Kepplegate House

We found the following examples of good practice

¿ The registered manager had ensured staff could access comprehensive and informative training in various aspects of infection control. Staff confirmed they felt confident in the training and their competency was checked to ensure they were implementing best practice.

¿ The environment had been arranged to minimise the risk of infection and support contact with visitors. The porch area of the home was used soley to enable socially distanced visits to take place and risk assessments were carried out to control associated risks.

¿ Visitors arranged to visit people at the service in advance and handwashing facilities, infection control gel and personal protective equipment (PPE) was available to support safe visits.

¿ People could have socially distanced conversations with people important to them by using technology. A computer was connected to a large screen tv in a separate room. Staff supported people to use the technology and then left the area so private conversations could be held. Staff also supported people to use electronic tablets and telephones to maintain contact with loved ones.

¿ People were supported to access health professional advice through the use of electronic tablets and care records were updated to reflect the advice.

¿ Processes to minimise the risk of infection were known by staff and carried out to minimise the risk and spread of infection. For example, temperature checks, safe waste disposal and increased cleaning of the home took place. Specialist cleaning equipment had been purchased to help maintain the cleanliness of the home.

¿ Covid 19 policies and risk assessments were available and known by staff. Staff told us they felt safe as the service was following best practice to minimise the risk and spread of infection and appropriate PPE was provided.

¿ The service was taking part in the whole home testing process. People at the home were supported to decide if they wanted to participate. Conversations explaining the risks and benefits took place and people could watch a video of the testing process to support their decision making.

¿ Appropriate signage was displayed throughout the home to promote best practice.

Further information is in the detailed findings below.

At the last inspection carried out on the 02, 03 and 10 February 2016 the service was rated Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager in place. 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.

People who lived at the home told us they were happy, felt safe and were treated with kindness at all times. People supported by the domiciliary care service told us staff who visited them were reliable, polite, friendly and caring. Comments received included, “I cannot say anything bad about the staff.” And, “I feel perfectly safe here. The staff are very kind.” Also, “You could set your clock by my carers. They would let me know if they had been held up for some reason but it’s never happened.”

The service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

Staff had been recruited safely, appropriately trained and supported. They had skills, knowledge and experience required to support people with their care and social needs.

Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required. People told us they received their medicines at times they needed them.

We saw there was an emphasis on promoting dignity, respect and independence for people supported by both services. They told us they were treated as individuals and received person centred care.

We looked around the care home building and found it had been maintained, was clean and hygienic and a safe place to live. We found equipment had been serviced and maintained as required.

The service had safe infection control procedures in place. People who lived at the home told us they were happy with the standard of hygiene in place.

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

People’s care and support had been planned with them. They told us they had been consulted and listened to about how their care would be delivered.

Care plans were organised and had identified care and support people required. We found they were informative about care people had received.

People told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

People were supported to have access to healthcare professionals and their healthcare needs had been met.

People told us staff were caring towards them. Staff we spoke with understood the importance of high standards of care to give people meaningful lives.

The service had information with regards to support from an external advocate should this be required by people they supported.

People told us staff who supported them treated them with respect and dignity.

People who lived at the home told us they enjoyed a variety of activities which were organised for their entertainment.

The service used a variety of methods to assess and monitor the quality of the service. These included regular audits, resident meetings and satisfaction surveys to seek their views about the service provided.

Further information is in the detailed findings below

Kepplegate House is a two-storey care home and domiciliary care service located in the village of Preesall. The home is within close proximity to shops and local amenities. The service has a minibus which is used to transport people to events and appointments. Accommodation is provided over two floors, with a stair lift providing access to the first floor. There is a large lounge with dining room and two small conservatories. There are garden areas with seating for people to use during the summer months. Car parking is available at the home.

Kepplegate House Limited is registered by the Care Quality Commission to provide care and support to people who live at Kepplegate House. In addition, it is also registered as a domiciliary service to provide care and support to people who live in their own homes. At the time of the inspection there were sixteen people living at the home and thirty-five people who received support in their own homes.

Kepplegate House Limited has a manager who is registered with the Care Quality Commission for the care home and the domiciliary 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 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 told us they were supported by two managers. The registered manager explained there was a manager for the care home and an additional manager for the domiciliary service. The registered manager told us they worked closely with the managers to ensure Kepplegate Limited ran smoothly.

People told us they were happy with the care and support they received from Kepplegate House Limited. People told us staff were caring and were knowledgeable of their individual needs.

There were systems in place to protect people at risk of harm and abuse. Staff were able to define abuse and the actions to take if they suspected people were being abused.

We found medicines were managed safely. We saw staff dispensed medicines in a calm and organised manner and took care to ensure people received their medicines as prescribed.

We saw appropriate recruitment checks were carried out to ensure suitable people were employed to work at the home and the domiciliary care service.

There were sufficient staff to meet people’s needs. People were supported in a prompt manner and people told us they had no concerns with the availability of staff. People who received support from the domiciliary service told us they were happy with the time keeping of staff.

Staff received regular support from the management team to ensure training needs were identified. We found staff received appropriate training to enable them to meet peoples’ needs.

Processes were in place to ensure people’s freedom was not inappropriately restricted and staff told us they would report any concerns to the registered manager.

We saw people were offered a variety of foods at Kepplegate House and people were supported to eat and drink sufficient to meet their needs. People told us they liked the food provided.

People were referred to other health professionals for further advice and support when assessed needs indicated this was appropriate. We spoke with two visiting health professionals who voiced no concerns with the care provided at the home.

We saw staff treated people with respect and kindness and people told us they were involved in their care planning.

Staff knew the likes and dislikes of people who received support in their own home and delivered care and support in accordance with people’s expressed wishes. During the inspection we saw people who lived at Kepplegate House were supported in accordance with their needs. We saw people enjoyed taking part in an organised activity.

There was a complaints policy in place, which was understood by staff. Information on the complaints procedure was available in the reception of the home and people we spoke with were aware of the procedures in place.

The registered manager monitored the quality of service by carrying out quality assurance checks. People who lived at the home and those who received support from the domiciliary service were offered the opportunity to participate in an six monthly survey. People told us the registered manager sought their views.

Although the members of staff spoken with appeared to have a good understanding of individual needs, wants and wishes of people, we noted that there were some missing or incomplete records. These included risk assessments, risk management plans or care plans specific to each area of identified need. This did not protect people living at the home or the staff that supported them.

At this inspection we saw that the provider had since introduced appropriate measures to improve the information contained in care plans so they provided an holistic account of all care needs in order to guide and direct staff. Care plans and risk assessments were in-depth, signed and regularly reviewed. People or their families had consented to care.

At the time of our visit in June 2014 we concluded that the records relating to the administration of medication were haphazard and incomplete. On the sample medication administration records (MAR) that we looked at there were many gaps and omissions. Whilst it seemed probable that the medication had been administered, the drug administration record did not always reflect this. This practice did not ensure that the drug administration record for each person was completed correctly or confirm that the person had received their medication as prescribed. This put people at risk of harm.

Since that inspection significant improvements had been made. Routine drug medication audits had been introduced. This meant that basic errors were being picked up. Any recording errors were being monitored, staff shortfalls identified and staff reminded of their responsibility to administer and record the administration of medication safely and accurately in order to protect people.

Although the home's recruitment policy and procedure was robust, this had not necessarily been followed before new members of staff had been allowed to take up their employment at the home. For example we saw two instances of members of staff starting their employment at the home before all the required references had been received and deemed to be satisfactory. This meant that the personal qualities and attributes of the individual were not necessarily known prior to them working at the home. This did not help to keep people safe or ensure that only suitable people were employed at the home.

We asked the service to provide us with an action plan demonstrating what they had done to address the issues of non-compliance. We received an action plan from the provider. This detailed the procedures put in place to address the concerns. We used this inspection to see what actions had been taken.

The summery is based on our observations during the inspection. We spoke briefly with two people living at the home, a relative who was visiting, two members of the care staff team, the registered manager, and deputy manager. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

This helped to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

Is the service safe?

From our observations people appeared relaxed, comfortable and secure. We saw that people were treated with respect and dignity by the staff team and their rights protected.

The home had information and procedures in relation to the Mental Health Act and Deprivation of Liberty Safeguards although no application had needed to be submitted. Staff were being trained to understand when an application should be made. This meant that people would be safeguarded as required.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

We looked at the recruitment of new staff. This showed that some required recruitment checks in respect of references and qualifications and training were not always being obtained prior to the person taking up their post at the home. This potentially put people at risk of being supported by staff that did not have the personal qualities or appropriate skills.

Some medication records we saw were incomplete. Therefore it was not possible to be confident that medication had been administered as prescribed. Staff had failed to report omissions in record keeping. These practices did not protect people or keep them safe.

We have asked the provider to tell us what they are going to do to meet the requirements of law in relation to recruiting new staff, medication, the monitoring the service provision and record keeping.

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It the service effective?

There was an advocacy service available if people needed it. This meant that people living at the home or their relatives could access additional support. The relative we spoke with told us that they were very pleased with the level of care that was being delivered in the home and that staff were, '100% working in partnership with the family's wishes.'

From our observations and through speaking with staff it was clear that there was a good understanding of each person's assessed needs and that personal preferences were accommodated.

We were assured that in the main, people's health and care needs had been assessed prior to admission and that the individual or their family were aware of the care being delivered. However we could not look at most of the pre admission assessments we asked for, as they could not be located. We also noted that although some assessments had been completed, the outcome of the assessments had not necessarily been carried forward to an individual care plan such as social activities. This meant that people may not have been provided with their preferred activities because staff had not been made aware of them.

People or where appropriate their relative, had not necessarily seen or had been given the opportunity to agree to the content of their initial care plan. Although no concerns at all were expressed about the level or type of care being provided, there was never the less potential for care to be delivered in a way that did not meet the expectations of the individual.

The internal quality monitoring systems in place had latterly not always focused on important areas in relation record keeping, including the development of holistic care plans. This meant that important records were missing or incomplete.

People's mobility and other needs had been taken into account in relation to the adaptation of the building, meaning that people were able to move round freely and safely.

We asked the provider to tell us what they were going to do to meet the requirements of law in relation to ensuring that people had a detailed and holistic pre admission assessment and care plan that encompassed all aspects of their assessed needs and requirements.

Is the service caring?

We saw that people were supported by kind and attentive staff. Care workers showed patience, humour and gave encouragement when supporting people. A relative told us, 'I cannot fault them. Everything is handled professionally. The staff are lovely, very caring and patient with people'.

Relatives and where appropriate people living at the home, had been provided with an annual satisfaction survey. We viewed the outcome of the most recent survey. Outcomes were positive. Action had been taken to address any suggestions made.

We also saw the minutes of staff meetings, entertainment meeting minutes, kitchen meeting minutes and management meeting minutes. Outcomes of residents' rendezvous meetings were highlighted in the monthly newsletter. These different forums gave people opportunity to have their say and influence change.

Is the service responsive?

People enjoyed a range of activities inside and outside the home. The home had its own adapted mini bus that helped people to keep involved in their local community. The home encouraged activities and we saw numerous things happening during the inspection, both collectively and on a one to one basis with individuals.

The home had received no formal complaints for some considerable period of time. People we spoke with did not express any complaints or concerns. The complaint procedure was on display in a communal area of the home for people or their relatives to access at any time. We looked at how the one complaint had been dealt with, and found that the responses had been open, thorough and timely. People would therefore be reassured that complaints were investigated and action taken as necessary.

Is the service well-led?

The registered manager had been in post for many years. The registered manager, deputy manager and staff team worked closely together on a daily basis. This helped to ensure standards were maintained and any shortfall quickly addressed. In addition, a range of routine audits was also completed. However some audits that could prove useful, such as medication audits, were not in use. This meant that shortfalls had not been identified and addressed. The audit systems did not systematically ensure that all the necessary documentation was completed or that record keeping was robust and routinely applied.

We asked the provider to tell us what they were going to do to meet the requirements of law in relation to ensuring that the required documents were routinely completed and that record was robust.