discrepancies to help ensure people always received their medicines in a safe way.

The service had systems in place to monitor, manage and improve service delivery and to improve the care and support provided to people. However, these were not always effective. Record keeping was not always complete or contemporaneous, for example when monitoring people’s weight, and medicines audits did not always identify discrepancies.

Incident forms recorded the details of the incident and the resulting actions. Risk assessments were in place but the risk management plans did not always have enough detailed guidance which meant they did not always mitigate risks to people.

There were procedures for reporting and investigating allegations of abuse and whistle blowing. Staff we spoke with knew how to respond to safeguarding concerns. Safe recruitment procedures were followed to ensure staff were suitable to work with people. People told us they thought there was enough staff to meet their needs.

Staff we spoke with understood how to manage infections and wore appropriate protective equipment to reduce the risk of the spread of infection.

People’s needs had been assessed prior to moving to the service and care plans included people’s likes and dislikes. There were also records of end of life wishes and Do Not Attempt Cardio Pulmonary Resuscitation’ (DNACPR) forms where these had been completed.

Care workers had relevant training, supervision and annual appraisals to dev

This unannounced focused inspection took place on 31 August 2017. We previously carried out an unannounced comprehensive inspection of this service on 3 and 4 May 2017. During the inspection, a breach of legal requirements was found. This was because the provider did not have suitable arrangements to ensure staff always administered medicines as prescribed. We could not also be sure the competency of staff who administered medicines had been appropriately assessed and recorded.

After the comprehensive inspection, the provider sent us an action plan and told us they would take action to meet legal requirements in relation to the breach. We undertook a focused inspection on the 31 August 2017 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Kenilworth Nursing Home on our website at www.cqc.org.uk.

Kenilworth Nursing Home is a nursing home registered to provide accommodation, personal care and nursing care for up to 40 people, some of whom are living with the experience of dementia, mental health conditions and people that are being cared for under the Mental Health Act 1983. At the time of our inspection there were 33 people living at the service.

There was a registered manager in post who was one of the partners who owned the service. 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 and associated Regulations about how the service is run.

At our focused inspection on, 31 August 2017 we found that the provider had followed their plan of action, and that the legal requirement in relation to safe care and treatment had been met. We are amending our rating for the key question, ‘Is the service safe?’ from ‘Requires improvement’ to ‘Good’. As the provider had strengthened governance arrangements around the management of medicines we have also amended the rating for ‘Is the service Well Led?’ from ‘Requires improvement’ to ‘Good’.

Medicines were administered and managed in a safe way. People’s medicines records were clear and alerted nurses if they were taking dispersible aspirin or PRN (as required) medicines and provided clear guidelines on how to administer these. These had not been managed safely at our last inspection.

Medicines administration records (MAR) charts had body maps attached to them and clear instructions so staff were clean how to administer topical creams. The provider ensured that medicines stock takes and audits were completed weekly.

The provider had implemented a detailed medicines competency test that all nurses had completed to help ensure they were administering medicines in a safe way.

The provider had made progress in auditing the management of medicines and the staff files to ensure there were no gaps in the required documentation.

The inspection took place on 3 and 4 May 2017 and was unannounced.

The last inspection took place on 11,12 and 13 April 2016, when we identified breaches regulations relating to safeguarding service users from abuse and improper treatment, safe care and treatment and the need for consent. Additionally we recommended that the provider continue to make improvements to the environment in line with the National Institute of Care Excellence (NICE) guidance about environments for people with dementia.

The provider sent us an action plan dated 24 June 2016 indicating how they would address the issues raised at the inspection. Improvements had been made, but some areas required further improvement.

Kenilworth Nursing Home is a nursing home registered to provide accommodation, personal and nursing care for up to 40 people, some of whom are living with the experience of dementia, mental health conditions and people that are being cared for under the Mental Health Act 1983. At the time of our inspection there were 33 people living at the service.

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.

We found that the service did not always administer medicines as prescribed. The provider told us they assessed the competency of staff who administered medicines but this had not been recorded at the time of the observation.

The service had safe recruitment procedures in place and there were a sufficient number of staff to meet people’s needs.

People using the service were protected from harm and abuse. Staff had safeguarding adults training and they knew how to report any safeguarding concerns the might have. Safeguarding information was displayed throughout the service.

The service had risk assessments and management plans in place with guidance on how to minimise risk and promote people’s wellbeing.

Staff were supported through supervisions and appraisals to have the skills they required to provide care and support to people using the service. However, observational spot checks were not formally recorded.

We saw evidence that consent to care and treatment was sought in line with the Mental Capacity Act (2005) guidelines.

People’s nutritional needs were assessed and met.

People’s files contained evidence of timely referrals and access to relevant healthcare professionals.

We observed staff were kind and caring. They treated people with dignity and respect and gave people the opportunity to make choices and have control of decision-making. Staff were aware of people’s individual needs and preferences.

The service had an accessible complaints procedure and people we spoke with knew how to make a complaint.

The service had systems in place to monitor how effectively the service was run to ensure people’s needs were being met.

Relatives and staff said they could speak to the registered manager about concerns.

CQC is currently considering the appropriate regulatory response to the repeated breach of Regulation 12 and we will report on this once this work has been completed.

The inspection took place on 11,12 and 13 April 2016 and was unannounced.

The last inspection took place on 19 and 20 May 2015, when we identified breaches of two regulations relating to safe care and treatment and the need for consent and good governance. Additionally we made two recommendations around the design of the environment and meaningful activities as directed by The National Institute of Care Excellence (NICE) guidance.

The provider sent us an action plan indicating how they would address the issues raised at the inspection. Improvements had been made, but areas such as those indicated by the recommendations required further improvement.

Kenilworth Nursing Home is a nursing home registered to provide accommodation, personal and nursing care for up to 40 people, some of whom are living with the experience of dementia, mental health conditions and people that are being cared for under the Mental Health Act 1983. At the time of our inspection there were 28 people living at the service.

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.

We found that some practices around the handling of medicines were not safe and this presented a risk.

The provider had not always assessed people’s capacity to consent to care and treatment, specifically around sharing bedrooms and the covert administration of medicines.

The service had improved the environment since the last inspection on 20 May 2015 but needed to continue the programme of redecoration in line with The National Institute of Care Excellence (NICE) guidance about environments for people with dementia.

The provider had daily activities in place but these were not suitable for all the people who used the service. We recommended the service develop the activities programme in line with The National Institute of Clinical Excellence (NICE) Guidance for leisure activities and choice.

We saw the majority of the medicines were administered and dispensed safely.

Staff were supported through regular supervisions and yearly appraisals. Staff were sufficiently deployed and appropriately trained to meet the needs of the people using the service.

The service had a safeguarding policy and procedures in place.

The environment had improved since the previous inspection and was clean and well maintained.

Health needs were being met through assessments, monitoring and support from the relevant professionals.

Staff were kind and caring. They knew the people who used the service well and were able to meet their needs.

People had person-centred care plans and we saw evidence that staff followed them to meet people’s needs.

People who used the service, staff and relatives told us the managers were approachable and they could raise concerns with them.

We found breaches in 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 the report.

This scheduled inspection was brought forward as a result of concerns that were raised with the Care Quality Commission about the quality of the care provided for people using the service. Concerns were raised about poor treatment of people using the service, the quality of care, the environment and the staff's ability to respond to people's needs.

We spoke with the manager of the service, the deputy manager and five other members of staff. We also spoke with 15 people who were using the service and one relative who was visiting the home.

People told us that their views were listened to and one person said, "If I had any problems I would tell them and they would listen." We observed positive interactions between staff and the people using the service and people told us that staff always treated them respectfully. One person said, "they're polite to me and I can sit down and joke with them." Someone else said, "they’re kind and considerate and if you need something it is there for you."

Care plans took people's individual likes, dislikes and preferences into consideration and promoted choice and independence. All of the care plans had been reviewed at regular intervals and updated to reflect people's changing needs.

People using the service and their relatives told us that the home was kept clean. One person said, "It's always clean, it's all been done this morning" and another person told us, "It's always clean, they hoover lots."

We found that there were systems in place to ensure that checks were completed as required to ensure the home was safe and maintained to a satisfactory standard.

We found that staff received support and were encouraged to undertake training so that they were able to meet people's needs effectively.

The home had quality monitoring systems in place to ensure that any areas for improvement were addressed.

We visited the service because we had received information that the service might not be complying with essential standards of quality and safety. In particular concerns were raised about end of life care, staff shortages and the recruitment of staff to work in the home.

We spoke with the provider, three members of staff and five people who used the service. We found that people had care plans and risk assessments in their care records that had been updated to reflect their changing needs. Health professionals had been contacted and involved in people's care and relatives had been contacted, kept informed and involved in decision making.

One member of staff said, "we have a care plan we follow and we ask the nurse for advice". Another member of staff said, "we have an end of life care plan and we respect people's choices". We observed positive interactions between the staff and people using the service. People we spoke with made positive comments about the staff such as, "the staff are lovely", "they are very good" and "they give me support".

Checks had been undertaken before staff started work at the home and staff were supported to obtain the knowledge and skills to meet people's needs effectively.

The staff we spoke with told us that there were always enough staff on duty to enable them to meet people's needs and the people we spoke with confirmed this. One person said, "there are always enough staff around".

We spoke with the provider, the deputy manager, four members of staff and seven people who used the service. People were involved in decision making about their care and the running of the home and one person told us, "staff are most obliging and helpful".

People's care needs had been appropriately assessed and a care plan developed to ensure that staff had the information they needed to care for them effectively. Risks were assessed to support people's safety whilst promoting their independence and people were supported to take part in a range of activities.

The home was well maintained, clean and warm. Health and safety checks were taking place at regular intervals and fire drills were taking place to ensure that people and staff knew what action to take in the event of a fire.

Appropriate recruitment checks were completed to ensure that people were protected from unsuitable staff. There was an effective complaints management system in place and the complaints procedure was clearly displayed throughout the home including in people's bedrooms to ensure that people were aware of how to raise any concerns they had.

People told us they had chosen to live in the home and they were happy. They also said staff were “kind and caring” and they could give their views about the home to staff. We saw evidence of meetings held for people and their representatives. These provided people with the opportunity to receive up to date information about the home and to share their views. Those people asked said they felt safe living in the home and would talk to staff if they had any concerns.

We saw staff communicating with people in a gentle and respectful manner. They supported people with their care needs whilst encouraging them to maintain as much independence as they could.

People told us there were other people in the home they could talk with and they could go out independently if staff assessed they were safe to do so. One person said they went to church and enjoyed going out and meeting other people.

People said there were some activities available and we saw an activities programme displayed on the lounge wall. During the visit we saw people watching television or drawing and colouring in pictures.

People confirmed staff supported them with their healthcare needs. They saw different healthcare professionals such as GP’s, dentists and chiropodists when this was required.

The inspection took place on 19 and 20 May 2015 and was unannounced. The last inspection of the service was on 10 July 2013 and there were no breaches of Regulation identified.

Kenilworth Nursing Home is a nursing home registered to provide accommodation, personal and nursing care for up to 40 people, some of whom are living with the experience of dementia, mental health conditions and people that are being cared for under the Mental Health Act 1983. At the time of our inspection there were 31 people living at the home.

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. People were not protected from the risk of infection because they were not cared for in a clean and hygienic environment.

Risks relating to the use of bedrails, call bells and managing behaviour had not been adequately assessed.

People’s capacity to make decisions about their care and treatment had not always been assessed. The staff did not understand the legal processes required when relatives consented on behalf of people.

The environment was not designed to meet the needs of people who lived with dementia or who were experiencing mental health needs. The environment did not promote people’s emotional well-being.

Although care plans contained information about people’s needs they were not comprehensive, some lacked sufficient detail to enable staff to provide personalised care. The care plans included a monthly review of people’s care although these gave little information on the evaluation of the care that was planned for people and whether their needs were being met adequately.

People had limited opportunities to participate in meaningful activities that were based on good practice guidance.

There were quality monitoring systems in place however, these were not always effective in identifying areas where the quality of the service was not so good or used to make improvements.

There were enough staff to meet people’s needs in the home and community and to keep them safe. Appropriate checks were carried out for new staff.

There were systems in place to ensure that people consistently received their medicines safely, and as prescribed.

Staff were knowledgeable about people’s support needs, and received regular training and support to increase their skills. Staff had a good understanding of safeguarding adults procedures and knew the process to follow to report any concerns.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that providers only deprive people of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them. Where people were deprived of their liberty in their best interests, the provider had followed the appropriate procedures.

People told us that they were happy with the food and drink provided. They were supported by staff to eat and drink sufficient amounts to meet their needs.

Staff worked with other healthcare professionals if there were concerns about a person’s safety or welfare.

People were treated with respect and their privacy and dignity was maintained. People were supported to access advocacy services

People were happy to talk to the manager and to raise any concerns that arose. There was a clear management structure at the service and people, staff and families told us that the management team were approachable, inclusive, and supportive.

We found a number 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 the report.