About the service:

¿ Kent Lodge offers accommodation and personal care for up to 38 older people, some of whom are living with the experience of dementia. The accommodation is provided over two floors. There were 35 people using the service at the time of our inspection.

¿ The service is provided by Shaw Healthcare (Group) Limited, a national organisation providing health and social care.

People’s experience of using this service:

¿ Improvements had been made to the management of medicines. People were receiving their medicines safely and as prescribed.

¿ Where there were risks to people’s safety and wellbeing, these had been assessed appropriately. There were guidelines and support plans in place and these were regularly reviewed and updated where changes were identified.

¿ Following concerns about the standards of hygiene in the kitchen, the Food Standards Agency had undertaken a further visit and were satisfied that all actions had been taken and standards were met.

¿ People were protected by the provider’s arrangements in relation to the prevention and control of infection. The home was clean and hazard-free.

¿ Recruitment checks were undertaken before staff started working for the service and included checks to ensure they had the relevant previous experience and qualifications.

¿ There were enough staff deployed to support people who used the service and meet their needs. The provider had contingency plans in place in the event of staff absence.

¿ The provider had processes for the recording and investigation of incidents and accidents. Lessons were learned when things went wrong, and appropriate action was taken to minimise the risk of reoccurrence.

¿ The provider had effective systems in place to monitor the quality of the service and put action plans in place where concerns were identified.

¿ The registered manager felt well supported by senior managers and worked with them to implement improvement plans and make the necessary improvements.

¿ There were regular team and management meetings where important information was shared. People who used the service and their relatives were consulted about the service and took part in regular meetings.

Rating at last inspection: At the last inspection, the service was rated requires improvement (Published on 28 November 2018) for the second consecutive year. At this inspection, the overall rating had improved.

Why we inspected: At the previous inspection, we found repeated breaches of two Regulations in relation to safe care and treatment and good governance and issued the provider with two warning notices, telling them to make improvements by 31 December 2018 and they sent us an action plan telling us how they would do this. We undertook this focused inspection to check that the provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to the key questions ‘is the service safe?’ and ‘is the service well-led?’ You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Kent Lodge on our website at www.cqc.org.uk.

Follow up: We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This comprehensive inspection took place on 24 October 2018 and was unannounced.

The last inspection of the service took place on 3 April 2018 when we rated the service requires improvement in all key questions and overall. At this inspection, although we found that some aspects of the service had improved, there were still concerns about the safety of people who used the service so we have rated the question, 'is the service safe?' as inadequate in and the question, ‘is the question well-led?' as requires improvement. The overall rating of the service is requires improvement.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve all the key questions to at least good. We received the provider’s action plan on 15 June 2018, telling us they would complete all actions by 20 June 2018.

Kent Lodge 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. The service is registered to provide care for up to 38 people in a single building. Accommodation is provided on two floors.

The service is provided by Shaw Healthcare (Group) Limited, a national organisation providing health and social care. At the time of our inspection, there were 32 people living at the service, one of whom was in hospital.

There was a manager at the service. They had been the manager for six months. They were in the process of registering with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 received confirmation on 1 November 2018 that the manager had successful registered with the CQC.

Although improvements had been made, staff did not always follow the procedures to manage medicines. This meant that people were still at risk of not receiving their medicines safely and as prescribed.

Risk assessments were in place for each person, however, the level of risk was sometimes wrongly calculated which meant that risk management plans might not have been adequate to mitigate the risks. Guidelines and support plans were also not always reviewed and updated when the risk had increased.

A recent Food Standards Agency inspection had highlighted some concerns about the standards of hygiene in the kitchen. We saw that the provider had taken immediate action to meet requirements and make the necessary improvements.

The provider had processes for the recording and investigation of incidents and accidents, however, where a person using the service had a fall, staff were unable to show us a record of the accident report and actions in place to reduce future risks.

The provider had a number of systems to monitor the quality of the service and put action plans in place where concerns were identified. However, their systems had failed to identify the issues we found at this inspection or what the Food Standards Agency found.

We found the continuing breaches of two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment and good governance. We are taking further action against the provider. Full information about CQC’s regulatory response to these concerns will be added to the report after any representations and appeals have been concluded.

The provider did not always act in accordance with the Mental Capacity Act 2005 (MCA). Processes had not been followed where a person using the service was receiving their medicines covertly. We have made a recommendation regarding this.

Care plans were comprehensive and regularly reviewed. However, these i

The inspection took place on 3 April 2018 and was unannounced.

The last inspection of the service took place on 13 April 2017 when we rated the service Good in all key questions and overall.

At this inspection we have rated the service Requires Improvement in all the key questions of Safe, Effective, Caring, Responsive and Well-led. The overall rating for the service is Requires Improvement.

Kent Lodge is a 'care home' without nursing. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered to provide care for up to 38 older people in a single building. Accommodation is provided on two floors.

The service is provided by Shaw Healthcare, a national organisation providing health and social care. At the time of our inspection there were 31 people living at the service.

The registered manager had left the service since the last inspection although they were managing a similar service within the company and were still involved in managing Kent Lodge. An interim manager had also recently left. The provider's representatives told us that they had recruited a manager who was due to start work at the service the day after the inspection and this person would apply to be registered with the Care Quality Commission. 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.

Staff did not always follow the procedures to manage medicines which meant that people were at risk of not receiving their medicines safely.

People were not always protected by the provider’s arrangements in relation to the prevention and control of infection. Some areas of the home had a malodour and we found some health and safety issues.

On the day of our inspection, we saw that people's needs were not always met in a timely manner and people’s concerns about their welfare were not always taken seriously.

People had access to healthcare professionals and the outcomes of their visits were recorded in people’s care plans, however, care plans did not always include guidelines where people had specific healthcare needs.

Some staff practices were not always person-centred and did not take into account people’s choices.

The provider had a number of systems in place to monitor the quality of the service and put action plans in place where concerns were identified. However, these had failed to identify the issues we found at this inspection.

The provider was not always acting in accordance with the Mental Capacity Act 2005 (MCA). There was no evidence that any attempts had been made to appropriately assess a person’s mental capacity in line with the MCA principles.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Safe care and treatment, Person-centred care, Dignity and respect, Need for consent and Good governance. You can see what action we told the provider to take at the back of the full version of the report.

The provider had not employed a full time or permanent manager for the service. The registered manager had moved to another service but was still involved in managing Kent Lodge and was therefore working part time at both services. This meant that improvements to the service were not as fast or embedded as they could be.

Most staff had received training in end of life care and some people had advanced care plans. However, the provider acknowledged that this area needed to be developed further to ensure they could meet people’s needs when they reached the end of their lives.

Processes had been followed to ensure that, when necessa

The inspection took place on 13 and 19 April 2017. The first day of our inspection was unannounced and we told the provider we would return the following week to complete our inspection. The service was last inspected on 17 March 2016 when we found two breaches of the Health and Social Care Act 2008 and associated regulations which related to the need for consent and safe care and treatment. Following the inspection the provider sent us an action plan detailing how they would make improvements. At this comprehensive inspection we found the provider had taken action to address the breaches we had identified and improvements had been made.

Kent Lodge is registered to provide accommodation and personal care for up to 38 older people. At the time of our inspection, 37 people were living at the service. The home is divided into two units, one on each of the two floors.

The manager had been in post for five months and had made an application to be registered with the Care Quality Commission. 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.

Improvements had been made in relation to the management of risk. The risks to people’s safety were identified and managed appropriately. The provider had put systems in place to ensure people lived in a safe environment. We saw a variety of health and safety checks were conducted on a regular basis by staff and external agencies.

The environment was safe, clean and free of hazards. The provider had processes in place for the recording and investigation of incidents and accidents.

The provider carried out regular fire checks and fire drills. All people using the service had personal emergency evacuation plans (PEEPs) in place.

Recruitment procedures and systems were in place to ensure that only suitable staff were appointed to work with people who used the service.

There were enough staff on duty to keep people safe and meet their needs, and there were contingency plans in place in the event of staff absence.

There were appropriate procedures in place for the safeguarding of vulnerable people and these were being followed.

There was a procedure for the recording, storing and administering people’s medicines and the staff were aware of this. Staff received regular training in the administration of medicines.

Assessments were carried out before people were admitted to the service to ensure the service could provide appropriate care. Care plans were developed from the assessments and reviewed regularly. People told us they were involved in care plan reviews.

The provider was aware of their responsibilities and had acted in accordance with the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People’s capacity was assessed and they consented to their care and support. Processes had been followed to ensure that, where necessary, people were deprived of their liberty lawfully.

People received support by staff who were effectively trained, supervised and appraised. Staff told us they felt supported by their manager.

Staff had received training identified by the provider as mandatory to ensure they were providing appropriate and effective care for people who used the service.

A range of activities was organised and external entertainers visited regularly to provide an activity program to people who used the service. The activity coordinator worked with the care staff to provide person centred activities for people who were living with the experience of dementia.

People’s nutritional and healthcare needs had been assessed and were being met.

Staff treated people with kindness and dignity and took into account their human rights and diverse needs.

There was a complaints proc

The inspection took place on 17 March 2016 and was unannounced. The service was inspected on 24 April 2014 and at the time was not meeting one of the regulations we inspected in relation to the safety and suitability of the premises. The service was inspected again on 12 February 2015 and at the time was found to be meeting the regulations we looked at.

There was a registered manager at the service 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.

Kent Lodge provides accommodation and personal care for up to 38 older people. The home is divided into two units, one on each of the two floors. The home provides a service for older people who have a range of needs including dementia care needs. There were 37 people living at the service at the time of our inspection.

Most of the home was in need of upgrading and redecoration. Not all the communal toilets had emergency cords that were accessible from the floor as they had been tied up or placed out of reach. A cupboard containing cleaning materials had a broken lock and another was secured with a bolt rather than a lock, so both could have been opened by people using the service. We made the manager aware of the safety issues and they told us they would address this without delay. The home was clean and tidy and free of hazards.

During the inspection, we saw that people were consulted and consent to their care and support was obtained verbally. However we found no evidence in people’s care records that they had consented to their care and treatment except for ‘consent to photos’ forms.

None of the care plans we looked at were signed by people or their relatives, and there was no evidence of review of care or involvement in care planning process beyond records of discussions with relatives, usually single issue discussions.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. However there were gaps in recording in some files and some care plans had not been updated correctly to reflect people’s current status. Some monitoring charts were not always consistently maintained and at times were disordered.

Care plans contained assessments of people’s needs and information on how care was to be provided. Care plans contained information about people’s daily routines and preferences.

Medicines were stored securely and staff followed the procedure for recording and safe administration of medicines. Staff received training in the administration of medicines, and this was refreshed annually. The management team undertook regular audits of medicines.

The provider had processes in place for the recording and investigation of incidents and accidents. Risks to people’s safety were identified and managed appropriately.

There were enough staff on duty to meet people’s needs in a timely manner.

People felt safe when staff were providing support. Staff had received training and most demonstrated a good knowledge of safeguarding adults.

People’s capacity to make decisions about their care and treatment had been assessed. Processes had been followed to ensure that, when necessary, people were deprived of their liberty lawfully.

Staff received regular supervision and an annual appraisal, and told us they felt supported by their manager. There were regular staff meetings and meetings with people and their relatives.

Staff had received training identified by the provider as mandatory to ensure they were providing appropriate and effective care for people using the service.

Recruitment records were thorough and complete and the provider had ensured that staff had a Disclosure and Barring Service (DBS) check

We carried out this inspection to follow up on the issues we found with some areas of the environment at the last inspection which took place 24 April 2014. Previously the registered person had not ensured that people lived in a suitable and safe service. There had been problems with some of the fire doors being propped open, a toilet door was not working properly and a battery on a fire door was beeping indicating it needed replacing. We had also found call bell cords had been tied up in some rooms making it difficult for people to use to call for staff assistance. The provider told us they would address this by 31st October 2014.

We visited to follow up on the maintenance and safety of the building. We saw improvements had been made to the checks on fire doors, the maintenance of the building where we saw the toilet door now closed properly and the call bell cords were not tied up and people could use them if they needed assistance from a member of staff.

Other assessments and systems were in place for example to check that the service was safe for people living, working and visiting the building. We saw a fire risk assessment from January 2015 and the registered manager had carried out an audit on the fire doors and furnishings in the service to make sure they were suitable in the event of a fire. Fire alarm tests and drills also took place on a regular basis to make sure staff and people knew how to respond if a fire occurred in the building.

There was an on-going decorating and building works plan for 2015 which had timescales to demonstrate when areas of the service would be updated. Improvements to the décor had started to take place since the last inspection. The lounges and corridors had been painted and carpets and chairs in lounges had been updated. The registered manager showed us other refurbishment plans that were in place to ensure the service continuously improved and was homely, welcoming and safe for people using the service.

The provider and registered manager were aware of and addressing the heating in the dining room which did not sufficiently keep the room warm. Steps had been taken for more suitable glazing to be fitted to the windows and the temperature of the room before each meal time was taken to ensure people were eating in a warm room.

We considered our inspection findings to answer 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?

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. Suitable risk assessments had been carried out and staff were knowledgeable about the specific needs of the people that they cared for.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. None of the people who used this service had applications submitted under this system. However, we saw evidence that staff had received training in relation to the operation of the DoLS and there were appropriate policies in place.

Members of staff had been through an appropriate recruitment process. This included carrying out background checks, for example, through the Disclosure and Barring Service. This meant the provider could demonstrate that the staff they employed were suitable and had the skills and experience needed to safely support the people living in the home.

We observed some problems with the maintenance and operation of the premises. In some cases this meant that people were not consistently protected against the risks associated with medical or fire emergencies. We have asked the provider to draw up an action plan in relation to these risks and we will go back to the service to check that these actions are implemented.

Is the service effective?

We found that people's needs had been assessed and suitable care plans were in place. These were regularly reviewed. There were systems in place for obtaining verbal and written consent prior to providing any care. Staff told us how they supported people to make decisions about their own care.

People were protected from the risks of inadequate nutrition and dehydration. People's special dietary needs were assessed and provided for. One person told us “The food is very good. There is enough to drink and a very nice tea.”

Is the service caring?

We spoke with five people who were using the service and three relatives. The majority told us that they were happy with the care that was being provided. For example, one person told us "I like everything here. Some of the staff are very nice and very kind." A relative of someone using the service commented that the staff "really do seem to care and it gives you a good feeling."

Is the service responsive?

We examined how the service responded to verbal and written complaints as well as what actions they took in response to any adverse incidents involving people who used the service. We saw that the service responded appropriately to any complaints that they received and kept records of what steps had been taken to address any problems. The service could also show us evidence of how they responded to incidents. We saw that team leaders or managers identified what actions could be put in place to minimise the possibility of any incident recurring.

Is the service well-led?

The provider had an effective system to regularly assess and monitor the quality of service that people received. People using the service were invited to attend resident's meetings intermittently. The service had plans to implement these meetings more regularly on a monthly basis. At these meetings people using the service and their relatives could discuss potential improvements to the service. Members of staff were also invited to attend meetings where they could raise any concerns and the quality of care being provided was addressed.

A quality audit had recently been carried out by the provider which had identified a number of areas for improvement. The need for updating and redecorating the premises was identified in this audit. This was also raised as a concern by the people who we spoke with. We saw the managers had prepared an action plan in response to these concerns.

We previously inspected Kent Lodge on 19 January 2013 and found the provider was not meeting the essential standards in respect of the management of medicines, safety and suitability of premises and staffing. The provider sent us an action plan on how they would improve. On our inspection on 21 May 2013 the provider had made improvements in the areas that had been identified.

During this inspection were observed some people who use the service were taking part in activities, supported by staff. We spoke with four people who use the service and they confirmed that their care needs were met by staff at Kent Lodge. We also spoke with two members of staff who said they received good training on how to work with people safely and this training improved their skills and ability to care for people effectively. One member of staff said the diverse staff group aimed to ensure people's cultural needs were met with particular reference to the provision of culturally appropriate meals at the home.

During the inspection we talked with six people using the service, three relatives and six members of staff. People said they received a good standard of care and staff supported them appropriately in their daily life. One person said “I am very happy in the home and I have settled very well”. Another said “they [staff] are very nice people and they look after you well”. Two relatives said they were satisfied with the way their family members were cared for and supported.

Staff talked to people before providing care and support so they knew what was happening. People could make choices in their daily life. One person said “I more or less get up and go to bed at the time I want to”. We observed people moving to different areas of the home, without restrictions unless their safety was compromised. One person said “I can choose what I do and I prefer to stay with the others”.

Whilst people were appropriately supported with their healthcare needs, we found that the arrangements for the management of medicines were not always effective in protecting people against the risk associated with medicines. The quantity of some medicines was not recorded when received and there were no guidelines in respect of medicines prescribed to be given as required to people.

A review had not been undertaken with regards to the staffing over the weekend. There were two staff on the ground floor in the afternoon. Most staff said this was inadequate because there was too much to do.

People said that they were being well looked after at the home. They said that staff made them feel valued and that they were able to make choices about their care, which were respected.

People said that they felt able to speak with staff about any concerns and that they were listened to. Visitors we spoke with also said that they felt confident to discuss any issues with the manager and that they would be addressed.

People told us that they liked the food and if they wanted something different then staff would always get it for them.

Visitors told us that they were always made welcome at the home. They said that the manager kept them up to date with any changes in their relative’s condition.