Background to this inspection
Updated
15 October 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 5 & 6 September 2016, the first day was unannounced.
The inspection team consisted of two adult social care inspectors, including the lead inspector for the service, and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.
In preparation for the inspection, we reviewed information from our own systems, which included notifications from the provider and safeguarding alerts from the local authority.
We gained feedback from external health and social care professionals who visited the home. As part of this we looked at safeguarding enquiries that we received from Lancashire County Council safeguarding enquiries team. Comments about this service are included throughout the report.
We spent time talking with people who lived at the home. We reviewed records and management systems and also undertook observations of care delivery. We spoke with three relatives, eight people who lived at the home, the registered manager, the business administrator, one domestic staff, two professionals who had visited the service and six care staff. We looked at five people’s care records, staff duty rosters, five recruitment files, the accident and incident reports book, handover sheets, records of residents and staff meetings, medicine’s records, service policies and procedures, records and service maintenance records.
Updated
15 October 2016
This inspection took place on 5 and 6 September 2016 and was unannounced.
The last inspection of Kenmure Lodge took place on 03 July 2013. At that inspection we found the service was meeting the legal requirements in force at the time.
Kenmure Lodge provides residential care for up to 24 people. The home is situated in a residential area, near to the city centre and is close to a range of local amenities. Accommodation is provided over two floors with a lift access to the first floor. The grounds are small, with limited provision for sitting outside. A ramp is provided for easy access.
The registered manager was present throughout our inspection. 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.
At the time of this inspection there were 18 people who lived at Kenmure Lodge Care Home. We spoke with eight people living at the home. People were able to share their thoughts and experiences with us. We spent time observing care delivery and spoke with people who visited the service.
People who lived at the service and their relatives told us that they felt safe.
We looked at how the service protected people against bullying, harassment, avoidable harm and abuse. We found that staff had not received training in safeguarding adults. Allegations had been made by people against one staff member however; this had not been adequately addressed by the registered manager. We made a safeguarding referral to the local safeguarding team immediately after the inspection. The safeguarding policy was outdate and not in line with the current local safeguarding board and national guidance.
The provider had recorded accidents and incidents and documented the support people were getting after experiencing falls. We found evidence staff had sought advice from health professionals. We however, recommended the service to put this information together and analyse it regularly to help them understand trends and help come up with preventative measures.
We found people’s medicines had not been managed in a robust manner. This included storage and administration practice that we observed. People did not have care plans for ‘as and when’ medicines (PRN). Staff had received medicines training however they had not been competence tested to ensure they were administering the medication as recommended.
We observed unsafe medicine administration and unsafe moving and handling practices from the registered manager during the inspection.
There was a building fire risk assessment on the premises and emergency plans were in place in case people needed to be evacuated from the premises urgently. People had personal emergency evacuation plans (PEEPS) to enable safe evacuation in case of emergency. However, the PEEPS lacked sufficient detail on individuals; they did not provide adequate guidance on the difficulties that staff could encounter when assisting people depending on people’s physical and mental health needs. We found fire doors were wedged. Although this can be permitted under certain circumstances, the fire policy did not identify when this can be permitted. This guidance need to be available for care staff. We made a recommendation.
Infection control measures were in place and standards of hygiene had been maintained. However, some toilets did not have hand washing soap for people to use and continence pads had been disposed in normal open bins. Following the inspection the provider acted promptly and addressed this.
Majority of the care staff had been safely recruited. However, we found concerns regarding safe recruitment of one care staff member. Evidence we saw showed safe recruitment procedures had not been adequately followed for this care staff which had a potential of exposing people to risk of abuse. The service did not have adequate care staff to ensure that people's needs were sufficiently met. People who lived at the home, relatives and care staff expressed concerns about the number of staff and how it was affecting the quality of care people received. There was an analysis of staffing levels by the provider which had not been consistently reviewed or changed when people’s needs had changed and they required more support. The provider acted on these findings and informed us they had been in the process of recruiting additional and had staff starting work in due course.
We found care planning was not done in line with Mental Capacity Act, 2005 (MCA). People’s consent to receiving care was not consistently recorded in their care files. There was no mental capacity training. Some staff showed awareness of the Mental Capacity Act, 2005 and how to support people who lacked capacity to make particular decisions. However, we found the knowledge of mental capacity among staff needed some improvement and the registered manager had limited awareness of the principles of mental capacity act and how to apply them in practice. Appropriate applications for Deprivation of Liberty Safeguards had been made however; no mental capacity assessment was completed before the application. Some people required DoLS authorisations however, they had not been considered.
People using the service had access to healthcare professionals as required to meet their needs. We found that people’s health care needs were assessed on admission to the service to ensure the home was able to meet their assessed needs.
Care plans demonstrated people’s involvement. People and their relatives told us they were consulted about their care.
The service demonstrated how they sought people’s opinions on the quality of care and service being provided. People informed us they were asked about their opinions in residents meetings. However, resident and relative’s surveys had not been undertaken to obtain people’s opinions in a more confidential manner.
People were not adequately supported with meaningful daytime activities, there were no activity plans, a designated activities co-ordinator or day trips. People told us they would prefer to have a choice activities and day trips. Staff informed us they could not always support with activities as they were busy with other tasks. We made a recommendation.
Management systems in the home were not robust. Staff had not received regular and adequate training to support them in their role. Care staff had not received adequate supervision and recruitment practices had exposed people to risk. The quality assurance systems were in place however they were not robust enough as some areas of people’s care were not audited regularly to identify areas that needed improvement. We found audits had been undertaken for the premises, health and safety and infection control however; areas such as medicines, care plans, staff recruitment files and kitchen had not been audited regularly. Staff shortages had impacted on the quality of support people received.
The provider was not meeting the Care Quality Commission registration requirements. They did not send notifications to CQC for notifiable incidents, such as serious injury, allegations of abuse, people going missing or incidents involving the police.
The fire policy did not reflect current practice in the home and the safeguarding policy provided information which was not in line with current practice. There was no pet policy in the home for the home pet. There was resident cat. We made a recommendation.
People felt they received a good service and spoke highly of their staff and the registered manager. They told us the staff were kind, caring and respectful. Many people appreciated having their privacy and independence. However, they expressed that staff shortage had meant that they had to wait for long periods of time to receive support from staff. People told us the providers visit the home regularly and are pleasant and approachable.
We found the service had a policy on how people could raise complaints about care and treatment however, there was no evidence to demonstrate how complains had been received and dealt with in line with regulations. Complaints had been dealt with face to face. We made a recommendation.
The registered manager and the provider sent us an action plan immediately after the inspection. They had responded to some of the concerns raised immediately.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to, Regulation 12 – Safe care and treatment, Regulation 13- safeguarding service users from abuse and improper treatment, Regulation 17 –Governance Regulation 18- Staffing and Regulation 18 of Registration Regulations 2009 -Notifications of other incidents.
The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if