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Archived: Knyveton Hall Rest Home Requires improvement

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Inspection report

Date of Inspection: 11, 12 August 2014
Date of Publication: 6 October 2014
Inspection Report published 06 October 2014 PDF


Inspection carried out on 11, 12 August 2014

During a routine inspection

We carried out a responsive inspection of Knyveton Hall Rest Home because of concerns we had received about the care provided to people living at the home and staffing levels.

This was an unannounced inspection which was undertaken over the course of two days. The care manager assisted us throughout the inspection.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

There were 36 people living at Knyveton Hall Rest Home on the day of our inspection. We spoke with nine people, one relative, the care manager, three members of staff the district nurse and a GP.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Care was not always delivered to meet people's needs. Where a need was identified, a plan was not always in place to meet this need. One person was identified as being at high risk of skin breakdown. We saw their care plan stated that they required an air mattress to protect this person from skin breakdown. However, when we checked this person's bed, we found that there was no air mattress in place. This meant that care and treatment was not always planned and delivered in a way that was intended to ensure people's safety and welfare.

People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. We found that some people living in the home had been prescribed creams. There were no care plans in place for people who required creams that set out where the creams were to be applied and how often. There were no records that showed that creams had been applied as prescribed.

During the inspection we found two wooden ramps, situated on the ground floor and first floor of the home. These were used to cover the stairs to enable carers to push people in wheelchairs up and down them. On closer examination of the ramps, we found that they were slippery, unstable and not purpose built. Following our inspection we raised our concerns with Bournemouth Borough Council safeguarding and health and safety team.

There were enough qualified, skilled and experienced staff to meet people's needs. We spoke with three members of staff during our visit who told us that they felt the home was appropriately staffed to enable them to provide good care to people living in the home. One member of staff told us "I have no concerns really, we work as a team."

Is the service effective?

Where people did not have the capacity to consent, the provider did not act in accordance with legal requirements. We found that where people had cognitive impairments associated with living with dementia, mental capacity assessments had not been completed. We looked at the care plan for one person with a diagnosis of Alzheimer's disease and found that mental capacity assessments and best interest decisions were not recorded. For example, we saw that the person had received a flu jab in the winter and they were having their medicines administered by staff. There was no capacity assessment in place for this person, nor was there a best interest decision recorded.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. No applications had been submitted; however, the care manager explained that following the recent Supreme Court ruling, they were in the process of preparing DoLS applications to submit to the local authority. The provider had a policy and relevant staff understood how an application should be made.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. Prior to our inspection concerns had been raised with CQC regarding one person�s pain relief medication being posted via untracked post to another care provider. We discussed this incident with the provider who confirmed this. This may have caused significant delay to the person receiving pain relief and there was an additional risk of the medicine becoming lost.

Is the service responsive?

We looked at the care plan for one person and saw that they were identified as at high risk of malnutrition. Their care plan stated "food and fluids monitored." However, there were no food monitoring charts in place for this person. They had not been weighed since the 2 May 2014 and their Malnutrition Universal Screening Tool (MUST) was incomplete. This meant that the provider could not be sure if the person was underweight to enable them to plan and deliver care in a way that was intended to ensure the person's safety and welfare. Another person was too frail to be weighed; we found that the provider had not considered any other methods such as measuring Mid-Upper Arm Circumference (MUAC) to ensure that the person was protected against the risks of inadequate nutrition.

Is the service caring?

We found the service was caring as people were treated with dignity and respect. We spoke with nine people who told us that they were happy with the service they received at the home. They told us they got on well with the staff, who respected their privacy and dignity. One person said "I find them very helpful. I don't have a problem with the staff at all." Another person told us "The girls are very good, excellent actually." A visitor told us that they felt their relative was treated with dignity and respect.

We observed positive interactions between staff and people living at the home during the inspection. We saw staff took time to listen to people when they needed support. We observed the lunchtime meal and saw that where people required assistance to eat, staff supported people in a relaxed and dignified manner.

Is the service well led?

The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. This was because of the shortfalls we identified in the assessment, planning and delivery of care and support to people. In addition to this we identified serious shortfalls in the safety of the premises. This was because the provider had not assessed and managed the risks and safety of the premises.

There was evidence that learning from incidents / investigations took place and appropriate changes were implemented. We looked at accident and incident records and found that there were details of what had occurred, actions taken if required and a periodic analysis to check for trends or triggers. For example, one person had been referred to the GP as they had been repeatedly falling in the home. We saw that as a result of this the person's medication had been changed to ensure their safety and welfare.

People were able to comment on the service provided. People told us that they had recently attended a resident meeting on the 01 July 2014 which included topics such as the summer fete and the importance of good hydration. We saw the minutes of the residents meeting which corroborated this.