Archived: Kinross

Updated 6 January 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 14 and 15 November 2017 and was unannounced. The inspection was prompted in part by concerns which were raised to us about the availability of staff at night and the way this affected the care people were receiving. Part of the inspection was completed during the evening on the 14 November 2017.

The inspection was undertaken by two inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

Before the inspection we reviewed information that we held about the service including previous inspection reports and notifications. A notification is information about important events which the service is required to send us by law.

We spoke with 14 people living at the home and four visitors. We spoke with the registered manager, clinical lead, four care staff and ancillary staff including, the cook and housekeeping staff. We also spoke with two visiting healthcare professionals including a care consultant who supported the home. We looked at care plans and associated records for seven people, records relating to staff recruitment, training and support, records of accidents and incidents, policies and procedures and quality assurance. We observed care, support and activities being delivered in communal areas.

Updated 6 January 2018

The inspection took place on the 14 and 15 November 2017 and was unannounced. Two inspectors and an expert by experience in the care of older people carried out the inspection. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Kinross is registered to provide accommodation for up to 29 older people. There were 27 people living at the home at the time of the inspection. The home is a large property and accommodation is arranged over two floors, the ground floor offering dining and lounge areas and bedrooms. The upper floor had most of the bedroom accommodation. Bathrooms and toilets were provided on both floors. There was a lift and stairs available to access the upper floor.

Kinross is a ‘care home’. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. We found the home to be clean and tidy throughout the inspection.

A registered manager was 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.

Previous inspections of the service in July 2016 and December 2016 had identified that the service had needed to make improvements to ensure people received safe effective care and that the service was well led. Whilst improvements had been made these have not been sustained over the longer term and there continues to be further improvements required.

A quality assurance process was in place. However, this had not identified the areas of concern we found during this inspection and ensured that improvements were sustained over time.

There were not always sufficient staff provided. In the late evening and overnight there would not be sufficient staff should an emergency occur.

Records of the assessment of people’s ability to make decisions about various aspects of their care had been undertaken and best interest decisions recorded. However, the recording did not clearly show discussions with other professionals involved with the person, or their family members and when these happened.

Although medicines were usually managed safely, systems were not in place to ensure times of administration were recorded where medicines needed to be taken at regular intervals.

Systems to ensure prescribed topical creams were used safely, to ensure medicines were only given with informed consent and individual information as to when ‘as required’ medicines should be administered required improvement.

Although staff felt supported they were not all receiving regular formal supervision.

We discussed these issues and some other minor issues with the clinical lead and registered manager who were responsive to the issues raised and undertook to take action.

Recruitment practices ensured that all pre-employment checks were completed before new staff commenced working in the home although full information about applicant’s previous employment was not always known. Staff were suitably trained and although they felt supported in their work.

Where necessary Deprivation of Liberty Safeguards (DoLS) applications had been made. Equality and diversity was seen to be actively supported with people being able to express themselves.

People received the personal care they required and were supported to access other healthcare services when needed. Staff worked well as a team and with external professionals.

People received a varied diet of their choosing and meal times were sociable unrushed occasions. Infection control procedures were followed and the home was clean.

People felt safe and staff knew how to identify, prevent and report abuse. Staff offered people choices and respected their decisions. Risks to people were managed safely with plans in place to minimise risks where possible. People were supported and encouraged to be as independent as possible and their dignity was promoted. People were encouraged to maintain relationships that were important to them.

Staff were ware of people's individual care needs and preferences although these were not always documented in care plans. People had access to healthcare services and were referred to doctors and specialists when needed.

People and external health professionals were positive about the service people received.

People and relatives were able to complain or raise issues on a formal and informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home.

Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are currently considering our regulatory response.