We conducted an inspection of The Kensington Care Home on 10, 13, 14 and 15 August 2018. The first day of the inspection was unannounced. We told the provider we would be returning for the other days.

At our last inspection on 11 and 17 July 2017, we identified some concerns in relation to moving and handling techniques used, the maintenance of a calm environment and the provision of mealtime assistance.

The Kensington Care Home 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 Kensington Care Home provides nursing care, respite and accommodation for up to 53 older people. The home is located in a Victorian terraced property, converted and arranged over three floors which each have lift access. At the time of our inspection there were 39 people using the service.

There was a registered manager at the service. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There were enough suitably trained and safely appointed care staff working at the home. Care staff were given enough training and ongoing support.

Risks to be people’s safety were managed appropriately, with clear guidance in place for care staff.

People told us they felt safe living at the home. The provider had an effective safeguarding policy and procedure in place and care staff were appropriately trained and aware of their responsibilities.

Good infection control practices were operated throughout the building. The home appeared clean, tidy and odour free throughout our inspection.

People were supported to maintain a healthy diet. Care records contained a good level of detail about people’s health and nutritional needs. Kitchen staff were also aware of people’s nutritional requirements and offered people choices with their meals.

People were supported with their healthcare needs. People’s care records contained a good level of detail about their current needs and care staff assisted them to access external healthcare professionals when needed.

People using the service and their relatives were involved in decisions about their care and how their needs were met.

The organisation had good systems in place to monitor the quality of the service. Feedback was obtained from people through quarterly residents and relatives meetings and we saw feedback was actioned as appropriate. There was evidence of further auditing in many areas of care and action was taken to rectify any issues identified as a result.

There were good systems in place for the safe management and administration of medicines. Staff had completed medicines administration training within the last year and were clear about their responsibilities.

Staff a good understanding of their responsibilities under the Mental Capacity Act 2005. Mental capacity assessments were completed when needed and we saw these in people’s care files. Authorisation had been sought and obtained from the local authority where staff felt it was in a person’s best interests to deprive them of their liberty.

People told us care staff were caring and our observations supported this. Care staff demonstrated they knew people’s likes and dislikes in relation to their care and demonstrated an understanding of people’s personal circumstances. Care staff respected people’s privacy and dignity and people’s cultural and religious needs were met. Care staff were trained to provide appropriate end of life care.

People knew how to make complaints and there was a complaints policy and procedure in place.

The service employed three activities coordinators

We carried out a comprehensive inspection of this service on 11 and 17 July 2017. The first day of our inspection was unannounced. We informed the home manager we would be returning to complete our visit on 17 July 2017.

Our last inspection took place in February 2016 where we reported improvements had been made and the service was meeting the legal requirements we checked. We indicated that we would require a longer term track record of consistent good practice before we were able to revise ratings for the service.

The Kensington Care Home provides nursing care, respite and accommodation for up to 53 older people. The home is located in a Victorian terraced property, converted and arranged over three floors. All floors have lift access. The provider’s website states that it is able to provide specialist dementia staff and ‘respectful pro-active care for residents and relatives in their last days of life.’

There were 29 people living in the home at the time of our visit. Occupancy levels were lower than usual due to a planned and extensive home refurbishment programme which began in July 2016.

The home manager informed us that building works (which include room redesign, redecoration throughout, new carpeting, furniture, fixtures and fittings) are likely to continue until September 2017. As a result, people living in the home, visitors and staff are subject to a certain degree of ongoing disruption and disturbance. The home manager told us the home remains open to new admissions during this period.

At the time of our visit, staff working on the two upper floors of the home were providing care and support to elderly frail adults some of whom are living with dementia and other long-term health conditions. People receiving respite care are accommodated on the ground floor. People have their own rooms with en-suite shower facilities and are able to access shared bathroom facilities should they prefer a bath. The home has a spacious open plan reception area, communal seating and dining areas and a large garden.

The home manager in post had begun the application process with the CQC to become the 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 home manager was supported in her role by a clinical services manager, a resident experience manager and three unit managers.

People's needs were assessed before they moved into the service and further assessments were conducted once people had moved into the home and were feeling settled. This information was used to develop individual care and support plans that evidenced consultation with people and their relatives.

Risk assessments were carried out and management plans were in place where risks to people and/or others were identified. Risk assessments were reviewed and updated in line with the provider’s policies and procedures.

People were encouraged to mobilise independently or with assistance where this was required. However, staff were not always using recommended techniques when providing people with moving, sitting and standing support.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

The provider had policies and procedures in place that ensured staff had guidance if they needed to apply for a Deprivation of Liberty Safeguards (DoLS) authorisation to restrict a person’s liberty i

We carried out an unannounced comprehensive inspection of this service on 7 and 10 August 2015 at which we found several breaches of the legal requirements. People using the service were not always protected against the unsafe storage, management and administration of medicines. We found the provider was failing to continually assess the risks to people’s health and safety, monitor restrictive practices, consider people’s individual choices and preferences and listen to and act on feedback from people living at the home and staff. In addition, the provider had failed to notify us of staff absence according to its registration requirements and was failing to operate adequate systems to monitor the quality of service provision and effect improvements where necessary.

Following the inspection in August 2015, the provider wrote to us to say what they would do to meet legal requirements in relation to these breaches. We undertook a focused inspection on the 22 February 2016 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to the above areas. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘The Kensington Nursing Home’ on our website at www.cqc.org.uk’

The Kensington Nursing Home is arranged over three floors with lift access to each floor. The home provides accommodation and support for up to 53 people. There were 40 people living in

the home at the time of our visit. People living at the home are generally older people, some of whom have dementia. Respite shorter stay care is also provided by the home.

The home did not have 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.

A project manager was responsible for the day to day running of the service and was supported in his duties by a deputy manager.

At our focused inspection on the 22 February 2016, we found that the provider had followed their plan which they had told us would be completed by 1 March 2016 and legal requirements had been met.

Medicines were managed, administered and stored safely. The provider had changed its policy in relation to self-administration of medicines to ensure risks to people’s health were minimised.

Risk assessments covered areas such as mobility and falls prevention, the use of bed rails, food and nutrition and pressure area care, behaviours that may challenge and epilepsy. Risk assessments had been reviewed on a monthly basis in line with the provider’s policies and procedures.

Appropriate referrals were made to nurse specialists from the community such as tissue viability nurses and speech and language therapists. Staff had completed training in pressure area care.

Fire alarms were tested on a weekly basis and we saw that fire equipment had been serviced appropriately. Fire risk assessments and personal evacuation plans had been completed for people living in the home.

Meal times were well organised and individual dietary and cultural needs had been addressed and the chef was aware of people’s preferences and requirements.

The service had policies and procedures in place that ensured staff had guidance if they needed to apply for a DoLS authorisation to restrict a person’s liberty in their best interests. Care plans recorded relevant capacity assessments and these had been signed and dated appropriately. Inappropriate restrictive practices were not in use.

The service had a complaint’s policy which explained how to make a complaint and to whom. We saw that the provider had received and logged two written complaints relating to care provision.

People using the service and their fam

People who used the service understood the care and treatment choices available to them. We spoke to three people who used the service and two relatives of people who used the service. They told us that they were involved in making decisions about their care and understood the choices available to them.

We found that people’s care was planned on an individualised basis. Staff told us that people’s needs and treatments were discussed at daily planning meetings. One member of staff said “before I start my shift I meet with the nurse that is on duty and they will let me know the plans for each person on my floor”. One of the relatives that we spoke with told us that the service had planned their relatives care in line with their individual needs “they do what we ask them to do.”

People who used the service told us they had no worries about the way they were treated and that they felt safe at the service. There were arrangement sin place to ensure the safety and well-being of people. We saw safeguarding concerns had been dealt with appropriately by the service.

Staff received appropriate professional development. All staff received mandatory training that was relevant to their role. We saw a training matrix that showed there was a clear programme of training and refresher training for all staff.

There was evidence that learning from incidents / investigations took place and appropriate changes were implemented. We saw a range of monitoring systems in the form of audits. This included audits of peoples' care records, medication administration and storage and complaint and incident records.

People who use the service said that they were happy at the home and one person said they were "well cared for”. Another person said “I choose to live here so that I can have that 24/7 care”. Relatives we spoke with were positive about the care their family members were receiving. People and their relatives were involved in planning the care and treatment that people received. One relative of a person using the service praised the “continuous care and love” provided by staff.

Consent was sought prior to any care or treatment being given. The home was clean and well maintained and people were protected from the risk of infection. There were sufficient staff to meet the needs of people who lived at The Kensington Nursing Home. People told us that call bells were answered promptly.

In general people were satisfied with the meals at the home. There were arrangements in place to ensure that people received adequate nutrition and hydration. There was a system to review complaints, investigate them and respond to the complainant. People we spoke with told us that they would raise their concerns with the staff or registered manager.

People who use the service that we spoke with said that they were happy at the home. Relatives we spoke with were positive about the care their family members were receiving. They had received information about the services offered and felt involved with the well-being of their family members.

We saw evidence that people using the service are invited to give their feedback and comments and suggestions about the home. We saw the results from the 2010 survey which demonstrate a high level of satisfaction with the service.

This inspection took place on 7 and 10 August 2015 and was unannounced. The Kensington Nursing Home is registered to provide nursing care to 53 people. The home is arranged on three floors with lift access to each floor. People living at the home are generally older people, some of whom have dementia. Respite shorter stay care is also provided. There were 47 people living in the home at the time of our visit.

The service had a registered manager. 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 not available at the time of our visit.

The service received referrals from Clinical Commissioning Groups and Local Authorities. People were also able to self-refer. Initial assessments were carried out by senior staff members to ensure that the service was able to meet people’s specific care needs. People and their family members were invited to visit the home and meet staff before making a decision about moving into the home.

Care plans were developed in consultation with people and their representatives. People’s risk assessments were completed and these covered a range of issues including guidance around personal care, moving and positioning, food and nutrition. Risk assessments were not always updated in line with the provider’s policies and procedures.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (2005) (MCA) and DoLS, and to report upon our findings. DoLS are in place to protect people where they do not have the capacity to make decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others. Senior staff understood when a DoLS application should be made and how to submit one.

Nursing and care staff had received training in mental health legislation which had covered aspects of the MCA and DoLS. However, staff were not always able to demonstrate a clear understanding of how these issues related to the care and support provided to people living in the home. We noticed some incidences where people’s movements were restricted and could not be assured that staff understood people’s rights and that these decisions had been appropriately assessed as being in people’s best interests.

Staff were able to demonstrate an understanding of safeguarding in relation to pressure wounds and told us they would report these concerns to senior staff. However, staff demonstrated less awareness of other forms of potential abuse and who, other than the manager, these matters should be reported to.

People were visited by a range of healthcare specialists and supported to attend health appointments as needed. There were protocols in place to respond to any medical emergencies or significant changes in a person’s well-being.

The home had an activities co-ordinator and a schedule was posted in the reception area providing information about the range of activities on offer. These included exercise and music sessions, pet therapy, birthday parties, food tasting and themed events.

People’s opinions as to the quality and choice of food on offer, was mostly positive although the provider was not always ensuring that people’s individual cultural food preferences were available to them.

Daily menus were posted in the reception area. People were able to eat in designated dining areas, in their rooms and/or in the garden (weather permitting).

There were arrangements in place to assess and monitor the quality and effectiveness of the service. This included annual surveys and medicines administration auditing. It was not always clear whether learning took place and improvements implemented as a result of audit findings.

We found breaches of the regulations relating to person-centred care, safe care and treatment, safeguarding, complaints handling, notifications and good governance. You can see what action we told the provider to take at the back of the full version of this report.