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Inspection carried out on 4 January 2017

During a routine inspection

Keb House is registered to provide accommodation for up to 18 older people, some of whom may be living with dementia. The service is a Victorian style house with the addition of a newer single storey extension. The service is accessible for people with mobility difficulties and comprises various communal rooms, en suite bedrooms, a laundry, and kitchen and activity room. There is outdoor garden space with areas of seating. On the day of the inspection there were 13 people using the service.

We undertook this unannounced inspection on the 4 January 2017. At the last inspection on the 7 January 2016 we found a breach in regulation. The registered provider had not always ensured the service was well maintained and in a good state of repair. The overall rating for the service was, “Requires improvement”. Following the inspection we received an action plan from the registered provider in August 2015 detailing how improvements would be made.

The service had a registered manager in post who was also the registered provider. 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.

During this inspection we found the cleanliness of the premises was satisfactory. The registered provider had made improvements to the general environment, which included redecoration to some areas of the older part of the building, such as a bathroom and the hall, stairs and landing. Two window frames in the main lounge had been re-painted and cracked glass replaced. The lights we checked during the inspection were all in working order, with the exception of one sensor light on an upstairs corridor where two bedrooms were located. We saw there was adequate ceiling lighting to compensate for this and the registered manager told us they would address this issue.

In the extension we saw nine bedrooms, the dining area and corridors had been re-painted. In one bathroom we found a bath support leg which was very rusty and in one bedroom we saw the person’s bed sheet had a rip in it. The registered manager addressed these issues immediately during this inspection.

It was recommended at the last inspection that the registered provider obtained information and direction from the local authority in respect of DoLS applications to ensure they are working within the principles of the Mental Capacity Act 2005 (MCA). At this inspection we found improvements had been made. The registered manager was following the principles of the MCA and seven applications had been submitted to the authorising body in respect of people being deprived of their liberty. The MCA legislation is designed to ensure that when an individual does not have capacity, any decisions are made in the person's best interest.

At the last inspection we made a recommendation for the registered provider to refer to good practice guidance with regard to making the environment more suitable for those people who may be living with dementia. At this inspection we saw there was pictorial signage as prompts to locate toilets, bathrooms, the kitchen and people’s bedrooms had signs on the door with their names on.

We also recommended at the last inspection that the registered provider reviewed the action plans produced following in house audits and ensured they were more detailed and robust in the recording. During this inspection we found improvements had been made to the maintenance recording and checks were more in depth and made on a weekly basis.

We found that people’s medicines were stored and administered appropriately. We saw medicine audits had not been completed since September 2016, but were completed regularly prior to that.

People living at Keb House said they felt safe and that staff were kind and caring. There were risk assessments in

Inspection carried out on 7 January 2016

During a routine inspection

Keb House is a care home situated in the village of Appleby near to the town of Scunthorpe and provides support for up to 18 older people, some of whom maybe living with dementia.

At the time of our inspection 12 people were been supported to live at the service. The service comprises of an older style Victorian house and a newer build single storey annex extension. The service offers en-suite rooms, various communal lounges and dining areas, a busy bee activity room, a kitchen, a laundry and outdoor garden space with seating areas. The service is accessible for people with mobility difficulties and onsite car parking is available.

The inspection was unannounced and took place on 7 January 2016. The last inspection was completed in December 2014 and the service was non-compliant in one of the five areas we assessed and required improvements in a further three areas. We then completed a follow up inspected at the service in March 2015 and found the service to be compliant. We did not change the overall rating of the service at the follow up inspection from requires improvement as we wanted to determine if the service could sustain the improvements that had been made over a longer period of time. The service had 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.

We found the service required improvements to three out of the five key areas we inspected. During this inspection we found a number of maintenance issues that required attention at the service. These included chipped paintwork, peeling wall paper, cracked windows and poor lighting in areas of the service.

We saw that one of the bathrooms had a storage cabinet which contained bath and hand towels which should have been stored in the rooms of people who used the service to prevent cross contamination. There was also a build-up of dust and dirt behind the cupboard where it had not been cleaned sufficiently. We found this was a breach of one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of this report.

Staff understood the principles and processes of safeguarding vulnerable people and had received training to support them. People living at the service said they felt safe and told us that staff were good and caring. We found that medicines were stored and administered appropriately in line with current guidance.

Staff had been recruited safely and appropriate checks were completed prior to them working with vulnerable people. Staff had good knowledge and an understanding of the needs of the people who used the service.

People were given choices at mealtimes, although the atmosphere over the lunchtime period was very quiet with no music playing and very little conversation taking place. Staff received regular supervision and appraisals and an on-going training programme was provided to assist staff to increase their knowledge and skills.

We observed that staff spoke in a positive way to people and treated them with respect. Staff and people who used the service interacted in a positive way and observations showed good relationships existed between them. People who used the service were offered a range of activities which they were encouraged to participate in.

We saw that accidents and incidents at the service had been documented and evaluated so that lessons could be learnt to help the service develop and improve. The registered manager was following the principles of the Mental Capacity Act 2005 (MCA) although no application had been submitted in respect of people being deprived of their liberty. The Mental Capacity Act 2

Inspection carried out on 21 November and 1 December 2014

During an inspection to make sure that the improvements required had been made

Keb House is a care home situated in the village of Appleby near to the town of Scunthorpe. It comprises of an older Victorian style house and an annexe of a single storey purpose built extension. There is a courtyard used for parking and domestic needs with a garden and sitting area to the front of the home. The newer part of the home has its own kitchenette, dining area and lounges. Accommodation comprises of 16 single bedrooms and one shared room, seven of which have ensuite facilities. At the time of our inspection 12 older people, many with dementia were using the service.

The service had 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.

This inspection was unannounced and took place over two days. The previous inspection of the service took place on 15 August 2013 and no issues were identified.

During the course of our first inspection visit we observed there were a number of issues relating to infection prevention and control. We found windows in one corridor contained large, thick cobwebs. We found problems with how mops were stored and the hand washing facilities in the laundry were insufficient. Although staff told us they had been trained in infection control procedures, they were not aware of the risks the issues we identified may pose.

The problems we found breached Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the registered provider to take at the back of the full version of the report.

We reviewed the care records for two people who the registered manager told us could not make decisions for themselves. We found no mental capacity assessments or best interests meetings had been undertaken. This meant there were no meetings with people’s families, external health and social work professionals, and senior members of staff should people be unable to make complex decisions for themselves. This showed any decisions made on the person’s behalf were not done so, after consideration of what would be in their best interests.

The problems we found breached Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the registered provider to take at the back of the full version of the report.

People who used the service told us they felt safe. Records showed staff had been trained in safeguarding vulnerable adults from harm or abuse. The registered provider had policies and procedures in place to protect vulnerable people from harm and abuse. Staff were aware of the registered provider’s whistleblowing policy and how to contact other agencies with any concerns.

Medicines were stored securely and administered safely. Records showed people received their medicines on time and in accordance with their prescription.

Our observations showed that people who used the service received regular interaction from members of staff although at the time of our inspection visits people did not receive any stimulation through activities.

People were supported by staff to maintain their privacy, dignity and independence. When possible, staff involved people in choices about their daily living and treated them with compassion, kindness, and respect.

Staff told us they felt supported by the management. The registered manager had put in place a quality assurance system using audits. They regularly surveyed people who used the service and their relatives to gain feedback. People and relatives told us the registered manager was approachable and listened to their views. One person said, “I can always ask the manager if there is anything I want to know.”

Inspection carried out on 18 July 2013

During an inspection to make sure that the improvements required had been made

We found that since the last time we visited, a new system of care planning had been introduced, to enable staff to support the people who used the service. We saw evidence that people who used the service and their relatives had been involved in the development of their care plans to ensure their wishes and feelings about this were respected.

People who used the service told us they were “Comfortable” and that staff were “Kind and helpful.” People told us that staff supported their health needs and took prompt action to involve external professionals when this was required.

We observed there was a relaxed atmosphere throughout the service on the day of our visit. We saw staff interacted with people in a friendly way, offering gentle encouragement to ensure their involvement in choices about their support.

Relatives we spoke with told us they were satisfied with the service provided. They told us they visited regularly and that staff kept them informed about changes concerning their members of family. Relatives told us that staff, “Do a wonderful job” and that they were, “Always made to feel welcome, no matter what time of the day.”

We observed that people who used the service were clean and looked well cared for and that the building had no unpleasant smells. One relative told us the bedroom of their member of family was, “Kept spotlessly clean” and that domestic staff ensured it was “Always neat and tidy.”

Inspection carried out on 17 April 2013

During a routine inspection

People told us they were “Comfortable” and that the service was “Really, rather good.” We observed staff talking and listening to people in a friendly and compassionate manner to ensure their personal dignity was maintained. We saw that staff involved people in relation to their support, to ensure they were provided with choices about how this was delivered.

We found that information about people was unsystematically maintained. We found that further work was required to ensure accurate care planning information was available for people, to enable their support to be delivered in a planned and consistent way that ensured their welfare and safety.

People who used the service told us their comments were taken seriously by the provider and that they were confident action would be taken, to ensure any concerns were appropriately addressed. Recent letters of relative thanks commented: “Thank you and your staff for the wonderful support you are providing” and “Pleased to see the good care xxxxx is receiving.”

Inspection carried out on 3 October 2012

During a routine inspection

We observed staff providing support in a friendly and supportive manner and we found that people’s bedrooms were highly personalised, to ensure their individual preferences and wishes could be respected. We observed that people were clean and looked well looked after. People told us they were “Very happy” with the service provided and had no concerns. A visiting relative told us that staff were “kind” and were quick in providing assistance when required.

We found that a range of assessments of people had been carried out to ensure they were kept safe from potential harm, although we observed that reviews and evaluations of their support had not always been consistently recorded in recent months.

We found that staff were provided with training to help them to carry out their roles, however we found this had not always been renewed in a timely fashion.

We found that systems were in place to enable people to share their views about the service, but that administration systems needed further development to ensure that potential risks could be easily identified.

Inspection carried out on 9 June 2011

During an inspection in response to concerns

We spoke to a number of people who use the service including those attending on a day care basis and they spoke positively about the staff, service and care they received. We received comments such as “staff are really good”, “plenty of hot water” and the home was “nice and warm”. People who use the service told us that they could have a bath or shower whenever they wanted to and staff helped them with anything they needed. People told us that they always received their medicines and the home was clean.

People we spoke to had no concerns or complaints about the service.

During a routine inspection

We have not spoken directly to people who use this service in undertaking this review. We last inspected this service under the previous regulatory system on 20 July 2009 and we observed that interactions between staff and people living in the home was positive and friendly. We received positive feedback from people using the service and their relatives which indicated their rights were promoted and the service was responsive to their needs. The relatives and friends of people who use the service told us that they were involved in the life of the home and that staff listen to them to ensure their wishes and feelings were respected and they were confident that any concerns would be listened to and acted upon.

North Lincolnshire Council undertook an assessment of this service on 17 November 2010 and they told us that the involvement, control, and independence of people who use the service was good with respect for people that use the service being assessed as excellent.

Reports under our old system of regulation (including those from before CQC was created)