About the service: Kenrick Centre is a care home that provides personal care for up to 64 people. At the time of the inspection 50 people lived at the home. The accommodation was established over two floors. On the ground floor there was a residential unit where 25 people lived, and on the first floor there was an enablement service where 25 people stayed at the time of our inspection visits. The aim of the enablement service was to prepare people for independent living following a stay in hospital or life changing event. People stayed at the enablement unit for approximately 4-6 weeks.

The Kenrick Centre also supplied the local community with day centre facilities, a café and a gym which were available for people to use. CQC do not regulate these types of service, so our inspection did not look at this aspect of the Kenrick Centre.

People's experience of using this service

•Risks which affected people’s health and wellbeing were not always documented and staff did not always have adequate information to manage and mitigate against risks to people.

•Medicines were not stored or managed safely, which put people at risk.

•Infection control procedures required improvement to ensure people were protected from the risk of infection and cross contamination.

•Staff did not always receive up to date information and training, to ensure they knew how to support people safely.

•Systems of audits did not effectively identify where improvements were needed.

•The leadership and governance of the service required improvement to ensure lessons were learnt, and improvements were embedded and sustained into practice, so that people received a good quality service.

•Care records were not always up to date, and did not always show who should be consulted about decisions regarding people’s care and finances.

•People were not always able to participate in activities, interests and hobbies that met their individual needs and choices.

•People told us they felt safe with staff who supported them.

•There were enough staff to meet people’s assessed needs across both units.

•Staff had completed safeguarding training and knew what to do if they were concerned about people’s well-being.

•People were supported to make daily living choices such as what they wanted to eat, and where they wanted to spend their time.

•Staff were aware people’s needs could change, and understood when to seek advice and involve other health care professionals and services when needed.

•Staff knew people well, and knew their preferred ways of communicating, to assist people to make choices.

•Staff encouraged and supported people to be as independent as possible.

•There was a registered manager in post on each of the units at the centre.

•Feedback from people and staff was sought to identify where improvements could be made in the delivery of service.

Rating at last inspection: Requires Improvement. The last report for Kenrick Centre was published on 16 January 2018. CQC had inspected this service on four previous occasions, a rating of Requires Improvement had been awarded on all the previous inspections.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The inspection was also prompted in part by notification of a potential serious incident. At the time of our inspection, we were conducting an ongoing investigation. Whilst this inspection did not examine the circumstances of the incident, we considered the provider’s management of risks; staff training, and quality assurance procedures. We may review our findings in more detail when the ongoing investigation is concluded.

Enforcement: The service met the characteristics of Inadequate in two key questions of safe and well-led, with Requires Improvement in effective, caring and responsive.

Follow up: We will continue to monitor the service closely and discuss ongoing concerns with the provider. The overall rating for this registered provider is 'Inadequate'. This means that

This inspection took place on 04 and 16 October 2017. This was an unannounced inspection.

At the last inspection in December 2016 the provider was rated as requires improvement in two out of the five areas we inspected against; whether the service was safe and well- led. This was because medicines were not always managed effectively to reduce any associated risks to people and the systems in place to assess and monitor the quality of the service were not always used to identify where improvements were needed.

During this inspection, we found that some improvements had been made; however further improvements were required.

The Kenrick Centre is a purpose built centre which is designed to accommodate up to 64 people across two separate services. On the first floor there is an enablement service which provides support for up to 32 people for up to four to six weeks following discharge from hospital. The purpose of the enablement unit is to provide a further period of recovery and assessment to prepare people for their return home or identified placement. The ground floor is registered to provide accommodation and personal care for 31 people. At the time of our inspection 56 people were living at the service. Changes were required to the registration of the service to reflect that people were receiving accommodation and personal care as part of the enablement service on the first floor. The provider has been informed of this and we await applications to make the necessary changes to their registration.

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. There were two registered managers in post at the time of our inspection, one on each of the two units whom were responsible for running the two services separately and independent of the other.

The service was not consistently safe or well-led because the management team had not always fulfilled the responsibilities of their role. The provider’s quality assurance systems had failed to identify the shortfalls found during the inspection and some of the improvements required at the time of our last inspection had not been made. These included issues related to the safe management of medicines within the home as well as sufficient oversight of auditing practices such as fridge temperatures and Deprivation of Liberty Safeguard (DoLS) authorisations.

We have made a recommendation about the management of medicines within the home.

Some people felt that more staff were needed to meet their needs in a timelier way. The provider was in a period of transition whilst staff from other locations were being transferred over to work at the Kenrick Centre. Staff shortages were managed using agency staff that were deployed on a regular basis to promote consistency.

Most of the people we spoke with felt safe living at the home and were protected from the risk of abuse and avoidable harm. The provider had effective systems in place to ensure that staff were recruited safely, received the training they required and were aware of the safeguarding processes in place.

People were cared for by staff who had been trained to meet their needs and who obtained their consent prior to supporting them. People were offered choices on a daily basis which included meal preferences. This meant that people had food that they enjoyed and any risks associated with their diet were identified and managed safely within the home.

People were supported to maintain good health because staff worked closely with other health and social care professionals when necessary.

The service was caring because people were supported by staff that were helpful and caring. Staff had taken the time to get to know people including their per

We inspected the Kenrick Centre on the 19 December 2016 and 05 January 2017 and it was unannounced on the first day of the inspection. At out last inspection in June 2015 there was one area where the service was not meeting regulations. We found that people had not always been involved in decisions about their care. At this inspection we found that improvements had been made regarding supporting people with decisions about their care.

The Kenrick Centre is a purpose built centre which is registered to provide two types of service.

On the first floor there is an enablement service which provides personal care for 32 people for up to four weeks following discharge from hospital. The purpose of the enablement unit is to provide a further period of recovery and assessment to prepare people for their return home or identified placement. The ground floor is registered to provide accommodation and care for 31 people. At the time of our inspection 59 people were living at the service.

A registered manager is required to manage this service. The provider had chosen to register two managers for this service. There were two registered managers in post at the time of our inspection one for each of the units. 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 systems in place to audit the quality of the service were not always effective because they did not identify where improvements were needed. Medicines were not always managed effectively to reduce the risks associated with them. Although issues raised at our inspection action was taken to address them. These issues had not been identified through the day to day auditing of the service.

People told us that they felt safe and staff we spoke with were confident that they could identify signs of abuse and would know where to report any concerns. Staff received training and supervision to support them in their role. Staff training was monitored and opportunities were provided to staff to further develop their knowledge and skills. Sufficient staff were employed to provide care and support to people and ensure their needs were met.

People told us that they felt safe and staff we spoke with were confident that they could identify signs of abuse and would know where to report any concerns. Staff received training and supervision. Staff training was monitored and opportunities were provided to staff to further develop their knowledge and skills. Sufficient staff were employed to provide care and support to people and ensure their needs were met.

People told us that People had been involved in decisions about their care and received support in line with their care plan.

People were supported to maintain good health and had regular access to healthcare professionals. They had enough to eat and drink and individual dietary needs were met where needed.

People were encouraged to pursue interests, hobbies and activities that were of interest to them. People told us that they felt confident that any concerns they raised would be dealt with.

The Kenrick Centre includes a residential home based on the ground floor and an enablement service on the first floor. During our inspection in March 2013, we focused on the enablement service where we found that improvements were required in the way that care was planned, delivered and recorded. We also identified gaps and inconsistencies in staff training. We set compliance actions and told the provider to improve. During this inspection we found that most of the areas of improvements in the enablement service had been addressed. We also included the residential home as part of this inspection as the home had not been previously inspected.

On the day of our inspection there were 29 people who used the enablement service and there were 29 people who lived in the residential home.

In the enablement service we spoke with 15 people, two relatives and looked at five sets of care records. We also spoke with four members of staff and the registered manager.

In the residential home we spoke with 6 people who lived there, three relatives and looked at four sets of care records. We also spoke with four members of staff and the registered manager. Some of the people who lived at the home were unable to verbally express their views to us. To help us understand how their experience of care, we spent time observing how staff delivered their care we also looked at care records and spoke with relatives and staff.

People's privacy, dignity and independence were respected. One person told us, “You are encouraged to do as much as for yourself as possible. It shows you can help yourself, so the enablement service is working”

Care was planned and delivered to ensure people’s safety and welfare. One person told us, “I get the care that I need and when I need to see the doctor they are called without delay”.

Safeguarding procedures were in place to identify the possibility of abuse and preventing abuse from happening.

Medicine management systems were in place so that people had their medicines as prescribed by their doctor to ensure their health and wellbeing.

People were cared for by staff who were supported, supervised and trained to deliver care to an appropriate standard. One person told us, “Staff are always polite, always helpful”

Gaps and inconsistencies in people’s care records meant that people were not protected from the risks of unsafe or inappropriate care because accurate and appropriate records were not consistently maintained.

The Kenrick Centre includes a residential home based on the ground floor and an enablement service on the first floor. Our inspection focused on the enablement service that consisted of four units. People stayed for up to six weeks to help them regain their independence following discharge from hospital.

On the day of our inspection there were twenty seven people using the service. We spoke with twelve people and four relatives. We also spoke with the registered manager, three members of staff and two health care professionals. We looked at three sets of care records for people using the service.

People’s privacy, dignity and independence were respected. However, improvements were required in the way that people using the service and those acting on their behalf were involved and informed of their care.

Lack of appropriate care plans and risk assessments meant that care was not always planned and delivered in a way that was intended to ensure people’s safety and welfare.

Safeguarding procedures were in place to identify the possibility of abuse and preventing abuse from happening.

Arrangements were in place to manage medicines, however improvements were required in the way that medicines were stored.

Staffing levels were adequate to meet people's needs, however there was a lack of training for staff.

People were not protected from the risks of unsafe or inappropriate care because accurate and appropriate records were not consistently maintained.

The Kenrick Centre is registered to provide care and accommodation for sixty four people over two floors. Our visit focused on the enablement unit on the first floor of the centre. People stayed on the unit for short periods of time of up to six weeks to help them recover after being in hospital so that they would then be able to live independently. If independence could not be achieved, people would move to more supported living or residential care.

During our visit we spoke with fourteen people who were using the service. They all expressed satisfaction with the service they were receiving.

People told us the care staff were ‘helpful’ and ‘efficient’. They told us staff were available to help them when needed. Staff were able to tell what the support needs of people were and how these were to be met. We saw that there were good relationships between the staff and the people living in the home. Staff were friendly and respectful when speaking to people. People told us they were receiving input from health care professionals to help them get ‘back on their feet’ so they could go home.

People told us they were satisfied with the meals served to them and we received several positive comments about the food. We were told there were a range of foods people could choose from. People could choose to have their main meals at lunch time or in the evening.

We spoke with thirteen people who used the service during our visit on 9 June 2011. People told us that the Kenrick Enablement Centre was a wonderful idea that helped them get on their feet again after a stay in hospital. Everyone we met was impressed by the high quality of the facilities and especially appreciated the privacy of a single bedroom with ensuite shower and toilet. They also told us they enjoyed being able to move around the floor to take advantage of different seating areas with views of the lovely parkland surroundings.

People staying at the centre praised the meals. We heard that meals had improved a lot since the centre first opened and the quality was now really good. Another told us meals were “as good as in a 4 star hotel”. People told us there was a choice of four main dishes and desserts at lunchtime and lots of choice at other meals too. People really appreciated that they and their visitors were always able to make drinks in a kitchenette area.

People told us that staff would give them any help they asked for, were very kind and “there is always someone on hand”. Some people told us it wasn’t always clear how things worked or what they could expect to happen and that staff took different approaches. We heard some worries where people felt they weren’t always listened to about the help they needed. Several people told us that the onsite physiotherapist helped them a lot, one told us “I could not walk, the physio really worked hard with me”.

This was an unannounced inspection, which took place on 16 and 17 June 2015. At out last inspection in June 2014 there were three areas where the service was not meeting regulations. We found improvements in two areas, but have on-going concerns in regards to how people’s rights were being protected.

The Kenrick centre is a purpose built centre, which is registered to provide two types of service.

On the first floor there is an enablement service which provides personal care for 32 people for up to six weeks following discharge from hospital. The ground floor is registered to provide accommodation for persons who require nursing or personal care for 31 people.

A registered manager is required to manage this service. The provider had chosen to register two managers for this service. There were two registered managers 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 service is run.

People said they received a safe service, procedures were in place to reduce the risk of harm to people and staff were trained and knew how to report and deal with issues regarding people’s safety. People received their medicines as prescribed and safe systems were in place to manage people’s medicines.

Sufficient staff were employed to provide care and support to people and ensure their needs were met. People received a service from staff that were trained, supervised and supported to ensure they were able to perform their role well. People’s rights were not fully protected.

People said they enjoyed their food and had a choice of food and drink to ensure they received a healthy diet. People’s health care needs were met and people said they saw the doctor and other health care professionals as needed. People received care from staff who were respectful, kind, caring and ensured people’s privacy and dignity was maintained.

People were able to participate in various social activities if they wished, and were confident their concerns would be listened to and acted upon. Clear systems were in place to investigate and respond to people’s concerns and complaints.

People were happy with the service they received, but procedures needed further development to ensure people felt fully involved and to ensure staff had the tools to protect people’s rights at all times. Safety concerns in the environment were not acted upon in a timely manner, despite the registered managers bringing them to the attention of the provider.

The action we told the provider to take can be seen at the back of the full version of this report.