The inspection took place on 7 December 2016 and was announced.

Kensington Lodge provides residential care for up to 15 people who are living with a learning disability. At the time of this inspection there were 12 people living within the home.

The accommodation is over three floors of a period building with communal areas including a lounge and dining room. Bedrooms have washing facilities and there are communal bathrooms available.

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.

At our last inspection in January 2015, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to the risks associated with the premises and the governance of the service. At this inspection, carried out in December 2016, we found that the provider had made sufficient progress to no longer be in breach of the regulations.

At our last inspection carried out in January 2015 we found that the service had failed to identify and rectify the risks associated with hot water, the storage of hazardous chemicals and infection. At this inspection we found that these concerns had been addressed by the service and measures were in place to manage the risks. Improvements had been made to the premises and these were ongoing.

The provider had audits in place to help monitor the quality of the service and rectify any identified issues. These had been completed on a regular basis and covered most areas of the service. The audits had been effective but required more attention to detail to become more robust in the event of any concerns.

Staff had been recruited following appropriate checks to ensure they were suitable to work in the service. There were enough suitably skilled staff to meet people’s individual needs in a person centred way.

People received support from staff who enjoyed their work, felt supported and worked well as a team. Staff had received an induction that prepared them for their role and completed relevant training. Their competency to perform their role was assessed and discussed in regular supervision sessions.

There was a warm and friendly atmosphere within the home and people were treated with respect. People were part of the running of the home and had choice in how they spent their days. Their dignity was maintained and their confidentiality respected by staff. People could come and go as they pleased and staff encouraged their independence.

Processes were in place to help reduce the risk of abuse and avoidable harm. The risks to the people who used the service and staff had been identified and managed. People received their medicines as the prescriber had intended and good practice guidance was followed.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service was working within the MCA although not all staff had a working knowledge of the legislation. We brought this to the registered manager’s attention and they contacted us shortly after our visit to confirm that training in this topic had been arranged.

People’s individual nutritional needs were met and they had choice in what meals were prepared. They received food and drink as they wished for it and the kitchen was open for people to access. Healthcare was available and the service supported people with this as required.

The service had discussed people’s care plans with them and they had been involved in this process. Care plans were developed with people’s consent and in an individual manner that met their needs. They had been reviewed on a regular basis.

The management team were spo

We inspected Kensington Lodge on 21 January 2015. The inspection was unannounced.

Kensington Lodge supports up to 15 people who have a learning disability.

At this inspection there were two registered managers in post. One of these was the main partner who owns the service but was not present to be in day to day charge of the home. The other was newly registered in the month before 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.

At the last inspection we asked the provider to make improvements in the safety of recruitment processes and the way people’s rights were protected if they were unable to make decisions for themselves. We also asked the provider to improve the way that people, their relatives and staff were consulted about the quality of the service. The provider told us what they would do to improve and this action had been completed.

Recruitment practices helped to ensure that people were protected from the employment of unsuitable staff. The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, and to report on what we find. Staff had an improved understanding of this legislation and how to use it to protect people who could not make decisions for themselves.

Opportunities for people to express their views about the quality of the service had increased. The manager asked people for their views at regular meetings. Surveys had also taken place so that they could make suggestions for any improvements they would like to see.

At our last inspection, we asked the provider to make improvements in cleanliness and the way any outbreak of infection would be controlled. The provider told us what they would do to improve but we found that not all the action they said they would take had been completed. They had taken action to improve cleanliness within the home but had not completed refurbishment of the laundry. This meant people would still be at risk of any infection not being properly controlled.

We also asked the provider to improve the way that risks to people’s safety within the home were assessed and managed. The provider had taken action to make the necessary repairs. However, risks to people’s safety, particularly from scalding, were still not properly assessed and controlled.

People were supported by a consistent staff team who had a good understanding of people’s needs and had established warm and caring relationships with them. Staffing levels were flexible so that people could engage in their hobbies and interests, both inside and out of the home and staff had training to help them understand people’s needs. Staff supported people to take the medicines they were prescribed and monitored their health to ensure advice was taken promptly if it was needed.

During this inspection the provider was in breach of Regulations 10 and 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Risks to people’s safety and welfare were not effectively identified, assessed and managed and the quality of record keeping was not properly taken into account. Arrangements for infection control still did not properly protect people from the potential spread of infection. These regulations have been replaced by 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.

One inspector undertook the inspection of Kensington Lodge. At the time of the inspection there were 14 people using the service.

We spoke with seven people who used the service, six care staff and the activities coordinator. The provider was on annual leave but we did speak with them via the telephone during our inspection. We reviewed three people’s care records and six staff files. We also reviewed a selection of other records that included the provider’s emergency plans and the risk assessments for the service.

We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA), 2005, and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The MCA provides a framework to empower and protect people who may make key decisions about their care and support. The DoLS are used if extra restrictions or restraints are needed which may deprive a person of their liberty.

At the time of this inspection no person was subject to a DoLS authorisation. The provider told us over the telephone that a number of applications for this safeguard were needed and that they would address this on their return to the service.

We reviewed three people’s care plans and noted that their mental capacity had been not been appropriately assessed . This meant that the management team did not fulfil their obligation to apply the principles of the MCA. We have asked the provider to tell us what they are going to do meet the requirements of the law in relation to the MCA, its main Codes of Practice and DoLS.

During our inspection we noted that people who used the service, staff and others were not always protected from the risks associated with exposure to infection. This was because the provider did not have effective systems in place designed to assess and minimise the risk of infection. This included unclean and unhygienic areas within the home. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring a clean and hygienic environment.

Effective recruitment procedures were not always in place. We have asked the provider to tell us what they are going to do to meet the requirements in law in relation to the requirements relating to workers.

There was limited evidence to show that people’s views about the care and support people received were sought or acted upon. The staff did not know whether accidents and incidents were audited. We have asked the provider to tell us what they are going to do to meet the requirements in law in relation to assessing and monitoring the quality of the service.

We found that risk assessments in relation to the home’s environment and the safety and welfare of people were out of date and contained incorrect information. We have asked the provider to tell us what they are going to do to met the requirements in law in relation to records.

There were procedures in place to manage and mitigate foreseeable emergencies. These included procedures in relation to fire, flood, adverse weather and power failure.

Is the service effective?

During our inspection we noted that people’s needs had been assessed and that their care and support had been planned to meet their needs. However, people’s risk assessments had not been dated or signed by the person who had completed them, and people’s care plans had not been reviewed on a regular basis. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to people's records.

People’s records included information about visits from other health and social care professionals. This helped to maintain multidisciplinary working to help ensure that all of the person’s needs were being met.

Is the service caring?

We spoke and communicated with six people who used the service and they all stated that they were happy living in Kensington Lodge. One person said, “I am happy here. I go to the centre and go horse riding and swimming. I don’t have any problems.” Another person said, “I have just come back from the day centre and have made some bracelets there. I have had fun.” A third person who could not communicate verbally gave us the ‘thumbs up’ when we asked them if they were happy with their care and support. Their sign meant that they were happy.

People’s care and support was person-centred and it was evident that the staff knew the needs of each person well. People’s likes, dislikes and preferences were documented. We observed people undertaking activities that they enjoyed. These reflected what were documented in their care plans.

We observed the interaction between staff and the people who used the service. The staff displayed kindness and courtesy to people at all times. People’s privacy and dignity were maintained. Staff displayed effective communication techniques to ensure people understood what was being said or proposed. This included the use of signs, pictures and easy read formatted information for people.

Is the service responsive?

People’s needs had been assessed and their planned care and support reflected their needs. This related to people’s physical, psychological and social needs. Staff responded appropriately to any deterioration in a person’s health.

Is the service well-led?

The service had a complaints procedure. Staff did not know whether complaints were audited and acted upon to help improve the quality of the service. We have asked the provider to tell us what they are going to do to meet the requirements in law in relation to assessing and monitoring the quality of the service.

All of the care staff we spoke with told us that the previous 12 months had been ‘challenging.’ They said that this was because they had been without a permanent registered manager. At the time of our inspection the provider of the service had just registered as the manager. The staff told us that they felt optimistic that the provider would bring positive changes to the service. One staff member said, “Things have improved with the provider being the manager. It feels more like a team now, especially since there are now three senior care staff. There is much more support.”

We conducted this inspection to follow up concerns identified at our previous inspection of 09 April 2013. These concerns related to the absence of an effective system of staff supervisions and appraisals. This meant that individual performance was not reviewed or evaluated and staff did not have formal opportunities to discuss their career development and progression. Our previous inspection also noted that the majority of staff required infection control training.

During the April 2013 inspection the service managers had advised us that a significant induction programme was being developed which all staff would be required to undertake. This would consist of the internal induction programme and Skills for Care training. Once this was in place and staff were familiar with the standards required by the service then appraisals and supervisions would be implemented. We were told this induction programme, appraisals and supervisions would be in place by the end of December 2013.

This inspection established that improvements had been made. The internal induction programme had been implemented. Staff appraisals and supervisions were being carried out. Staff had completed the outstanding training on infection control.

People we spoke with at Kensington Lodge told us they were well looked after and enjoyed their lives. One person who was unable to communicate verbally had conveyed to us that they had enjoyed an ice-cream out the previous week. Another person was looking forward to going horse-riding the next day.

The relatives we spoke with told us their family members were happy and well looked after by the staff. One relative told us that the staff were brilliant. Another said that when their family member spent the day with them they were always happy to return to Kensington Lodge.

People's care records were well ordered and clear. They reflected people's likes, dislikes and their preferences. Where people had specific requirements we found detailed records of what needed to done and how it needed to be done to enable care and support to be delivered safely and effectively.

Training programmes were in place and Skills for Care training and organisational training was about to be rolled out to all staff. However, no staff appraisals or supervisions had been carried out.

Kensington Lodge had a complaints policy that was available in a suitable format for people living at the home. We found that when necessary staff would support people by helping them to make a complaint.

We used a number of different methods to help us understand the experiences of people using the service, during our inspection on 09 May 2012, because some people had more complex needs and were not able to tell us their experiences.

One person we spoke with wasn't able to communicate verbally but, with sign language and facial expressions, they told us that they were happy and they enjoyed doing their needlework. This person also showed us their birthday cards and gave us the 'thumbs up' when we asked if they had enjoyed their day.

Other people we met and spoke with told us that they were happy and one person told us that they were going for a walk later that day.

Throughout our visit, we saw people doing as they wished and any support or assistance was provided respectfully by staff.

We saw that there were enough staff available to meet people's needs and we saw from the staff rotas that the staffing levels were consistent with those seen during our visit.

People told us they were very excited about going to Majorca for their holiday.

One person told us, "I chose this place, as it is much better that the other home where I was before. My social worker helped me and sorted all for me".

One person told us that they had no problems with money, as the manager gave it to them when they needed it.

We spoke with several people who use the service through two visits, one in the evening of 15 July and the other on 21 July 2011. People told us and showed us that they were happy with the service provided. All people were very relaxed and comfortable.

Four people joined two staff in the living room to talk with us on 15 July 2011. They showed trust in staff and frequently looked for staff approval to talk with us openly and honestly. They said that they trusted staff and felt supported and helped. They all thought that two staff on each shift could help them with all they needed. People told us that they were happy for staff to look after their medication and for the manager to look after their money. Some of them said that they were happy to help staff with cleaning. Three of them stated that they make their own drinks whenever they want, but preferred staff to do cooking, as staff cooked very well and food was fine.

People told us that they get on very well with each other. Two people stated that, “Rare rows could sometimes go over the top”.

On the second visit on 21 July one person told us that he would like a more active life. However, when prompted by the manager, he added that his activities were spread over five days a week. We spoke with him just prior to his outing to a community organised charity event that he and eight other people were looking forward to with excitement.

We observed how care workers were interacting with two more people who stayed at home. One person showed us how he learnt signs used by another person with limited verbal abilities and how they communicated very well.

Our observations showed that people were clean, shaven, appropriately dressed and generally well looked after.

We did not speak with people about their experiences, with regard to the service they received at Kensington Lodge, during either of our inspections on 09 or 15 November 2011. This was because we were specifically checking that the compliance actions we made at our last inspection had been met.