Kenwyn

Kenwyn is a residential care home providing personal and care and support to 19 people aged 65 and over at the time of the inspection. The service can support up to 25 people.

Kenwyn is an adapted building with bedrooms and communal areas over two floors. There is a passenger lift to access the first floor.

People’s experience of using this service and what we found

People living in the home and their relatives told us they were happy and well looked after. People were safe. Since the last inspection the provider had made improvements to many aspects of the care and the accommodation. A relative told us they were, "Very happy, especially with how they've been about COVID. I've really felt like I didn't have to worry about mum. They took all the precautions they needed to". The home was clean, well maintained, and comfortable. The home was following government guidance to reduce the risk related to COVID-19

Safe systems were followed to ensure people’s medicines were stored, administered and recorded correctly.

Sufficient staff were employed to provide the care and services people needed. New staff were carefully checked before employment to ensure they were suitable for the job.

People received effective care. The staff demonstrated a sense of pride in the home and their jobs. There was a strong sense of teamwork and a happy atmosphere. A member of staff told us, “I’m loving my job”. Care plans provided good information on each person’s health and personal care needs. People received care that was responsive to their changing needs. Care plans were reviewed and updated regularly Records showed staff had provided the care and support people required. There was a strong emphasis on supporting people’s well-being and happiness. Staff knew people well, understood the things that people were interested in, and supported people to participate in a range of group and one-to-one activities. People received personalised and sensitive care at the end of their lives.

The level of training for staff had improved since the last inspection. The provider supported staff to gain relevant qualifications.

Staff worked closely with local health professionals to ensure people received treatment and advice promptly when needed. Risks associated with people’s health were monitored closely, for example weight loss, skin damage and falls.

People had been consulted to ensure menus reflected their choices and nutritional needs. A range of healthy and appetising snacks were also offered.

The service was well-led. The provider had systems in place to monitor all aspects of the care and services and ensure the home was running well. The provider employed a team including training manager, quality assurance and a director of operations who supported and monitored the home through visits, telephone and video calls. The provider had sought the views of people living there, relatives and staff to ensure the quality of the service was constantly reviewed and improved.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection and update: The last rating for this service was Requires Improvement (published 21 November 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. We carried out an unannounced comprehensive inspection of this service on 9, 11 and 13 September 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the safe care and treatment, staffing and governance of the home.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kenwyn on our website at www.cqc.org.uk

Kenwyn is a residential care home providing personal and care and support to 17 people aged 65 and over at the time of the inspection. The service can support up to 25 people.

Kenwyn is an adapted building with bedrooms and coummunal areas over two floors. There is a passenger lift to access the first floor.

People’s experience of using this service and what we found

People said they felt safe, comfortable and well cared for. Comments included, “The staff are all very nice and kind. They ask all the time if they can do anything for me, which helps me feel safe.” And “There are always people around to offer help or to call for assistance, which is much safer than being alone at home.” Similarly visitors and relatives were positive overall about the service. One said, “We’re amazed how (the Service User’s) health and mental strength have improved since they came here, which shows how caring and kind the staff are.”

Since the last inspection some improvements were noted, however, were still some aspects of care which required improvement.

People did not always receive their medicines in the way prescribed for them. There were improvements needed to the way medicines were administered and recorded.

On the first day of the inspection, some parts of the home had an unpleasant odour and some areas required a more thorough cleaning. By the second visit, this had improved. The provider said they were short on housekeeping staff, but were in the process of employing more and increasing the housekeeping hours.

Some key training to ensure people and staffs safety had not been completed. This included fire training for staff on night duty. When we fed this back the manager and provider’s quality lead person, theyorganised for night staff to receive fire training that evening before the start of their shift. Not all staff had received training that was appropriate to their role, for example the team leaders had not completed infection control training. The maintenance person had not completed health and safety training or accredited fire safety despite them being responsible for maintaining the fire system and instructing staff in fire drills. We were informed this was being addressed with the introduction of a new member of the quality assurance team who would be overseeing and delivering some of this training.

The mealtime experience for people was poor on the first day of the inspection, but had significantly improved by the next visit. Staffing levels had improved but some staff felt they were still rushed to meet everyone’s needs in a timely way.

There had been significant improvements in the way people’s care and support was being planned and recorded. Care plans contained more detail and were more personalised. This meant staff could provide a more consistent and person-centred approach. People and their relatives said staff were kind, caring and respected their dignity and privacy.

Improvements had been made to ensure there were meaningful activities and entertainment for people. This was work in progress. The provider had employed a wellbeing coordinator who was due to join the team. Their key responsibility was to coordinate activities and ensure good links with the community.

People were offered a varied diet. Snacks and drinks were made available throughout the day. Almost everyone we spoke with said the food served was of a high quality and there was a good choice. Where people were at risk of poor nutrition or hydration, staff closely monitored this and referred onto their GP as needed.

The provider had introduced a tracker tool which included what people had eaten and drunk each day, and what care and support they had received. This was being closely scrutinised to ensure people’s needs were being met. The provider’s quality assurance team had daily oversight of this and other key areas.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There were systems in place to protect people from abuse and avoidable harm. There were enough staff to support people safely and the provider had robust recruitment processes to help ensure they were suitable for the role.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection (and update) –

The last rating for this service was Requires Improvement (published 9 MAY 2019)

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection not enough improvement had been made and sustained and the provider was still in breach of regulations. We have have therefore repeated the breaches of regulation 17 and 18. We have noted actions were being taken to address the these areas of breach in regulation but this was still work in progress and had not been sustained to show they were fully embedded.

The service remains rated Rrequires Improvement. This service has been rated requires improvement for the last three consecutive inspections. We are meeting with the provider on a regular basis to discuss their improvement plans and progress to become compliant.

Why we inspected

We had brought forward this planned comprehensive inspection due to the service being in a whole home safeguarding process. This means the commissioners and other health and social care professionals had concerns about the quality and safety of care being delivered at Kenwyn. At this inspection improvements had been made in the areas identified in the safeguarding process, for example people’s care needs being met safely. However, we found medicine management placed people at potential risk. We have issued a requirement in respect of this.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

People’s experience of using this service:

People said they felt safe and well cared for by a staff team who understood their needs. Staff knew people’s needs, wishes and what was important to them. However, we were not confident they could always provide the right support safely. This was because there were significant gaps in staff training. The provider said this would be addressed as a matter of urgency. We have received confirmation some of this training has been booked.

Care and support were well planned and there were enough staff to meet people’s assessed needs. People were treated with kindness and respect.

People benefitted from the food, drinks and snacks being offered throughout the day. One relative raised the fact that snacks were available but may not be accessible to everyone.

People’s medicines were managed safely however some areas of medicines recording could be improved.

There were a range of activities which people enjoyed. This included regular visits from singers, arts and crafts and local ministers.

People were supported in the least restrictive way possible; the policies, systems and culture in the service supported this practice.

People said they were listened to and could make their concerns known, but these were not always recorded. Staff had raised some concerns which the providers quality assurance manager was in the process of addressing.

We have made a recommendation in respect of ensuring complaint investigations are fully recorded.

The provider own quality monitoring had identified gaps in training but this had not been robustly followed up.

Rating at last inspection: Requires Improvement – report published July 2018.

Why we inspected: This was a planned inspection to look at improvements the service had made following the previous rating. We did bring the inspection forward due to several concerns being raised to us about staffing and quality and quantity of food. We did not find anything to substantiate these concerns. We also brought the inspection forward due to some concerns raised and identified in the providers other services. We did however find improvements were needed in ensuring staff had the right training to keep people safe.

This is the third time the service has been rated requires improvement. We will be meeting with the provider to discuss their action plan to ensure this service improves to at least- Good.

Enforcement): Action we told provider to take. We have issued two requirements notice in relation to regulation 18- having sufficient and suitably qualified staff, and 17- good governance.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned based on the rating. If we receive any concerns, we may bring our inspection forward.

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

We have received some further information of concern which we have shared with commissioners and the local safeguarding board as well as the provider. These centred on

• Staff attitude and lack of knowledge of people’s needs

• Basic care needs not being met

• Possible poor moving and handling practices.

• New staff not having a full induction

• Lack of understanding around end of life.

We received information from Devon doctors outs of hour’s service who were asked to visit a person and was then later called to say they were no longer needed. The GP who took the call decided to visit the person at the service and found them to be in pain and needing to be admitted to hospital. The provider had taken disciplinary actions to ensure this incident did not occur again.

We attended a whole service safeguarding meeting on 23 May 2018 and heard that although visiting healthcare professionals had increased confidence in the manager and in people’s basic care needs being met, further improvements were still needed to ensure people’s social and emotional needs were met. .

This inspection was completed on the 1 June 2018 as a responsive comprehensive inspection. This means we looked at all five key areas to help make a judgement about the quality and safety of care and support being delivered.

This is the second inspection where the service has been rated Requires Improvement. At the focussed inspection completed in April 2018 we found all three areas we inspected as requires improvement. At this inspection we have found two areas requires improvement.

Where we had previously identified staffing needed to improve to meet people’s needs, this had been addressed. Following feedback at the inspection on the 19 April, the manager took urgent action to increase staffing by one additional care worker each day. This had had a positive impact for people. This was because staff had more time to ensure people’s needs were being met in a timely way. The medicines management had improved. The manager had ensured each person; including new people and those staying for short breaks had care plans. This enabled staff to plan their care and support safely and in a way the individual preferred. Some further work was being done to ensure that the provider’s quality assurance checks and audits looked at key aspects of how care was being delivered and the records relating to this.

Kenwyn 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. Kenwyn is registered to provide personal and nursing care for up to 25 people. They provide care and support for frail older people and those people living with dementia, but do not provide nursing care. On the day of the inspection there were 18 people living at the home.

The manager has been in post since the beginning of January 2018 and is in the process of registering with CQC. 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.

Since the last inspection the provider had purchased more appropriate dining room furniture. Tables were set with condiments and the whole lunchtime experience was improved with staff being available to help people when needed.

The interactions we observed between staff and people living at the home were kind, respectful and ensured people’s privacy and dignity was upheld. The manager said that following our previous feedback, he had arranged more training including some dementia awareness training to ensure staff understood people’s needs. They were also in the process of organising specialist training from the nurse educator on conditions associated with frailty and old age.

There was a program of activities being developed and we saw people being supported to do artwork and to have a sing-along during the afternoon. Further work is needed to ensure activities are planned in line with peoples need, wishes and past social interests.

People and their visiting family and friends reported some positive changes since our last inspection. This included a positive change in the atmosphere of the home. One person told us “The atmosphere is so much better in the last two weeks. It is so much more relaxed and so much better now they have more staff on each shift.”

At the last inspection we highlighted the lack of suitable and appropriate outside space for people. The provider had developed a two stage plan. The interim plan was to develop an area outside near the car park. They had received quotes and were about to commission this work. Their longer term plan was to develop an area at the back of the home. This would involve some excavation work and would be written into their business plan for future development. The provider had acknowledged that more suitable outside space was required which included suitable furniture and was putting this plan into action.

During this inspection we noted that there was a queue at key times to use the one available toilet in the downstairs area. There was a staff toilet which could be utilised and as part of our feedback we asked the provider to consider more accessible toilets in the main communal areas.

You can see what action we told the provider to take at the back of the full version of the report.

In January 2018, we completed a comprehensive inspection and rated the service as ‘good’. However, due to there not being sufficient staff available at key times, we judged the ‘safe’ question as requires improvement’. We did not issue a requirement because we were assured by the provider and manager that they were addressing staffing levels.

At this focussed inspection we looked at three key questions safe, responsive and well-led. No risks, concerns or significant improvement were identified in the remaining key questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection

Kenwyn 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 provides care and support without nursing for up to 25 people. Most people are living with dementia and illnesses associated with frailty and old age.

The manager for the service joined the company in January 2018. He is in the process of applying to register 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.

On this inspection, we again found there was insufficient staff at key times to meet people’s needs and keep people safe. There were three care staff which included the team leader for 20 people, some of whom had complex needs. We observed people during the morning sitting for long periods with little or no stimulation. One person remained in a transit wheelchair for all of the morning. This placed them at risk of developing pressure sores as transit wheelchairs are not designed for people to sit in for long periods. When we fed this back to the manager, they agreed this was not best practice and asked a member of staff to ensure the person was transferred to a more comfortable armchair after lunch.

We observed another person becoming increasingly agitated with people around them. They shouted out at people if they came close to them. The sun lounge was exceptionally hot as it was a hot day and the person refused to allow anyone to turn the fan on which was placed next to them. There were no staff available to monitor this situation. We asked the manager to monitor the temperature in this area as people looked hot. At some points this rooms was registering as over 30 degrees and was unpleasant to sit in. The manager went out to buy more fans, but when these were used they did not have much impact in reducing the high temperature.

The mealtime experience needed improvements. Tables were not set, few had condiments and one table still had breakfast crumbs and debris which was not cleared even when the lunchtime meal was brought out. Some people were sitting in armchairs at the dining table and they were positioned at a parallel to the table, meaning people were eating from a sideways angle. We asked the manager to reposition some people to ensure their comfort and save them from twisting during the mealtime.

We found two pressure relieving mattresses were set at the wrong setting for the weight of the person using them. This placed people at possible risk of pressure damage. A pressure relieving mattress needs to be at the right setting in line with the person’s weight in order for it to be effective in reducing the risk of pressure damage.

Two people who were staying at the service for respite care, did not have care plans. This meant we could not be assured staff knew how to meet their assessed needs in a consistent way or if the people had been included in their plan of care. One of these people had complex needs and their health needs had deteriorated since the funding authority assessment had been completed. Therefore the records available to staff to refer to were out of date. Staff used portable electronic devices to record what care and support they had delivered to each person. For those without plans, it was difficult to judge whether their care and support had been tailored to their individual needs. For example staff had ticked they had delivered personal care and they had been given drinks, but without a care plan, staff did not have clear instructions about what sort of support they needed to meet their individual needs.

As it was a very warm and sunny day, the manager encouraged people to spend some time outside. There was a small seating area next to the car park, which was not secure. The seating was too low for people with mobility needs and there was no shade. The area looked shabby and in need of some refurbishment. However, we saw the manager had ensured people had sun cream and a staff member was available to attend to their needs.

The programme of activities offered was not always planned in line with people’s interests and hobbies. Some people’s section of interests and hobbies were not completed and there was no correlation to people’s assessed and stated wishes with the activities on offer.

People said staff were kind and caring. Staff interactions were friendly and encouraging.

People and relatives said their views and concerns were listened to.

There were effective staff recruitment and selection processes in place. Staff understood about abuse and who to report any concerns to.

Quality assurance processes and audits helped to ensure that the quality of care and support as well as the environment were monitored, but staff using these systems had failed to pick up key areas for improvement. We have made some recommendations in respect of ensuring

• the accessibility standard is followed.

• Hand gel is placed out of reach of people living with dementia

• the recording of some aspects of medicines management are reviewed, including the process for handwriting additions to MAR charts, the application of external products, and returns records.

• improvements to the outside area to ensure it is suitable for the needs of people living at the service and is a pleasant place to sit.

We found three breaches of Regulations in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The action we have asked the provider to take can be found at the back of this report.

At this inspection completed on 18 January 2018 we found the service remained Good- and the area which was identified as requiring improvement- Responsive was now also rated as good. This was because the provider had taken steps to show how staff ensured the needs of those people who chose to remain in their rooms, were being met. We did however find that there were key times when staffing levels needed to increase due to the number of people, their location and care workers having to complete additional tasks such as cooking the Sunday lunch. We have therefore rated Safe as requires improvement. The provider was actively recruiting for a cook and the lift is now working so people are mainly in the downstairs lounge areas. This meant staff can more easily check their safety and comfort.

Why the service is rated Good.

We brought forward this comprehensive unannounced inspection in light of some information of concern we had received. The main areas of concern were about staffing levels, low staff morale, staff leaving and there being a strong odour at the home. There was also a concern raised about the lift being out of order. During this inspection we found the provider had already taken actions to address staff morale and staff recruitment. There was no odour at the home. At the time of the inspection the lift engineers were in attendance trying to replace a part to fix the lift. This was the lift engineer’s second visit because their previous repair had failed.

The home was required by the Care Quality Commission to have 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 away on leave at the time of the inspection. The provider said the registered manager had planned to resign from their role. The provider had a new manager who had started working at the service at the beginning of January 2018. It was their intention to become the registered manager of Kenwyn. The new manager had already had a positive impact on staff morale and team building.

People said they felt safe and well cared for. They praised the staff for their kindness, support and compassion. Some people did acknowledge there had been recent staff changes. Comments included “The carers ask you ask at each step and I'm always glad of their help. They are always gentle - no complaints at all.” And “We don't have anything wrong here. I think it's wonderful – I get lovely treatment. They are all great. Everything is here on the doorstep. The girl’s works so hard and I can't praise them enough. They put themselves out to make everything right…”

People had sufficient food and drink to keep them healthy and well nourished. On the day of the inspection people were unaware of what the menu options were. The provider said there was normally a menu board and staff went around to ask people for their choices. They agreed to remind staff this needs to happen so people can make choices each day. People said they enjoyed the meals. There were snacks and drinks available in each of the lounge areas in additional to the regular meals offered.

There were systems and audits in place to check the quality of care and ensure the environment was clean, safe and well maintained. We noted that two taps in the first floor bathrooms were running very hot and were a risk of scalding people. These had been checked two days previously and no fault was found. The provider immediately called in a contractor to re-set the mixer valves which prevented hot water from coming out at above 42 degrees. They had also asked them to review all water outlets whilst they were in attendance. We also noted that one downstairs communal toilet also had a door leading to a staff area where they stored their bags. We highlighted this may compromise people’s respect and dignity, if a staff member entered the door whilst someone was using the toilet. The provider immediately locked the door and said they were already in the process of purchasing lockers for staff to use in another area of the home.

There were sufficient staff on most days with the right skills to meet people’s needs. However as the lift had been out of action meaning people were more dispersed, staffing levels for this emergency had not been considered. Also at weekends the senior staff member had to help prepare the Sunday roast as there was currently no cook for Sunday. This meant only two staff were available to meet people’s needs during the lunchtime preparation period. During times when care staff needed to be in the kitchen preparing food, there were only two care staff for 16 people. We judged this to be insufficient to meet people’s needs in a timely and safe way. For this reason we have judged this outcome as being requires improvement. We have not given a requirement because we were assured by the provider this was being addressed

Medicines were well managed and people were kept safe. This was because staff understood what to do if they suspected abuse. Robust recruitment processes ensured only staff who were suitable to work with vulnerable people were employed.

Care and support was well planned. The introduction of electronic care plans and daily records had helped to ensure all staff had easy access to clear records of how to keep someone safe and what sorts of tasks they needed to do to keep them well and check on their emotional well-being. This included having bar codes within each bedroom that care staff needed to scan to show they had checked on people and to record what tasks they had completed. This gave a clear record of the number of occasions each person in their rooms were checked on and for how long. Daily care tasks included one to one time for staff to spend talking with people. This was particularly important for those who may be socially isolated in their rooms.

People’s rights were upheld and people were treated with kindness, respect and dignity.

We have made one recommendation in relation to infection control.

Further information is in the detailed findings below

Kenwyn is located in a quiet cul-de-sac near to the centre of the small market town of Crediton. It consists of a main house with an extension which provides additional bedrooms and sitting areas. The location is registered to provide care for up to 25 people. Everyone living at Kenwyn had their own bedroom, some of which were en-suite. At the time of the inspection 19 people were living at Kenwyn, some of whom had been resident for a number of years. Some of the people living at the home had dementia.

People said they liked the home for example one person commented “I have been at this home for several years and think it is really good.” The home was clean and odour free throughout the inspection. Some areas of the home, for example bedrooms, a wet room and corridors had been newly decorated and furnished. Some areas of the home had been changed to make them more dementia friendly. For example, bedroom doors were painted in different colours and corridors had been decorated to give a more homely feel. There were plans to undertake further improvements to the home to support better dementia care.

Family and friends were welcomed into the home and were supported to be involved in their relative’s care, where appropriate. During the inspection we met three relatives who visited the home, two of whom said they visited several days a week. One relative said “I can call in anytime.” Another commented the staff “are brilliant” and another said “staff are really communicative” which they found helpful.

People were supported to have enough to eat and drink. Specialist dietary needs were also catered for. People said the food was really good. One person commented “you can’t complain about the food, it’s what makes this home worth staying in!” We observed people enjoying the meals they were being served and being offered alternatives, where they did not want the meal on offer.

There were sufficient numbers of staff to provide support and care for the people at Kenwyn. The provider said they were planning to increase staffing levels from February 2016 to support better dementia care. People were kept safe by staff who understood how to protect vulnerable adults from the risks of abuse. People’s risks, needs and preferences had been recorded when they arrived at Kenwyn and care plans had been developed to support them. Care plans described people’s care and the support they needed. Staff knew people well and worked in a compassionate and caring way. However we found, on some occasions, staff did not undertake sufficient regular checks to meet people’s needs.

Staff administered and recorded medicines safely. Stocks of medicines were kept secure and staff followed safe procedures to return medicines to the pharmacy when they were no longer required. People’s physical and mental health needs were addressed by staff working with health and social care professionals including the GP, dentist, optician and local hospital. A health professional commented; “the home works in partnership with the [health professional] team.”

Staff were recruited safely and received an induction when they commenced working at Kenwyn. This included work shadowing experienced staff as well as undertaking training. Staff had received training to ensure they were able to deliver care effectively. This included training identified as essential, for example health and safety, fire safety and safeguarding vulnerable adults. Staff also completed other courses to support them in developing specific skills, for example end of life care. Some staff were undertaking a year-long course on dementia care, which they were planning to deliver to other staff. They were also developing an action plan to introduce changes to the home to support better dementia care. This included making changes to the décor and furnishings as well as changes to the way people worked with people with dementia.

Staff understood the requirements of the Mental Capacity Act 2005. Where a person had been identified as not having the capacity to make a particular decision, staff had undertaken best interest meetings which had included family, health and social care professionals. Where a need to keep a person safe had amounted to a deprivation of their liberty, staff had applied for a Deprivation of Liberty Safeguards authorisation.

The home was required by the Care Quality Commission to have 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 resigned from their post in September 2015 but was still working part time at the home and had decided to apply to be the registered manager again. Since September 2015, operations staff from the provider’s organisation had provided management support to the home.

There were systems in place to quality assure the standards and safety at the home. These included regular audits, surveys and resident and staff meetings. Where there were areas that needed to be improved, the provider and senior staff made sure that they made the changes and monitored them.

There were 23 people living at the home at the time of the inspection, this was full capacity as two rooms are double rooms used as single rooms. We spoke with the senior care worker in charge, the provider on the telephone, five staff members and five visitors. We also spoke with five people who were able to tell us about their experiences of living at the home and we spent time observing care in the communal areas. Responses were all positive and although some people were living with varying degrees of dementia and unable to tell us directly about their experiences, we saw that their needs were well met in a dignified, inclusive and respectful way. We saw staff chatting with everyone throughout the day and recognising people's body language signs such as anxiety or showing that they needed assistance or a drink. For example, one person repeatedly asked for their chair to be changed and then forgot they had asked. Staff were kind and respectful when meeting this person's needs. Another person believed that they were living in a hotel and staff responded appropriately to ensure that the person did not become distressed.

People's health and welfare needs were identified and well met including wellbeing and social needs. For example, care plans were detailed and clearly informed staff about how to meet people's individual needs. When we met with people we saw staff delivering care as stated in the care plans. This meant that care was personalised for individuals. People were able to spend time with staff on a one to one basis and staff were friendly. We spoke with five visitors who all spoke highly of the care provided for their friends and relatives at Kenwyn. One relative told us 'I've been visiting for many years and the manager runs a tight ship. It's very nice here and I would be happy to complain but I haven't needed to.'

People told us they were pleased with the environmental improvements, which were ongoing. We saw the provider had taken the comments and compliance action made by us at the previous inspection seriously. We saw a maintenance programme detailing how and when re-decoration and updating was being done. We toured the entire building and saw lots of evidence of improvements such as painting, updated toilets and bathrooms, new decorations and pictures and new flooring. We found there were no offensive odours. One relative said 'There have been lots of changes for the better recently although long overdue. I visit most days and there are never any bad smells. It smells fresh and the cleaners are very good'. All areas were clean and we saw a cleaner working throughout the day. They told us it was a lovely place and they had no worries working there. Everyone we spoke to confirmed that the provider and manager were 'lovely' and 'very approachable' if they had any concerns or complaints.

The service was complaint with both outcomes that we looked at during this inspection.

We spoke with four people living at the home, two relatives, ten members of staff, a visiting health care professional and a hairdresser. Some people were unable to comment directly on their care so we spent much time with them to help us understand what life was like at the home.

The manager was not present on the day of inspection.

People living at the home appeared comfortable, looked after and at ease with all the staff. One person told us 'they all do their very best' and another said staff are "very good".

Care staff had a good knowledge of people's individual needs but not all information was held in the care records. Relevant referrals were made to the health care team.

People received nutritious and appealing food and one person commented "the food is good". Some people did not always receive the support needed to help them eat their meals.

Staff demonstrated that they understood the signs of abuse and how to report any concerns. The home was aware of the process to follow in cases of suspected abuse.

Staff were appropriately trained to give people their medicine.

All people had private rooms which were homely and personalised. Some areas of the home appeared tired and worn in places.

We saw people being treated with respect in a dignified manner, the needs and preferences of people were taken account of in their care plans, and they were able to participate in their care plan reviews. People who use the service are asked to consent to having treatment or support, some people who don't have the capacity to do so have mental capacity assessments recorded.

The home has a well developed care planning system, this was evidenced by care plans we that reviewed. There was also evidence that the home worked collaboratively with other professionals. The needs of people within the home are changing, leading to higher levels of dependency. We were told that protocols are in place to monitor increasing needs and enhancements to staffing can take place to maintain safe care.

The home offered a clean hygienic environment and had recently been awarded a five star Kitchen Hygiene award.

Staff are recruited to the home using recruitment policies that seek to appoint suitably experienced and qualified staff. Prior to appointments staff are subject to a series checks including references and CRB checks.