Kathryn's House

We found the following examples of good practice.

Infection control processes were regularly reviewed by the registered manager and deputy manager. A range of audits were completed including a specific COVID-19 audit which reviewed additional measures implemented in response to the pandemic. Staff received infection control training which was regularly updated and discussed in team meetings and daily handover meetings. Training included the safe use and disposal of personal protective equipment (PPE). Staff had access to sufficient PPE and were observed to use this correctly.

Cleaning schedules had been adapted to ensure high touch areas were cleaned regularly and hand gel was available throughout the home. Cleaning products used had been changed where required to ensure they were effective. Adaptations to the home had been made such as creating a testing and PPE area and implementing a quiet room where people could have video calls with their loved ones.

Testing for COVID-19 was completed in line with government guidance. Contingency plans were in place to guide staff on the appropriate action to take should anyone test positive. The registered manager ensured on-going learning through membership of external forums, working with health care professionals and analysis of the home’s practices. This included developing resources and additional checks when people were isolating to minimise risks such as social isolation, loss of mobility and ensuring people ate and drank well.

Visiting protocols were in place which included a booking system for visits and information for Essential Care Givers. Visitors were required to complete health checks prior to entering the home which included a test for COVID-19. Government guidance for visiting was followed and people and their relatives informed when changes were made. People were able to receive their visitors in their rooms, communal areas or in the visiting pod, depending on their preference.

Kathryn’s House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Kathryn's House provides care for up to 29 older people, some of whom were living with dementia and some who were living with other mental health support needs. At the time of our inspection there were 20 people living at Kathryn's House.

There was registered manager in post who supported us during 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 2008 and associated Regulations about how the service is run.

There were sufficient skilled staff available to ensure that people’s needs were met promptly and people were not waiting for their care. Safe recruitment practices were in place to help ensure that only suitable staff were employed. Staff received the induction, training and support they required to carry out their roles.

People lived in a safe, clean environment which was adapted to meet their needs. Staff were aware of safe infection control practices and systems were implemented to help reduce the risk of people developing infections. Health and safety checks were completed to ensure the environment remained safe for people. The provider had developed a contingency plan which meant people would continue to receive safe care in the event of an emergency or unforeseen event.

Staff treated people with dignity and respected their privacy. People were supported to maintain and develop their independence and where relevant other professionals were involved in supporting people to achieve their goals. People’s legal rights were protected as the principles of the MCA were followed. People were offered choices and these were respected by staff. Visitors to the service were made to feel welcome.

Risks to people’s safety were assessed and control measures implemented to keep people as safe as possible. Accidents and incidents were recorded and action taken to prevent them happening again. Staff were aware of their responsibilities in safeguarding people from abuse and any concerns were reported to the local authority. People received support to remain healthy and healthcare professionals were involved in people’s care as required. Safe medicines systems were in place and regularly monitored to ensure people received their medicines in line with prescription guidelines. People were provided with a nutritious diet and choices were available. Specialist diets were catered for and staff were aware of people’s dietary needs. Regular feedback on the food provided was sought.

People and their families were involved in the assessment process and developing care plans. Regular reviews were completed of the care people received to ensure staff had the most up to date guidance when providing people’s support. Care plans included personalised information regarding people’s communication needs, life histories and how they preferred their care to be provided. Staff were knowledgeable about people’s needs and preferences. The support people wanted when reaching the end of their life was recorded and staff understood the need to promote people’s dignity at this time. People had access to a range of activities, many of which were personalised and provided on an individual basis. People’s cultural and religious beliefs were respected.

People and staff spoke highly of the management of the service. Staff told us that they felt supported and knew that there was always someone available to help them when needed. We received positive feedback regarding the care staff from relatives and people living at Kathryn’s House. A positive culture had developed and the values of the service were upheld by staff. The registered manager conducted a range of quality assurance audits and action was taken where shortfalls were identified. Complaints were addressed in line with the provider’s policy and used to improve the service. People, relatives and staff were asked for feedback regarding their experiences and regular meetings were held to gain people’s opinions and suggestions.

The inspection took place on 13 April 2017 and was unannounced.

Since our last inspection a new registered manager had been appointed and was present on the day of the 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 2008 and associated Regulations about how the service is run.

At our inspection in April 2016, breaches of legal requirements were found and the service was placed into special measures. We returned to the service in August 2016 and found that although some improvements had been made there were on-going concerns regarding the service people received. We undertook a further inspection in December 2016 and found the improvements previously made had not been sustained and identified nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was a lack of management over-sight of the service, sufficient staff were not deployed to meet people’s needs, people did not always receive safe care and staff were not aware able to demonstrate their understanding of safeguarding. The training staff received was not effective in supporting them in their role and staff did not receive supervision. People did not always receive care in line with their needs, there was a lack of activities which took into account people’s interests and people’s legal rights were not protected. As a result of this Kathryn's House remained in special measures.

We undertook this inspection to check that the provider had taken action to meet their responsibilities. We found that significant improvements had been made in all areas and no breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found. The rating for the service remains as requires improvement to ensure that the changes in the care people receive and the governance of the service are sustained and embedded in to practice. However, due to the extent of the improvements made in responding to people’s individual needs and the personalised care people are now receiving the service has been rated as good in the responsive domain.

Risks to people’s safety and well-being were assessed and control measures were in place to help minimise risks. Staff were aware of how to support people to manage risks safely. Accidents and incidents were recorded and monitored to identify any trends and minimise the risk of them happening again. Staff were aware of their responsibilities in safeguarding people from potential abuse and any concerns were appropriately reported. The provider had a contingency plan in place to ensure that people’s needs would continue to be met in the event of an emergency or if the building could not be used.

There were sufficient staff deployed to meet people’s needs safely. People’s needs were responded to in a timely manner and staff had time to spend with people. Staff received regular training and supervision to ensure they had the skills required to meet people’s needs. Training was provided in line with the learning needs of staff to ensure their understanding. Safe recruitment processes were in place to ensure people received support from suitable staff.

Safe medicines practices were practised and people received their medicines in accordance with their prescriptions. Staff competency in managing medicines was assessed and regular medicines audits were completed. People’s healthcare needs were known to staff and appropriate referrals were made to healthcare professionals where required.

People’s legal rights were protected as staff were acting in accordance with the Mental Capacity Act 2005. Staff gained people’s consent prior to delivering care and understood the need to offer choices and respect people’s decisions. People told us they were involved in decisions regarding their day to day care.

People were supported by staff who knew their needs well and provided personalised care. People’s dignity and privacy was respected. People and their relatives told us that staff were caring and treated them with kindness. Care plans were person centred and contained details of people likes and dislikes. Staff supported people to maintain their independence and respected people’s privacy and dignity. People told us they enjoyed the food provided and choices were available. People’s nutritional needs were met and the catering staff were informed of people’s needs and preferences. People’s weight was monitored and appropriate action taken where significant changes were identified.

There was a range of activities available for people to take part in and people received the support they required to be involved. In addition to planned activities, staff spent time with people individually. We found that some people still spent periods of the day with little activity. The registered manager was able to demonstrate that they were continuing to work on developing activities in line with people’s needs and preferences. Resident meetings were held quarterly and people and their relatives were able to make suggestions regarding the running of the service and the food and activities provided.

The provider had a complaints policy and people told us they felt any concerns would be addressed. The registered manager maintained a complaints log which showed that concerns had been addressed and responses given. Quality assurance processes were in place and regular audits of the quality of the service completed. The registered manager had taken action to rectify any shortfalls identified. Staff told us they felt supported by the management team and were able to discuss any concerns openly.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The inspection took place on 8 December 2016 and was unannounced.

At our inspection in April 2016, breaches of legal requirements were found and we took enforcement action against the provider. We issued warning notices in relation to safe care and treatment, person centred care and good governance. As a result of our concerns Kathryn's House was placed into special measures. The provider wrote to us to say what they would do to meet legal requirements. We undertook a further inspection in August 2016 to check the provider had taken action to meet the regulations. We found the provider had made some improvements in the quality of people received. However, these were not sufficient as the care people received was not always safe, staff were not able to demonstrate their understanding of safeguarding, people did not always receive care in line with their needs, there was a lack of activities which took into account people’s interests and the provider had not ensured that quality assurance systems were in place. There were continued breaches because the provider had failed to take proper action. As a result of this Kathryn's House remained in special measures.

We undertook this inspection as a result of receiving concerns regarding people’s care and to check that the provider had taken action to meet their responsibilities. We found that previous improvements made had not been sustained and that there were on-going concerns regarding the care and treatment people received.

There was a registered manager in post. 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 is responsible for the day to day management of the home and was available throughout the inspection.

There was a continued lack of managerial oversight within the service. The provider and registered manager had not identified shortfalls with the care people received or poor practices in staff performance. There was a lack of understanding with regard to the responsibilities as registered persons. The provider had failed to ensure that the CQC had been notified of significant events at the service.

Risks to people’s safety were not adequately identified and addressed. Accident and incident forms were not always completed in detail and were not analysed to minimise the risk of reoccurrence. Sufficient staff were not always deployed to meet people’s needs and the minimum staffing levels determined by the provider were not always met. Staff had failed to identify safeguarding concerns and ensured that these were reported to the relevant authorities.

Staff had not received training in relation to people’s specific needs including supporting people living with dementia and other mental health conditions. Staff had received some training to support them in their role but were unable to demonstrate their understanding in practice. The provider had failed to ensure staff received effective, on-going supervision which monitored their skills and practice. Staff told us they felt supported by the registered manager.

People’s legal rights were not protected as the principles of the Mental Capacity Act 2005 were not followed. Capacity assessments had been completed in relation to a number of restrictions but had not been shared with staff. There were capacity assessments completed in relation to locked doors and DoLS applications had not been submitted to the local authority.

People’s nutrition and hydration needs were not adequately met and action was not taken where people had experienced significant weight loss. People did not have sufficient choice about what they ate and specialist dietary needs were not fully catered for.

Staff did not always treat people with kindness and people’s dignity was not respected. People did not always receive personal care in line with their needs and the provider had not ensured that checks were maintained to ensure people were not being woken at an unreasonably early time in the morning. We observed that on occasions some people’s requests for support were ignored.

The care people received was not person centred and staff were unable to describe people’s past lives, hobbies and interests. Care plans were not organised and contained contradictory information. Staff confirmed they had not read people’s care plans which meant they were not fully aware of people’s needs and preferences. There was a lack of activities provided to people and staff did not understand the importance of providing a stimulating environment. Staff did not interact positively with people.

Improvements had been made to the way people received their medicines and systems in place were found to be effective. When required people had access to healthcare professionals. Emergency plans were in place to ensure that people’s needs would continue to be met in the event of an emergency and staff were aware of the support people required to leave the building safely.

There was a complaints policy displayed and where a complaint had been raised this had been addressed to the person’s satisfaction.

The overall rating for this service is 'Inadequate' and the service remains 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 there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

During this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The inspection took place on 19 August 2016 and was unannounced.

At our inspection in April 2016, breaches of legal requirements were found and we took enforcement action against the provider. We issued warning notices in relation to safe care and treatment, person centred care and good governance. As a result of our concerns Kathryn’s House was placed into special measures. The provider wrote to us to say what they would do to meet legal requirements.

We undertook this inspection to check that they had followed their plan and to confirm that the service was meeting legal requirements. We found the provider had made some improvements however sufficient improvements had not been made to meet the requirements of the Health and Social Care Act 2008 (Regulated Activities) 2014. There were continued breaches during this inspection because the provider had failed to take proper action. As a result of this Kathryn’s House remains in special measures.

Risks to people’s safety were not always identified and adequately controlled. Staff were not aware of risks to people’s safety and well-being and records were not completed to provide guidance. Care plans were not seen by staff and some people did not have care plans in place to guide staff in providing safe care. Staff were not able to demonstrate their responsibilities regarding safeguarding people from abuse. Risk assessments relating to people’s nutritional needs were not completed and referrals were not always made when concerns were identified. People’s needs were not always assessed prior to them moving into the service and staff were not given guidance regarding their needs. Care was not always provided in accordance with people’s individual needs. After the inspection the provider informed us that full risk assessments and care plans were now in place for people and that staff had now received training to ensure that people were kept safe.

People medicines were not managed safely and records were not accurately maintained. We found gaps in the recording of people’s medicines and safe procedures were not followed.

Information relating to the evacuation of the building in an emergency had been completed but staff had not been made aware of how to access this information.

There were sufficient staff available to meet people’s needs although staff were not always deployed appropriately. Staff were not provided with guidance on the staffing levels needed within the communal areas of the home which placed people at risk. However since the inspection the provider has assured us they have changed how staff are deployed to assist everyone that needs help with their meals so people are not waiting. New staff were subject to recruitment checks to ensure that they were suitable to work in the service.

People’s rights were not protected as the Mental Capacity Act 2005 (MCA) was not always followed. This meant that people may be subject to restrictions which had not been legally authorised. The registered manager and staff were unable to demonstrate their understanding of their responsibilities in this area. Assessments of people’s ability to make day to day choices had been completed but not shared with the staff supporting them.

Activities were not planned in accordance with people’s preferences and were not observed to engage people.

There was a lack of effective leadership of the service and systems were not in place to ensure that the service would operate smoothly in the absence of the registered manager. Although there were some improvements in the way the quality of the service was assessed and monitored continued work in this area was required. The registered manager did not receive the support they required to identify shortfalls in the management of the service. However, since the inspection the provider has assured us that they have increased their work with the registered manager and auditing of the service to identify and address concerns and shortfalls.

Improvements had been made to the way people received their care at night. People’s continence care was managed well which meant people were now sleeping better and people were supported to get up in the morning at a time of their choosing.

Infection control procedures had been implemented and regularly checked to ensure they were effectively managed. Regular health and safety checks were completed to ensure that people lived in a safe environment. Call bell audits were completed to monitor the time people needed to wait for a response. Since the last inspection all staff had received mandatory training and we observed that this had positively impacted on some areas of their work including moving and handling, infection control and health and safety. However, training provided with regard to the MCA and safeguarding had not provided staff with the relevant knowledge and skills they required.

People told us that they enjoyed the food provided and were offered a choice. Health care records showed that people received support from relevant healthcare professionals and relatives told us that any concerns were communicated to the in a timely manner.

Staff supported people in a kind and gentle manner and people responded positively. However, one staff members responses to people did not demonstrate compassionate care. We have made a recommendation regarding this. Relatives and visiting professionals told us they thoughts staff were kind and attentive to people’s needs. The provider had procedures in place to ensure that any concerns regarding the service would be investigated and relatives told us they were confident that concerns would be addressed promptly. Relatives were complimentary about the registered manager. One relative told us, “She’s brilliant, always has time for people and looks out for everybody.”

The overall rating for this service is ‘Requires Improvement’ and the service remains 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 there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

During this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Kathryn's House provides accommodation and personal care for up to 29 older people, some of who may be living with dementia. At the time of our inspection there were 26 people living at Kathryn’s House. The home is set over three floors with access to the upper floors via a small lift.

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.

Where risks were identified suitable risk assessments and control measures had not been implemented. Unsafe moving and handling practices were used and people did not receive support and reassurance during times of high anxiety.

Effective infection control systems were not in place and guidance was not available for staff. The home had a policy in place regarding safe laundry processes. However this was not followed and laundry procedures put people at risk of infection. The home was clean and maintained to a good standard.

Safe medicines processes were not always followed. Protocols were not in place for the administration of ‘as required’ medicines and unsafe administration practices were observed. People received their medicines according to the prescribed guidelines and medicines were stored securely.

Staff did not understand their responsibilities under the Mental Capacity Act (MCA) and had not received training in this area. We saw no evidence of mental capacity assessments in people’s care files. The registered manager told us they were aware this was an area which required work.

Staff had not received effective training to undertake their roles and responsibilities. There were a large number of gaps in training records. Staff received supervisions in groups and did not meet with their manager individually to assess their progress and skills.

People were not always supported with their food in a safe way and people did not have a meaningful choice of food or drinks. The food provided looked appetising and portion sizes were good.

People were not supported in a caring and respectful manner. We found that people were being woken and supported to get ready for the day at an unreasonable time. People did not receive appropriate care with regard to their continence needs and continence aids were not provided at night. This meant people were left in wet and soiled beds until staff next checked if they required support.

Staff did not always speak to people in a caring and respectful manner although we also saw some positive interactions between people and staff where care was provided in a gentle and reassuring way.

Care plans were not completed in a timely and effective way. A number of people did not have care plans in place and plans were not adapted when people’s needs changed.

People did not have access to a range of activities in accordance with their individual needs and preferences. Relatives told us they would like to see more activities for people.

The service did not undertake regular audits to monitor the quality and effectiveness of the service and there was a lack of managerial oversight. Relative satisfaction questionnaires were completed annually although action plans were not implemented to ensure comments were acted upon. Records within the service were not always accurately maintained.

There were sufficient staff deployed in the home. Appropriate recruitment checks were undertaken when new staff were employed to ensure they were suitable to work with people living in the service.

People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them.

People’s privacy was respected. Staff were seen to knock on people’s doors before entering and personal care took place in private areas.

There was a complaints policy in place and relatives and people told us they would speak to the manager if they had any concerns.

People and their relatives spoke highly of the registered manager and staff team. Relatives told us they were able to visit at any time and were always made to feel welcome.

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 there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

During this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People who used the service experienced effective safe and appropriate care treatment and support. People were fully assessed prior to joining the service and regularly thereafter. Care plans were detailed and ensured that the welfare of people was protected. Staff treated people with respect and, through the provision of policies and procedures, people's welfare and safety was assured.

People who used the service were protected from abuse because staff had received appropriate training and were able to recognise abuse if it occurred. During our visit we spoke with people who used the service and staff. One person told us 'Oh yes, I don't have any worries. They always look after me.'

The service was clean and hygienic and the risk of infection was minimised by the presence of policies and procedures and relevant guidance. We saw that the home was well maintained and clean. Portable equipment and appliances were also clean and hygienic.

Records kept by the service were comprehensive, appropriate and securely stored.

At the time of our inspection there were 25 people accommodated at Kathryn's house.

During our inspection we looked to see how the service involved people in making choices and decisions about the care, support and daily life. We found that the provider couldn't evidence in all cases how people were included in important decisions about their life.

We saw that care records and risk assessments that contained important information about how people's care should be delivered and how they should be protected from the risk of harm, were not up to date, or in place for some people. We also saw that people's records and personal information was not always secured.

We saw that medication administration and storage arrangements were suitable and that staff had received appropriate training to administer medication safely.

We looked to see if there were enough suitably trained staff to meet people's needs. Training records showed that people had received the training they needed.

The registered manager told us that complaints were taken seriously. A relative told us that they didn't have any complaints.