Kitwood House Care Residence

Kitwood House Care Residence is a residential care home, providing personal and nursing care to 60 people at the time of the inspection. The service can support up to 68 people across 4 units and specialises in providing care to people living with dementia. Two of the units provide support for people with complex needs and expressions of emotional distress.

People’s experience of using this service and what we found

Systems and procedures were in place to protect people from abuse. People received their medicines as prescribed, administered by trained and competent staff. During the inspection we observed there were sufficient staff to meet people’s needs. People received support from a consistent and familiar staff team. Safe recruitment procedures were followed, including relevant safety checks. Systems were in place to prevent and control the spread of infection and staff had access to plentiful supplies of personal protective equipment, such as masks, aprons and gloves. At the time of the inspection there were no restrictions in place regarding visiting arrangements.

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

Staff received training relevant to their role. There was an induction programme for permanent and agency staff. People’s nutritional needs, risks and preferences were assessed and regularly reviewed. We observed the lunchtime experience to be a calm and sociable experience, where staff assisted people who required support with their meal in a warm, friendly and unhurried manner. People spoke positively about the food on offer. People were offered choice and cultural dietary needs were considered and catered for.

Governance systems were in place to assess and monitor the quality of the service. People and staff told us there was a positive culture within the service and felt the service was well-led. The manager demonstrated a clear focus to continually improve the service and to capture learning at every opportunity.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (25 January 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations relating to safeguarding people from harm, safety around medicines and accidents and incidents, staffing, and good governance.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 25 November 2021 and 9 December 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding service users from abuse and improper treatment, staffing and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kitwood House Care Residence on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Kitwood House Care Residence is a residential care home providing personal and nursing care to 21 people at the time of the inspection. The service can support up to 68 people across four units and specialises in providing care to people living with dementia. Two of the units provide support for people with complex needs and expressions of emotional distress.

People’s experience of using this service and what we found

People were not always protected from the risk of avoidable harm. Staff did not always have the skills or experience to support people with complex needs and expressions of emotional distress.

When safeguarding incidents occurred the provider did not always ensure lessons were learnt to prevent repeat or further incidents happening.

The provider failed to ensure COVID-19 guidance was consistently followed. We found some agency workers had been deployed without checking they had been vaccinated against COVID-19. During the inspection the provider took action to improve their system for checking agency workers vaccination status. Other aspects of COVID-19 guidance including testing and use of PPE was sufficiently managed.

People were supported by a high number of agency workers because the provider had not been able to recruit sufficient numbers of permanent staff. People did not always receive consistent support and relatives told us they were concerned about the amount of agency staff relied on. The provider did not always ensure agency workers were checked for good character or training before they were deployed.

Medicines were not always effectively managed. We found shortfalls in relation to the management of covert medicines, stock control and record keeping.

The environment was purposely designed to facilitate and improve orientation and quality of life for people who live with dementia. Excellent hygiene standards had been maintained. Regular maintenance checks were undertaken to ensure good housekeeping and equipment safety.

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

People’s needs, preferences and pastimes were assessed and reviewed on a regular basis. However, the provider had not fully considered their model of care to effectively design and review support for people who lived on the ‘Dementia Plus’ unit. This unit was designed to support people who displayed complex levels of emotional distress. These people required staff with enhanced knowledge and training to support them. During the inspection the provider took action to improve staff training and liaised with external health and social care professionals to improve people’s experiences.

Staff told us they felt supported and listened to by the senior management team. The provider had quality assurances processes in place and a strong senior management team. They showed they had the ability to remedy concerns identified during the inspection processes. The nominated individual transparently shared their route cause analysis of why failures had occurred. They had worked closely with commissioners to improve safety standards.

Staff supported people in a kind and dignified way. People and relatives told us they were happy with the way staff supported them. People had regular access to stimulating and meaningful activities.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 02/08/2021 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding incidents. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report.

During and after the inspection the provider took action to mitigate the risks we identified. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safeguarding people from harm and abuse, medicines management, staff training and deployment and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.