We undertook an unannounced inspection of Kenneth House on 28 April 2017 and 2 May 2017. When the service was last inspected in August 2016 six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. Following this inspection, we served a Warning Notice for a breach of Regulation 17 of the Health and Social Care Act 2008 as systems for assessing and monitoring the quality of the service were found to be ineffective.

During this inspection we checked that the provider was meeting the legal requirements of the regulations they had breached and had complied with the Warning Notice. You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for Kenneth House, on our website at www.cqc.org.uk

Kenneth House provides personal care and accommodation for up to eight people with learning disabilities. At the time of our inspection there were six people living at the home.

A registered manager was in post at the time of our inspection. 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 home is run.

At this inspection we found that significant Improvements had been made. The warning notice had been complied with and all regulations had now been met. A positive attitude had been adopted by the registered manager and staff team and they recognised the importance of continual improvement.

Staff’s training had mostly been updated. We found some guidance and protocols were not up to date or in place around eating and drinking guidelines and a specific health condition.

The service had undergone redecoration and maintenance. The garden area had been improved and was now a pleasant, accessible space. The service was clean and well kept. Systems and checks had been established to keep the service well maintained. Furniture and flooring had been replaced. Changes had been made to ensure infection control risks were minimised.

The storage and administration of medicines was safe. Protocols were in place for as needed medicines. People had assessments in place to minimise risks and there was suitable guidance for staff in risk management.

Staffing levels had improved and a team leader had been appointed. We received positive feedback about the impact of this. People now had the support they needed to access and be engaged with stimulating activities of their choice. Community links had been developed and a wider range of opportunities were available to people. There was a positive team culture, staff were proactive and enthusiastic.

Safe recruitment procedures were followed. Staff were supported through an induction and regular supervision. Staff now had good knowledge of the Mental Capacity Act (MCA) 2005. Capacity assessment and best interest meetings were decision specific. The service was compliant with the requirements of the Deprivation of Liberty Safeguards.

We observed good relationships between people and staff. Staff knew people well and how they preferred their care and support delivered. Staff were kind, caring and respectful. People’s dignity and privacy were protected.

Staff were responsive to people’s care and support needs. Care records described people’s personal preferences and individual support needs. Care records were up to date and regularly reviewed. People’s feedback was welcomed and acted upon. People were consulted and involved with changes within the service and their personal space.

The provider had improved support to the registered manager and the service. Systems were in place for the registered manager and provider to monitor, review and improve the quality of care and support. Communication was effective to staff and relatives. Positive feedback was

We carried out this inspection on 9 and 17 August 2016 and it was unannounced. When Kenneth House was last inspected in August 2013 there were no breaches of the legal requirements identified.

Kenneth House provides care and accommodation for up for eight people with learning disabilities. On the days of our inspection there were seven people living in the service.

There was a registered manager in place at the time of our inspection; 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.

On the second day of the inspection the registered manager was on annual leave. The home was represented by another of the provider’s registered managers.

The provider's quality assurance systems and processes did not ensure that they were able to effectively assess and monitor the quality of the service and mitigate the risks relating to the health, safety and welfare of service users.

The provider did not have an effective system to monitor records made by staff or records that related to the management of the service.

The home was not suitably safe and clean. Hygiene practices within the laundry did not meet the Department of Health guidance for the prevention and detection of infection.

The administration of medicines was not in line with best practice.

There were not sufficient numbers of staff to support people safely. Staff refresher training was not up to date.

Staff did not have a good understanding of the Mental Capacity Act 2005 or Deprivation of Liberty Safeguards (DoLS). The registered manager had made appropriate applications for DoLS where they had been required. These safeguards aim to protect people living in care homes from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely.

We observed occasions where people’s care and dignity were compromised. Some people were wearing torn and dirty clothes.

Care was not consistently person centred. Care plans did not contain unique individual information and references to people’s daily lives.

Meetings had been arranged in order to enable people's best interest to be assessed when it had been identified that they lacked the capacity to consent to their care and treatment. Records relating to capacity assessments and best interest decisions require improvement.

The provider had made appropriate arrangements to identify and respond to allegations of abuse. Staff were aware of the provider’s safeguarding policy and how to respond to actual or suspected abuse to keep people safe.

Incidents and accidents were recorded and actions to prevent them reoccurring were recorded.

Staff felt that their views and concerns would be listened to but were not confident these would be acted upon.

People were supported by the staff to use the local community facilities and had been supported to develop skills which promoted their independence.

People sustained good health by the means of nutritious food and sufficient drinks.

People had access to healthcare professionals when required, and records demonstrated the service had made referrals when there were concerns.

Staff supervisions were undertaken as planned to provide staff with support to carry out their work.

There was a complaints procedure for people, families and friends to use and compliments were also recorded.

There was a robust staff recruitment process in operation. The process was designed to employ staff that would have or be able to develop the skills to keep people safe and support individuals to meet their needs.

We found six breaches of regulations at this inspection. You can see what

We met six people who were living at Kenneth House on the day of our inspection. Every person we spoke with told us how happy they were at Kenneth House. Examples of the comments people told us about what life was like at the home included, “the staff are lovely”, “I like all of the staff”, and “ it’s my home I’m much happier here than where I lived before ”.

People who used the service were supported and encouraged to live an active fulfilling life at Kenneth House and in the community.

People were provided with a variety of nutritious meals at the home. Menus were planned based on people’s choices and preferences.

People were protected from risks posed by unsuitable staff being employed at the home. People were actively involved in the recruitment process to help ensure only suitable staff supported them at Kenneth House.

The quality of care and service people received was checked and monitored to makes sure it was safe and suitable. People who used the service were fully involved in the quality checking process.

At the time of our visit, there were eight people living at Kenneth House and we were able to speak with five of them. We received a number of positive comments such as “I like it here” and “it’s nice”. When we asked people if they felt able to talk to staff if they were unhappy, people answered that they would. This was supported by the results of a questionnaire that we reviewed, which asked people whether they felt able to make complaints.

We found that people were supported in a clean and hygienic environment and that there were policies and procedures in place to support staff. This included guidance on how to manage particular illnesses.

People living at Kenneth House were supported by sufficient numbers of staff. At times when staff may be required to work alone in the home, there were strategies in place to manage any potential urgent concern.

We spoke to two people living at the home.

We were told:

“(Staff) Treat us well”

“Like the food”

“We do our own thing”

We saw comments had been made, by some people, through the Service User Inclusion and Satisfaction questionnaires for 2012. These included comments such as:

"Its good at Kenneth House"

"It's good that you can handle it (complaints or concerns) yourself"

"The staff are good"

People spoken with told us they felt safe and that they trusted the staff.

People gave us examples of how they made choices in their life. These included choosing the décor of their bedroom, food preferences, holidays and activities. They confirmed that they were spoken with and treated in a respectful way. We saw staff knocking on a person’s bedroom door and waiting for a response.

We observed staff interaction when supporting people in making decisions about their day. We saw by their behaviour that they felt comfortable and at ease in their conversations with staff.

We spoke to two people living at the home who confirmed that they made personal choices about the way they wanted to live and that staff helped them to maintain their independence.

They told us they liked helping in the kitchen. They said they peeled the potatoes, cooked spaghetti bolognaise and helped with the Sunday roast.

They said there was no set time for people to help out in the kitchen and that people chose to help when they wanted to. Staff confirmed this and it was evident that this flexibility suited peoples’ differing lifestyles.

We saw people preparing to go to their different activities. One person was going out with their day service support to a gym and have their lunch out in Bristol.

Kenneth House is a care home providing accommodation, personal care and support to adults with learning disabilities. Eight people lived there at the time of our visit.

The service provided a safe environment for the people who lived there. The staff encouraged people to be independent. People who used the service were formally involved in the assessment of their own needs and were consistently supported to have their views taken into account.

The people who used the service and their relatives provided positive feedback about the personalised approach of staff. People felt they were listened to and that their needs and preferences were supported. Relatives felt their relative’s needs were at the centre of their support and, where appropriate, they were involved in their relative’s care plan reviews.

When we visited 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 and shares the legal responsibility for meeting the requirements of the law with the provider. The staff felt well-supported by the registered manager as they placed an emphasis on being open and approachable. Staff told us they would approach the registered manager if they had any concerns and felt confident these would be addressed.

Staff offered appropriate and effective support to people as needed.  People were offered a wide range of choices regarding social and educational activities. We observed that the staff enabled the people who used the service to be as independent as possible.

The service had policies in place about upholding people’s rights and they were consistently followed. The registered manager was in the process of reviewing and up-dating each person’s mental capacity assessment. The principles of the Mental Capacity Act 2005 were being followed. The Act protects the rights of people who are not able to make decisions about their care or treatment. People’s human rights were properly recognised, respected and promoted.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). An application was going to be processed for one person to ensure their protection. There were proper policies and procedures were in place for staff to follow. The relevant staff had been trained to understand when an application should be made, and how to submit one.

Safeguarding procedures were followed and staff understood their role in safeguarding the people they supported.

Systems were in place to make sure that the registered manager and staff learned from events such as accidents and incidents, complaints and concerns. This reduced the risks to people and helped the service to continually improve.