This inspection took place on 15 and 16 January 2019. It was an unannounced visit to the service.

Kent House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Kent House is registered to provide support up to 22 older people. At the time of the inspection 20 people lived at the home.

Kent House is a purpose built unit, it is made up of single bedrooms, one bedroomed bungalows and a first floor flat. It provides support to people who have an acquired brain injury. Some of the people who live at the home also have a physical disability and depend on a wheelchair for all mobility. The home has communal seating, dinning and activity areas. The home benefits from an onsite therapy room, in which a physiotherapist and an occupational therapist work. Clinical psychologist support was available when needed.

At our last inspection we rated the service 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 inspection we found the service remained Good.

We received positive feedback from people, their relatives and community professionals. Comments included “I like the staff, I get on with them” and “I have been here 11 years and have always been looked after, I am happy here.” Another person told us “I am very happy.” A relative told us “My brother [Name of person] has lived at Kent house for a number of years, without their good care and understanding I doubt if he would still be here.”

People were supported to take and manage their prescribed medicines. We noted dispensing labels and medicine administration records (MARs) for thickening agent for drinks did not always match the advice from the speech and language therapist. We have made a recommendation about this in the report.

People were supported by staff who knew them well. However, care plans were not always updated following changes made. When we spoke with staff they were aware of the changes made. We have made a recommendation about updating records in a timely way.

People were supported by staff who had been recruited safely to ensure they had the right skills and attributes to work with people. Staff were supported with ongoing training to maintain their knowledge and skills.

People were supported to maintain their health. The service worked closely with external healthcare professionals. Where people were admitted to hospital the service ensured hospital staff were aware of the person’s likes and dislikes.

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.

People were supported to maintain family and friendships which were important to them. People had opportunities to attend community centres, where they could participate in cookery programmes, singing groups and gardening projects.

People told us the service was well-led, Kent House had an experienced registered manager in post who was supported by two assistant managers. The management team worked together to drive improvements to benefit people who lived at the home.

Further information is in the detailed findings below.

This inspection took place on 08 and 10 June 2016. It was an unannounced visit to the service.

We previously inspected the service on 15 April 2014. The service was meeting the requirements of the regulations at that time.

Kent House is a care home for adults who have an acquired brain injury, some of whom may live with a physical disability. It is registered to provide accommodation for 22 people. At the time of our inspection 20 people lived at Kent House.

The service had 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.

The home is located in a residential setting; people who lived at the home were familiar with the local area and neighbours.

People were protected from avoidable harm. Risk assessments were comprehensive and gave good detail on how staff should support people to live and full and active life.

People received their medicines when needed; we observed good practice by staff when they administered medicines.

People were protected from abuse as staff had received training on how to recognise it. Staff knew what to do in the event of a concern being raised and would not hesitate to use a confidential whistle-blower helpline.

Incidents and accidents were recorded. Onward referrals were made when the need was identified. For instance, when someone was identified at high risk of falling, they were referred to the specialist healthcare professionals at the service which helped to maintain balance and muscle strength through exercises.

People had access to healthcare and good systems were in place to monitor people’s health and appointments were made in a timely manner. A therapy assistant supported staff; they told us “We offer a unique programme to maintain health.”

The home worked within the principles of the Mental Capacity Act 2005, and where required, appropriate referrals were made to the local authority to authorise a deprivation of liberty.

People had access to a wide range of activities both within the home and the local community. External events like a charity gardening scheme and a singing group were attended by people.

People were supported by staff, who provided a person centred service. Care plans reflected individual likes and dislikes, and gave a good description on how staff needed to support people. Staff had developed good working relationship with people.

People knew who to talk with if they had any concerns. Management were visible and approachable.

Kent House provides care, support and accommodation for up to 22 people with acquired brain injury. Not everybody who used the service was able to express their views verbally. In those cases we observed the interaction between them, staff and other people who lived in Kent House to help us make judgements. We talked to five people who received support and to nine members of staff and one family visitor. We looked at care records, staff training and supervision records and records of staff and service user meetings which had been held

We considered the evidence we had gathered under the outcomes we inspected. We used this information to answer the questions we always ask:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found-

Is the service safe?

People were cared for safely. Staff had the knowledge and skills they needed to help them provide safe and appropriate care. There were risk assessments in place, together with appropriate behavioural plans to address specific patterns of behaviour, where applicable. These included details of how risks were to be eliminated or managed and how behaviour could be safely, effectively and appropriately managed.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). The home had policies and procedures in relation to the Mental Capacity Act 2005 and DoLS. Relevant staff had been trained to understand when an application should be made, and how to submit one. There was one DoLS in place which had been subject to a formal review. This confirmed there were proper safeguards in place.

The provider had an emergency contingency plan in place. This showed how staff should respond in an event which may have presented a risk to the home, for example flooding or power failure. This demonstrated the provider had arrangements in place to deal with foreseeable emergencies.

Is the service effective?

People who received care and support were positive about their experiences. We observed good interaction between staff and people who received support. Staff had a very clear understanding of the individual care needs of people and how they wanted their support provided.

People's care needs were assessed with their involvement. We saw care plans were subject to review so they remained appropriate and up to date.

People were provided with the specialist equipment they needed to meet their mobility or other care needs. People had ready access to community health services, for example GPs, dieticians and specialist nursing teams. This ensured their care and support was appropriate and effective.

The staff team included qualified psychologists and occupational therapists who advised and worked with other care and support staff to promote effective, high quality care. Staff training and supervision had now been delivered and/or was planned to ensure it was received regularly and consistently to help staff maintain effective support to people.

Is the service caring?

The relative we spoke with told us how supportive and caring staff were. People who received care were positive about the standard of care and support they received.

We observed respectful and sensitive care being provided. Care staff supported people without hurrying them and gave them encouragement whilst doing so.

Although the most recent survey of satisfaction had not been well supported, those who did respond were positive. The previous survey had a significant majority of positive responses about the standard of care and how it was provided.

Is the service responsive?

We saw care plans included details about people's preferences, interests, likes and dislikes. These were in formats which were accessible to them and had been used to determine how their needs were to be met. Where people's needs changed, the care planning and review system in place enabled this to be identified and action taken to respond effectively. This meant care planning and delivery was sufficiently flexible to respond to changes in a person's assessed needs.

We saw people were able to access the local community and to retain contact with people who were significant to them.

Is the service well led?

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

We found systems were in place to measure the quality of the service provided. There were regular audits of key areas of the home's operation to monitor quality. Views of people who used the service and those responsible for their care were sought on a regular basis. Where response levels had been disappointing, the provider had actively taken steps to improve this by considering changes to the way feed-back was obtained and by looking at alternative additional systems and processes.

We spoke with staff at all levels and with different roles. They confirmed prompt action had been taken to address concerns reflected in the previous report by the Commission of December 2013. These were about support for staff and the frequency and consistency of staff supervision and training. Additional forums for staff had been proposed and staff training and support through meetings and supervision had become more regular and consistent. We were told the service continued to go through a significant period of change. This remained a challenge for the service and their were differing views as to the outcome.

People who lived in Kent House told us they were well-cared for. They appeared to be at ease with staff and had positive views of their care. One person talked about their painting and how they attended art groups in the community. Another person told us about how they were helped to access the community and maintain contact with family and friends.

We spoke with staff and found they had a very good knowledge of those individuals they supported. This meant they were able to provide care in a way which met, as best as they were able to, the individual needs and wishes of the person concerned.

We saw safeguarding policies and procedures were in place, with information readily available to staff on how to respond to any safeguarding concern. We spoke with 12 members of staff, including management, administrative and ancillary staff. They had a clear understanding of what constituted abuse and they knew what to do if they saw or suspected it. This showed people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

The evidence we saw and the people we spoke with showed us there were enough qualified, skilled and experienced staff to meet people’s needs on the day of our visit. Staff told us they felt the training they received was satisfactory. We found the provision of staff training, supervision and appraisal had been inconsistent. Staff we spoke with told us they had ensured any of their concerns about changes to the service had not adversely impacted upon the health, safety or well-being of people who lived in Kent House and relied on them for their care.

We saw evidence the provider invited external bodies to assess and audit areas of the service. We saw feedback from one external visit which highlighted some areas of good practice as well as where improvements could be made. There was evidence that learning from incidents / investigations took place and appropriate changes were implemented.

When we talked with people who use the service they told us they were able to make decisions about what they did and when. One person told us they liked to spend time in their room painting whilst another said they liked listening to music in their room or playing the French horn. When we observed communal areas in Kent House we saw people being supported individually to take part in, for example, going through the main news of the day. They were given choices as to what they did and whether they wanted to participate or not.

We looked at five care plans. Each contained details of the person's individual preferences. There was evidence of the involvement of people who live in Kent House in drawing up their initial care plan and in the process of review and updating of them. People told us staff were 'good' and throughout our visit we saw very positive interaction between support staff and people living in Kent House.

People told us they felt safe living in Kent House. They said they would speak to staff if they had any concerns at all. When we spoke to people living in Kent House they told us staff supported and cared for them well.

We saw an 'easy to access' service user satisfaction questionnaire. We saw the results of the 2011 survey had been analysed to identify overall satisfaction. We saw action plans had been drawn up to address any issues identified.

One person said they felt safe at the home. People identified their views were respected and they were involved in making decisions about their care. People confirmed they consented to their care and that their care had been reviewed with them yearly.

People told us that they were able to participate in meetings if they chose to do so. People told us the multi-disciplinary team providing their care were approachable and friendly. People confirmed they knew who their key workers were and who to approach should they wish to raise concerns.

People said they liked the food. People said they were helped by staff when they had chosen to prepare and cook their own food.