Archived: Kings Lynn Residential Home

The home has had the current registered manager in post since February 2015. 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.

Staff were aware of safeguarding people from the risk of abuse and they knew how to report concerns to the relevant agencies. They assessed individual risks to people and took action to reduce or remove them. There was adequate servicing and maintenance checks to fire equipment and systems in the home to ensure people’s safety.

People felt safe living at the home and staff supported them in a way that they preferred. There were enough staff available to meet people’s needs and the registered manager took action to obtain additional staff when there were sudden shortages. Recruitment checks for new staff members had been made before new staff members started work to make sure they were safe to work within care.

People received their medicines when they needed them, and staff members who administered medicines had been trained to do this safely. Staff members received other training, which provided them with the skills and knowledge to carry out their roles. Staff received adequate support from the registered manager and senior staff, which they found helpful.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The home was meeting the requirements of DoLS. The registered manager had acted on the requirements of the safeguards to ensure that people were protected. Where someone lacked capacity to make their own decisions, the staff were making these for them in their best interests.

People enjoyed their meals and were able to choose what they ate and drank. They received enough food and drink to meet their needs. Staff members contacted health professionals to make sure people received advice and treatment quickly if needed.

Staff were caring, kind, respectful and courteous. Staff members knew people well, what they liked and how they wanted to be treated. They responded to people’s needs well and support was always available. Care plans contained enough information to support individual people with their needs. People were happy living at the home and staff supported them to be as independent as possible.

A complaints procedure was available and people knew how to and who to go to, to make a complaint. The registered manager was supportive and approachable, and people or other staff members could speak with them at any time.

Good leadership was in place and the registered manager and provider monitored care and other records to assess the risks to people and ensure that these were reduced as much as possible and to improve the quality of the care provided.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at. If you would like to see the evidence that supports the summary, please read the full report.

We spoke with five people who received a service and the relatives of another person. We also spoke with the manager and five members of staff.

Is the service safe?

People told us that they felt safe with, and trusted, the staff who provided their care. We saw the provider had robust recruitment procedures in place. This ensured that only suitable people were employed to work with vulnerable adults.

The manager was clear about how to respond to allegations and the procedures for reporting these to the appropriate agencies. However, other staff that we spoke with were not familiar with, and could not locate, the provider's safeguarding policy and procedure. This meant that there was a risk that safeguarding concerns would not be reported to the appropriate agencies.

During the inspection we became aware that a person may have been assisted to move using an unsafe practice. We reported this to manager who reported it to the local authority under safeguarding protocols for investigation.

There were not effective systems in place to reduce the risk and spread of infection. A senior manager had recently conducted an audit which had identified 24 points for where action needed to be taken in order for the service to meet the Department of Health's code of practice on the prevention and control of infections. Shortfalls covered various areas including general management, staff training, guidelines and policies, the general environment and specific areas of the home including bedrooms, sluices, bathrooms, and toilets.

Throughout the day of our inspection we noted an unpleasant smell in some areas of the home, for example the area around the 'small lounge'. We sat in an armchair in the main lounge during lunch time and found the seat cushion was soaking wet and smelled unpleasant.

Is the service effective?

We spoke with five people who received care from this service. Most people were complimentary about the care they, or their relative, received. One person said the service they received was, 'Lovely, you couldn't get better.' Another person said, 'It's all fine. I feel really at home here.' One person's relative's told us that they thought the service was, 'Brilliant.' They said they felt reassured that the staff always let them know if their relative was unwell.

However, one person told us they didn't get the support they needed with their personal care. In addition, people also told us that there wasn't much to do at the home. Some people said they enjoyed the activities, such as bingo, and the outings when they took place. However, we noted the activities co-ordinator only worked three afternoons each week.

We looked at three people's care records. We saw that care needs assessments were carried out prior to the person moving to the home. This ensured the home were able to meet the person's needs. However, we found that care plans and risk assessments were brief and did not provide staff with sufficient information on how to reduce an identified risk or how to provide the care people needed. None of the records we looked at contained care plans about how to meet people's social or recreational needs.

Is the service caring?

During our inspection we saw lots of positive interactions between staff and the people living at the home. Staff were kind, friendly and were patient with people. However, we also saw some less positive interactions where people were not consulted about actions that affected them, for example, changing the programme on the television.

We saw that people's privacy and dignity was not consistently protected. For example, people were partially dressed, but curtains were open at bedroom windows and one person's door was open while they were semi-clothed and care was being provided to them.

We found that people's confidentiality was not consistently protected. We heard handovers held in the reception area of the home and saw people's personal information left on an unstaffed desk in the reception area.

Is the service responsive?

People told us that staff generally gained their consent before carrying out care. However, none of the people we spoke with could remember their care plans being discussed with them.

We found that the manager, who had taken up post three weeks before our inspection, was aware of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were of appropriate procedures in relation to ensure that people who could not make decisions for themselves were protected. However, this was not the case with other staff who worked at the home. Staff told us they had received training in the MCA and DoLS. However, staff gave us differing views regarding the capacity of people living at the home to make specific decisions. We saw no completed capacity assessments on any of the files we looked at.

We noted a key pad had been installed on the front door of the home and a code was necessary in order to leave the home by the front door. We could not see the code displayed. This meant that people had to ask staff to let them out of the building.

Is the service well led?

There was no registered manager at this service at the time of our inspection. A new manager had recently been appointed and had taken up post three weeks before our inspection.

We saw that the provider had carried out a survey in October 2013, seeking the views of people living at the home. In general we noted the responses were positive. Where people were less satisfied with the service, for example in relation to the lack of activities and the menu and choice of food, the provider had noted the areas to be improved. However, we did not see any follow up monitoring of these areas. We also noted that that some areas of dissatisfaction did not have follow-up actions. For example, six out of seven people who completed the survey said that there was not always a senior member of staff available to speak to. We saw no information as to how this was being addressed.

The provider had quality assurance policies in place, which included the use of various audits. However, we found that two of these provided inconsistent and inaccurate information.

We saw that the manager took account of complaints and comments to improve the service. For example, following a complaint, we saw that the manager had reviewed procedures followed when people were admitted to hospital from the home. This helped to maintain people's dignity and improve the communication of information to health care professionals.

We found that the provider was not compliant with the regulations in six of the seven areas we assessed. We have asked the provider to tell us how they will make improvements and meet the requirements of the law. If you wish to see the evidence supporting our summary please read the full report.

At our previous inspection on 30 April 2013 we found that suitable arrangements were not in place to ensure that staff were appropriately supported. Staff were not supported by receiving a regular supervision. Staff were not supported with an annual appraisal.

During our inspection of 01 August 2013 we reviewed records which evidenced to us that staff were supported with regular supervisions and an annual appraisal. We also saw that systems were in place to ensure that staff who had not yet received an annual appraisal would do so at a point where they had received several supervisions to support their annual appraisal.

People were supported to maintain or increase their independence but only where this was safe to do so. People told us that the care provided by staff at Kings Lynn Residential Home was very good and that the staff were always polite and respectful.

The provider had policies and systems in place which ensured that people would be protected from the risks of abuse. Staff were knowledgeable about the signs of abuse and who they needed to inform and how to report any concerns they may have.

Staff's competence to safely administer medication was assessed prior to staff safely administrating medication. Medicines were kept securely and at the recommended safe temperature. People were assured that they would be administered their prescribed medication at the correct time.

Staff were supported with their training and were from time to time able to gain additional qualifications in health care. However, staff were not always supervised on a regular basis. Staff had not been appraised of their performance during the past 12 months.