The inspection was unannounced. Kingswood Lodge Care Centre is registered to provide residential and nursing care for up to 44 older people. However there were only 40 available beds because shared bedrooms were no longer used. At the time of our inspection there were 32 people in residence. There were 11 beds for people who required residential care and 29 for those who needed nursing care. All bedrooms were now for single occupancy and the majority of rooms had en-suite facilities. One side of the home is a converted older house and the other part is purpose built.

The registered manager for the service was on leave and not present for this inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The deputy manager and regional manager supported the inspection process.

People were safe. This was because the staff team had all received safeguarding adults training and were knowledgeable and protected people from being harmed. The staff knew how to raise and report concerns if they witnessed, suspected or were told about any bad practice or abuse. Any risks to people’s health and welfare were assessed and appropriate management plans put in place to reduce or eliminate the risk. Where people needed to be assisted to move, their moving and handling needs were assessed and a moving and handling plan was written. Medicines were well managed and administered to people safely.

Checks to ensure the premises and facilities and all the equipment were completed regularly to safeguard people from being harmed.

The provider used a formulae to calculate the staffing numbers required for each shift to ensure each person’s care and support needs could be met. Staff were provided with regular training and were supported by their colleagues and their managers to do their jobs.

The staff team were aware of the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were asked to give consent to care, support and treatment. Where people lacked the capacity to do this, staff worked within best interest decision making procedures.

People were provided with sufficient food and drink. Food and fluid intake was monitored where risks of weight loss or dehydration had been identified. Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to do so.

The staff had developed kind and caring working relationships with people who lived in the home. Staff spoke well about the people they were looking after. Relatives talked about caring and friendly staff. People’s privacy and dignity was maintained. Where possible people were involved in making decisions about their care and support. Families were included where this had been agreed upon.

People received personalised care which met their specific needs. They were encouraged to express their views and opinions, the staff listened to them and acted upon any concerns to improve the service. The improvements we had asked the service to make in respect of do not resuscitate decisions had been made and these were now recorded correctly.

A new registered manager and deputy were now in post. They provided good leadership and management for the staff team. The quality of service provision and care was monitored and, there was an on-going improvement plan in place to raise the quality of the environment and improve experiences for people.

On the 28th May 2013 we carried out an inspection of Kingswood Care Home and found that improvements were needed in the way the quality and safety of the service was assessed and monitored and how some specific records were maintained. Following the review, Four Seasons (Bamford) Limited (the provider) told us about the changes they intended to make. The purpose of this review was to check that these improvements had been made.

We found that the required improvements had been made. There was now a robust programme of audits and checks in place. This ensured that people received a quality service and that their care and support needs were met. Improvements had been made with people’s care records. This removed the risks of them receiving unsafe or inappropriate care, because accurate records were maintained.

We spoke with seven people who lived in the home and two relatives/visitors. We spoke with nine staff members including the manager, two nurses, care staff and ancillary staff.

Some people had dementia and were unable to tell us about the way they were looked after but comments included “they are very good to me”, “I like things done my way and they help me” and “we get a choice of what we would like to eat”. Relatives were complimentary about the way their loved ones were looked after.

We found staff were knowledgeable about the people they looked after and were able to relate the individual needs, choices and preferences of people.

We spent time watching whilst the midday meal was served. This helped us see how people were treated, the type of support they received and what types of interaction they had with the staff and other people. We found that people had positive experiences and there was good interaction between people and staff. We saw people being supported with their meals, being encouraged to continue eating their meals or eating their meals independently.

We looked around the home and found it to be clean and tidy. People lived in a clean environment. An ongoing programme of refurbishment and redecoration was in place and the home was smarter then when we had previously visited.

We have asked the provider to make improvements in the way they assess and monitor the quality of the service provided, and the standard of record keeping.

This was a follow up inspection to check that the provider had made the appropriate improvements after we had issued enforcement actions in January 2013.

We did not involve people who lived in the home or the staff team during this inspection but spent time primarily with the home manager and some time with the regional manager.

We found that sufficient improvements had been made in respect of how the staff team were supported to fulfil their job roles. We found that measures had been taken to ensure that the staff team had completed their mandatory training and a programme of supervision had been instigated.

We found that the arrangements that the provider had now ensured were in place to assess and monitor the quality of service provision, enabled people who lived in the home and/or their representatives, to feedback their views and opinions. We found that senior managers also monitored the staff teams compliance with mandatory training requirements.

This was a follow up inspection to check on the progress that the provider had said they would make after our inspection in July 2012. They had told us they would make the required improvements to the quality of service by the end of September 2012 and had submitted their action plan in respect of how they were going to achieve this.

We did not involve people who lived in the home or the staff team during this inspection but spent time with the home manager and the regional manager.

We found that improvements had been made in the way that the staff involved people and their relatives in making decisions about how their care to be delivered. The quality of care planning documentation and other care records had improved, and where appropriate the person had signed their agreement to their care plans.

However improvements had not been made in respect of how the staff team were supported to fulfil their job roles. We found that the staff team continued not to be properly trained, supervised or appraised. This meant that people could not be assured of their competence to meet their safety, health and welfare needs. The arrangements that the provider had in place to assess and monitor the quality of service provision were not robust enough. The improvement action plan that they had submitted to us in August 2012 had not been followed through.

This was a planned inspection which we brought forward due to concerns reported to us by a member of the public whose relative had lived in the home until recently.

Most of those people who lived in the home that we spoke with were unable to tell us whether they understood the care and support choices available to them. They were also unable to tell us whether they were involved in making decisions about their care needs and how they would like to be cared for. They did make the following comments. “I am very well looked after here and the staff are good to me”, “the staff let me do as little as possible and that is fine by me. They do everything else for me” and “I am helped with washing and dressing and my meals but most of the time I am bored. We just sit around all day staring at each other until we fall asleep”.

We spoke with two sets of relatives who were visiting the home at the time of our inspection. They told us “my parent is well looked after”, “we visit a couple of times a week and we are always find our relative comfortable, clean and tidy” and “the staff have a very hard job and always do their very best”.

We found that improvements were needed to ensure that people were involved in making decisions about their care and how their needs were met. Assessment and care planning arrangements were inadequate and had the potential to mean that people would not be looked after the way they wanted to be.

We found that the way in which the staff team were supported was inadequate. Staff training and individual staff meetings had lapsed and the provider needed to take action to implement a consistent programme for all staff. Not all concerns or complaints were handled correctly.

Some people were able to look after some of their own medicines and told us that they were happy with this arrangement.

People told us that they were given their medicines at the right times. One person told us that sometimes they were given their medicines “a bit late” if staff were held up.

The inspection was unannounced. Kingswood Care Home provides residential and nursing care for up to 45 older people. At the time of our inspection there were a total of 34 people in residence, 24 who needed nursing care and 10 people who needed residential care (personal care). All bedrooms were for single occupancy and the majority of rooms had en-suite facilities. One side of the home is a converted older house and the other part is purpose built.

The registered manager for the service had recently left and a new home manager had been appointed. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The new home manager had already started the process of applying to be the registered manager.

People were kept safe because the home manager and the staff team were all knowledgeable about safeguarding issues and protected people from harm. They knew how to raise and report concerns if they witnessed, suspected or were told about any bad practice or abuse. All staff had received training in safeguarding adults. Medicines were administered to people safely and appropriate action had been taken to rectify the poor work practice we witnessed during our last visit.

Risks were assessed and appropriate management plans were in place. All the appropriate checks to maintain the premises and facilities had been completed regularly. Where people needed to be assisted to move, their moving and handling needs were assessed and a moving and handling plan was written.

Staffing numbers on each shift were calculated to ensure each person’s care and support needs could be met. Staff were provided with regular training and were supported by their colleagues and their managers to do their jobs.

People were on the whole satisfied with the quality of the food and drink provided. Food and fluid intake was monitored where risks of weight loss or dehydration had been identified. Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to do so.

The relationships between staff and people who lived in the service were good and staff spoke well about the people they were looking after. Relatives talked about caring and friendly staff. People’s privacy and dignity was maintained. Where possible people were involved in making decisions about their care and support. Families were included where this had been agreed upon.

People received care and support which met their specific needs. They were encouraged to express their views and opinions, the staff listened to them and acted upon any concerns to improve the service. Improvements were required to ensure that plans for end of life care and do not resuscitate decisions, were recorded correctly. This would remove the potential of people receiving the wrong care and treatment.

The management of the service had improved with the appointment of a new home manager who was keen to use feedback from the staff and people who lived there to make positive changes. The staff team talked about better leadership and feeling more positive about their jobs. The quality of service provision and care was monitored and there was an on-going improvement plan in place to raise the quality of the environment and improve experiences for people.