The inspection of Kenton House took place on the 5 December 2017. It was unannounced.

At the last inspection of the service on the 4 and 6 January 2017 we rated the service as ‘Requires Improvement’. The provider was in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we found deficiencies in the training and supervision that staff received, and a person was being deprived of their liberty for the purpose of receiving care without lawful authority. Also systems and processes were not established and operated effectively to assess, monitor and improve the quality and safety of the service.

Following the inspection, we asked the provider to complete an action plan to show what they would do to improve the key questions Effective and Well-led to at least good. The provider sent us an action plan setting out the actions that they would take to meet the regulations. During this inspection we found appropriate systems were in place to ensure that staff received the training and support that they needed to carry out their role and responsibilities. Legal authorisations were in place where people needed to be deprived of their liberty for the purpose of receiving care or treatment, and systems to effectively monitor and improve the service provided to people were in place.

Kenton House is registered to provide accommodation and personal care for eleven people. The home provides care and support for older people some of whom may have dementia. At the time of the inspection there were eleven people using the service.

There was a registered manager in post. The registered manager had managed the service from early 2017. A registered manager is a person who has registered with the Care Quality Commission [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.

The registered manager was aware of their role and responsibilities, and since being in post had worked hard to develop and improve the service. They had promoted a positive culture in the service, which staff understood and supported. People’s preferences and choices were supported and they were encouraged to be involved as much as they wanted to be in decisions to do with the running and development of the service.

There were systems in place to keep people safe. Staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse .People had risk assessments in place to enable them to be as independent as possible and minimise the risk of them being harmed.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service.

Fire safety checks and appropriate service tests had been carried out to make sure that the premises were safe.

Arrangements were in place to make sure people received the service they required from sufficient numbers of suitably trained staff.

People told us that staff were kind to them. We saw staff engaged with people in a friendly and considerate way.

People’s care plans included details about their individual needs and preferences. They contained important information about each person's background and interests which helped staff to get to know them. Where people had capacity to do so they had signed their own care plans. Where people lacked the capacity to make a specific decision, legal requirements had been met to ensure any decisions were made in the person’s best interests.

Staff had the skills and knowledge to meet people’s needs. When required, staff assisted people to receive the advices, treatment and care that they needed from healthcare and social care professionals. Staff had a good understanding of each person’s needs and abilities.

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This inspection of Kenton House took place on 4 and 6 January 2017. The first day of the inspection was unannounced; the provider knew we would be returning on the second day.

At our previous inspection on 14 October 2014 the service was rated good and met regulations.

Kenton House is a care home registered to provide personal care and accommodation for 11 older people who may also be living with dementia. There were eight people using the service including one person who was in hospital at the time of our inspection. The home is located in Kenton on the outskirts of Harrow and has access to public transport and there are a range of shops within walking distance of the service.

The care home had a registered manager at the time we inspected the service, however they had recently left the service and applied to deregister with us. This process was completed by us on 9th January 2017. 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. A registered manager from another of the provider’s services and the business manager were providing management support to the service at the time of our inspection.

People using the service and their relatives informed us they were happy with the service but raised some concerns about the home not having a permanent manager. A person using the service told us they missed having a manager and would like a manager to be in place as soon as possible.

Staff were appropriately recruited. Staff received some training to enable them to be skilled and competent to carry out their roles and responsibilities. However, records showed not all staff had completed or were up to date with the provider’s mandatory and refresher training. Staff told us they were well supported by senior staff but records did not show care staff had received regular one-to-one supervision to support them to carry out their roles and responsibilities.

Staff had some understanding of the Mental Capacity Act 2005 (MCA). They were aware of the importance of gaining consent for the support they offered people. People were encouraged and supported to make decisions for themselves whenever possible. Staff knew about the systems in place for making decisions in people’s best interest when they were unable to make one or more decisions about their care, treatment and/or other aspects of their lives.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person's best interests. The documentation of one person’s DoLS was not available and the provider did not show they had followed the requirements under the act to ensure an application to deprive another person of their liberty had been authorised by a local authority.

Although checks were carried out in some areas of the service there was a lack of effective systems in place to comprehensively regularly assess, monitor and improve the quality of the services provided for people. There was no indication that feedback from people was sought to assist in the evaluation and improvement of the service.

There were procedures for safeguarding people. Staff knew how to safeguard the people they supported and cared for. They knew how to recognise abuse and that it needed to be reported to management staff but some care workers needed prompting before telling us they could inform the local authority safeguarding team if senior staff took no action.

People were cared for by staff who treated them with respect and engaged with people in a pleasant and courteous ma

This unannounced inspection of Kenton House took place on the 14 October 2014.

Kenton House is a care home registered to provide personal care and accommodation for 11 older people who may also have a dementia. On the day of our visit there were11 people living in the home. The home is located in Kenton on the outskirts of Harrow and has access to public transport and there are a range of shops within walking distance of the service.

At the time of our inspection the registered manager was no longer working in the home as she had recently left the service. The deputy manager, who had worked in the home for some time and knew the home well, was carrying on the role of acting manager. We spoke to a business manager who informed us that recruitment of a new manager was planned to take place and they would take appropriate action to ensure that the registered manager applied to deregister with us. 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 this inspection people told us they were happy with the service. They said they felt safe living in the home and we saw there were systems and processes in place to protect people from the risk of harm.

We found staff were aware of their roles and responsibilities to keep people safe. People knew who to speak with if they had a concern or a complaint and were confident they would be listened to and appropriate action would be taken in response to any concerns they raised.

The atmosphere of the home was relaxed and welcoming. We saw people participated in a range of activities, which they said they enjoyed. People were encouraged and supported to maintain links with their family and friends and were asked for their feedback about the service.

Staff knew people well and provided people with the care and assistance they needed. People's individual needs and risks were assessed and identified as part of their plan of care which contained the information staff needed to provide people with the care they wanted and required.

We saw interact with people in a friendly and courteous manner. They smiled and laughed with people and spent time chatting with them. People told us the staff were kind and treated them with respect. A person told us, "The staff are very nice to me. I am looked after very well." We saw people were cared for by sufficient numbers of suitably qualified and experienced staff. Robust recruitment and selection procedures were in place to make sure only suitable staff were employed.

People were provided with a choice of food and drink which met their preferences and nutritional needs. People told us they enjoyed the meals. A person told us, "The food is very good. I can choose what I want."

Staff received relevant training and were supported to develop their skills so they were competent to meet people's needs. People's health was monitored and referrals made to health professionals when required. Medicines were managed and administered safely.

Staff had an understanding of the systems in place to protect people who were unable to make some decisions about their care and other aspects of their lives. Staff knew about the legal requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS)

There were effective systems in place to monitor the care and welfare of people and improve the quality of the service.

During the inspection we spoke with all the people who used the service, two relatives of people who used the service, two care staff, the deputy manager, the registered manager, and a district nurse. People who used the service told us that they were happy living in the home and the staff were kind and treated them well. We saw people who used the service approach staff without hesitation and they accessed their bedrooms, communal areas including the garden freely.

People were supported to make choices. These included decisions about what they wanted to do and when they wanted to get up and go to bed. Staff interacted with people who used the service in a respectful and very sensitive manner. Comments from people who used the service included “I can choose what to do,” “I couldn’t be better looked after,” “I have help when I need it,” “the staff are always very busy,” and “I am happy living here.”

Each person who used the service had a plan of care that included up to date information about the individual support and care they needed. People’s health, safety and welfare were protected as they received the advice and treatment that they needed from a range of health and social care professionals. Staff had the skills to meet people’s needs and they received appropriate support and advice from the manager.

People told us they received the care they needed and wanted and spoke positively about the staff that supported them. People approached staff without hesitation and staff supported people in a friendly, sensitive and professional manner. Staff knew about their roles and responsibilities in meeting the varied needs of people who use the service.

People had been involved in the assessment of their needs and their recorded plan of care. We saw care provided to people had been monitored and the health care needs of people had been met. People’s likes, dislikes, preferences and goals were considered in relation to the care and support that they received.

People spoke about the activities they participated in and enjoyed. We saw people took part in a range of leisure activities.

People told us they made decisions about their lives. We saw people make a number of choices. These included deciding what they wanted to eat and what they wanted to do. These choices were respected by staff.

People told us they felt safe and knew who to talk to if they had any worries or concerns. Policies and staff safeguarding training protected people from abuse.

There were systems in place to monitor and make improvements to the service provided to people.