Background to this inspection
Updated
14 October 2016
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 13 September 2016 and was unannounced. One inspector undertook the inspection.
Prior to this inspection we reviewed the information we held about the service, including the statutory notifications received. Statutory notifications are notifications that the provider has to send to the CQC by law about key events that occur at the service. We also reviewed the information included in the provider information return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.
During the inspection we spoke with three people living at the home, five relatives representing three families, and seven staff including the registered manager and one of the directors. We reviewed six people’s care records and three staff files. We undertook general observations at lunchtime and throughout the service. We looked at medicines management processes and records relating to the management of the service.
After the inspection we spoke with a representative from the local authority. We also received additional evidence from the registered manager in regards to audits and findings of satisfaction surveys.
Updated
14 October 2016
We undertook an unannounced inspection on 13 September 2016. At our previous inspection on 4 September 2014 the service was meeting the regulations inspected.
Kelstone Court provides accommodation and nursing care to up to 30 older people. At the time of our inspection 26 people were using the service.
At the time of our inspection a new manager was in post. They had been in post for four weeks and were in the process of applying to become the registered manager. 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.
People were not always protected from risks to their health and safety. Environmental risk assessments had not been completed and the risks to people’s safety posed by the environment had not been considered or mitigated. Individual risks assessment were not regularly reviewed and adequate management plans were not in place to mitigate the risks, particularly in regards to the prevention of pressure ulcers, moving and handling and the prevention of falls.
Adequate assessments had not been undertaken to identify people’s needs and the support they required. Care plans did not contain sufficient information to ensure people’s care needs were met. Care plans were not updated in line with their changing needs, and did not provide accurate information about their current support needs.
Staff were aware of who was receiving end of life care, however, their care records had not been updated to reflect this. We also saw that advanced care plans were not updated, and there was a risk that people’s wishes and preferences had changed without this being captured and made available to staff.
There were insufficient processes in place to review and monitor the quality of service, including reviewing the quality of service delivery and ensuring accurate, complete and contemporaneous care records were maintained. Where the current processes had identified that improvements were required this had not always been actioned.
The environment was not being adequately maintained to ensure it was suitable to meet people’s needs. There were stains to walls and carpets, and peeling paintwork throughout the service. The provider informed us they were in the process of rolling out a redecoration programme, and we saw that this had been started.
There were sufficient staff deployed to meet people’s needs. There had been a high turnover of staff in the last year, and the manager was in the process of rebuilding the staff team. At the time of our inspection there was a reliance on agency staff, however, the manager ensured as much as possible that the same agency staff were used to maintain consistency in staffing.
Staff had the knowledge and skills to undertake their duties. They were required to complete training considered mandatory by the provider, and attend regular refresher courses. At the time of our inspection the staff were due to refresh their training, and we saw that courses had been booked. The new manager was also in the process of scheduling supervision sessions with staff to review their performance, and identify any support they required to undertake their duties.
Staff adhered to safeguarding adults procedures. They were able to describe signs of possible abuse and escalated any concerns observed to their managers and the local authority. Staff also adhered to the Mental Capacity Act 2005 and ensured people consented to the care and support provided. Where people did not have the capacity to consent, best interests’ decisions were made. The manager had organised for everyone with authorisation to be deprived of their liberty to be reviewed to ensure the restrictions were still appropriate.
Safe medicines management processes were in place and people received their medicines as prescribed. Staff were aware of people’s dietary requirements and liaised with healthcare specialists where they had concerns about people’s nutritional intake or swallowing. Staff organised for people to access healthcare professionals in order for their health needs to be met.
Staff were caring and interacted with people in a polite and friendly manner. They informed people about what support they wanted to deliver, and involved people in decisions about how they were cared for. Staff respected people’s privacy and dignity.
A range of activities were made available to engage and stimulate people. People had the opportunity to access individual and group activities, as well as accessing local amenities.
People and their relatives were aware of how to make a complaint. The complaints process had been updated to ensure it was in line with best practice and ensure people and their relatives knew they were able to complain to the home manager. People and their relatives were asked for their opinion about the service through the completion of annual satisfaction questionnaires.
Staff morale was improving and there was good team working. Staff felt able to access the manager and express their views and opinions. Staff felt any suggestions made were listened to. The manager was in the process of reintroducing a staff meeting to further obtain staff’s opinions and disseminate information about the changes the manager was making to improve and strengthen service delivery.
The provider was in breach of the legal requirements relating to person-centred care, safe care and treatment, suitability of premises and good governance. You can see what action we have asked the provider to take at the back of this report.