The inspection took place on 7 and 10 December 2018 and the first day was unannounced. At the last inspection in April 2016 the home was rated as good in key questions 'Safe', 'Effective', 'Caring' and 'Well Led'. The home was rated requires improvement in 'Responsive'. At this inspection, we found that the key questions 'Responsive' had improved to good but the key questions of ‘Safe’ and ‘Well Led’ were now rated as Requires Improvement.

Kingsmount Residential Home is a 'care home'. People in care homes receive accommodation and nursing or 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. Kingsmount Residential Home is registered to provide care, nursing and accommodation to a maximum of 32 older people, some of whom may be living with dementia or memory loss. At the time of the inspection, there were 31 people living at the home.

At the time of the inspection there was no registered manager in post. The provider had employed a new manager who had started at the home two days prior to the inspection. The new manager was an experienced care home manager and they told us they would be submitting an application with the Care Quality Commission to become the registered manager of the home. The new manger was supported during this inspection by the deputy manager and the nominated individual. The report refers to them as ‘the management team’.

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.

Risks to people were assessed and risk assessments tools were used to identify common risks such as those relating to falls, skin integrity and medication. However, daily monitoring records did not always show that care was being delivered as it should. Equipment used to minimise risk was not always set correctly in order to reduce the risk of skin damage.

Where people were at risk of dehydration, fluid monitoring charts did not indicate if action had been taken or guidance sought when a person had consistently not reached their target intake amount.

Improvements were required to ensure that medicines were managed safely. Whilst medicines were stored and administered safely, random sampling of five medicines found discrepancies with the stock levels of three medicines. Other aspects of medicines were managed safely

Systems and processes in place to monitor the quality and safety of the home failed to identify and address the issues we found during this inspection.

People told us staff supported them with kindness and respect. Comments included, “They are very caring here”, “Staff are on hand and we can call them anytime, they have been as good as gold” and “They’ve always been kind to me, it feels safe here.” Staff respected people's privacy and dignity and interacted with people in a caring, compassionate and professional manner. People were encouraged to be as independent as possible but where additional support was needed this was provided.

People told us they felt safe when they received care and support from staff at the home. One person told us, “It’s very clean here, and safe.” A relative said, “I sleep at night because they look after mum so well.” People were protected from the risk of abuse because staff understood how to identify possible abuse and were clear in how they would report this. Staff told us they had received safeguarding training.

People were supported by staff that had been recruited safely and had sufficient knowledge and skills to enable them to care for people. There was a comprehensive staff training programme in place and staff told us they felt supported and received regular supervision. However, duri

This unannounced inspection took place on 19th and 20th April 2016.

Kingsmount Residential Home is a care home for older people some of whom may be physically frail or living with dementia. At the time of our inspection there were 22 people living at Kingsmount. The home has two lounges, one of which is a smaller “quiet” lounge with direct access to a small garden area containing garden furniture at the rear of the property. The dining room leads off from the main lounge. All bedrooms are pleasantly decorated, some with fantastic sea views and all are fitted with a call system and have access to bathroom and toileting facilities.

The home had a registered manager. 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.

The registered manager had been in post for seven years and was highly regarded by the staff, residents and their visitors. The management team had a positive and proactive approach to managing the home and maintaining high standards of care.

People who live at the home told us they felt safe, and we found that the provider had a number of systems and processes in place to promote safety. Staff received training in and understood their responsibilities in safeguarding of vulnerable adults. We found risks to individuals were well assessed and staff applied measures to minimise risk to people. However, risk assessments did not clearly document what measures the home had put in place to minimise risk to individuals. This was discussed with the registered manager and immediate action was taken to address this.

Care plans contained assessments of people's capacity to make decisions in line with the Mental Capacity Act 2005. Where people lacked capacity to make a decision we saw documentation of best interests decisions and who had been involved in making those decisions.

People received personalised care and staff treated them as individuals and with respect. Staff knew peoples' likes and dislikes. We saw staff offering people choices and people who lived in the home, where able, told us how they made choices in relation to their care and support such as when they wanted to get up, what they wanted to eat and where they wanted to spend their day.

There were systems in place for monitoring the quality of the service and the care and support that people received. If there were areas for improvement that were highlighted through the audit process there were action plans to rectify the issues.

Recruitment processes were robust and thorough checks were always completed to make sure staff were safe and suitable to work in the care sector before they started work at the home. Staff had received sufficient training to support them to carry out their roles. They received regular supervision and appraisal. They told us they felt supported by the management team and were comfortable making suggestions.

People were supported to take their medicines. Medicines were secured safely and accurate records were maintained. Safe systems were in place to manage medicines so people received their medicines at the right times.

People were given a choice of nutritious and seasonal home cooked meals. There were plenty of hot and cold drinks and snacks available between meals. However, we had mixed reviews from people about the quality of the food provided. Some people told us they liked the meals and they had plenty to eat. Some people remarked that the food was inconsistent and not very hot. We saw good support given to people who needed assistance to eat. We saw that staff were patient with the people they were supporting and did not rush them.

People had their healthcare needs identified and were able to see healthcare professionals such as their GP or den

On the day of our inspection there were 25 people living at the home and receiving care from the service. We spoke with five people who lived at the home, the manager, five support workers and four ancillary workers. We also spoke to people visiting the home. One person told us "We are impressed by the culture at Kingsmount".

We found that people's consent had been obtained for care and treatment provided to them by the service. People were being given choice about their daily activities and treated with kindness and respect.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. There was a variety of healthy and nutritious food and drink available. Where people had special dietary requirements or needed support we saw staff met those needs and skilfully assisted people to enjoy their meals.

We observed that care workers had time to complete tasks. They were busy, well organised and were meeting people's needs. We saw care workers were courteous and were vigilant to people’s wishes. One person told us "delighted with things here”.

We looked at the quality assurance systems in place to monitor the quality of care

delivered. We saw that the provider monitored the service and sought feedback.

Kingsmount provided care for up to 32 older people, most of whom had some degree of dementia.

People we spoke with told us the home met their needs well. A relative told us "The atmosphere is always homely. It doesn't matter what time I come up". Another person told us "They look after you so well. Nothing is too much trouble".

We observed an activity session which showed us that people had very much enjoyed the activity. This was down to the approach and skills of the staff involved. A visitor confirmed that activities were provided every day.

We saw staff knocking on people's doors before going into their rooms and consulting with them about day-to-day issues.

We saw that people with impaired communication were given time to make decisions when staff were communicating with them. We saw this with medication being given out and at mealtimes. We saw staff communicated with individuals at their eye level.

Some of the care plans we saw contained information about people's social and personal history. This helped staff understand people's behaviour in the context of the life they had lived.

We found people's care files contained good information about their physical needs. However, there was little information of how any memory loss impacted on their lives, and we did not see clear information on how people's capacity to make decisions had been assessed.

Some of the records, staff training and support systems needed attention or updating.