Archived: Keswick House

Updated 10 December 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by one inspector, an assistant inspector and a specialist advisor. The specialist advisor had specialist knowledge of learning disabilities.

Service and service type

Keswick House is a ‘care home’. People in care homes receive accommodation and nursing or 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.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The registered manager was unavailable at the time of the inspection and we spoke with the acting manager at the time of the inspection.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We reviewed the information we held about the service. This included notifications about events that had happened at the service, which the provider was required to send us by law. For example, safeguarding concerns, serious injuries and deaths that had occurred at the service. We gained feedback from commissioners who have experience of working with the service. We used all of this information to plan our inspection.

During the inspection

We spoke with eight people who used the service and two relatives about their experience of the care provided. We spoke with five members of staff including the provider, the acting manager, senior care workers and care workers.

We reviewed a range of records. This included seven people’s care records, daily records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including quality audits, incidents and safeguarding.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and improvement plans.

Updated 10 December 2019

About the service

Keswick House is a residential care home that was providing personal and nursing care. The service supports people who have a learning disability.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 15 people. 13 people were using the service at the time of the inspection. This is larger than current best practice guidance detailed in Registering the Right Support. The provider had started to work towards meeting best practice guidance and people were encouraged to increase their independence. The staff culture was changing, and they understood the importance of supporting people when they needed it, whilst prompting people to make their own choices. Further improvements were needed to mitigate the impact of the environment on people.

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

The provider’s legal entity was registered with us as a partnership and remained inappropriate at this inspection due to concerns that had been raised about the partnership. Action still needed to be followed to ensure the new company registration continued. Improvements were needed to ensure all systems to monitor the service were effective in identifying and mitigating risks.

Improvements to the environment were ongoing to ensure infection control risk were mitigated and the design reflected the needs of people. Staff knowledge and skills still required further development to ensure people received effective care.

We made a recommendation for the provider to seek guidance on the advance planning of people’s end of life wishes.

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. Improvements were still needed to ensure the policies and systems in the service supported this practice.

Risks to people’s health and wellbeing were identified and managed to keep people safe. There were enough staff available to provide support in an unrushed way and to meet people’s needs. People were supported with their medicines as prescribed.

People were involved in the planning and preparation of their meals and their nutritional needs were monitored and managed. People were supported to access health professionals and advice received was followed by staff.

People were supported by caring staff who respected people’s choices. People were encouraged to make choices and to increase their independence. People’s privacy was upheld.

The service had started to apply the principles and values of Registering the Right Support and other best practice guidance. The outcomes for people using the service had started to reflect the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People received support in line with their preferences and they were involved in the planning and review of their care. Goals were set by people with support from staff to help them achieve a greater independence. People accessed the community and were involved in activities which they enjoyed.

People, relatives and staff were able to approach the registered manager if they had concerns and the registered manager worked in partnership with other agencies.

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 (published 12 July 2019) and there were multiple breaches of regulation. At this inspection the service had made some improvements and there was one remaining breach of regulation. The service remains rated requires improvement.

This service has been in Special Measures since 06 November 2018. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was planned to follow up on the concerns at the last inspection in line with our ‘special measures’ procedures. We needed to check that people were supported safely and whether the provider was meeting the Regulations.

We found improvements had been made. However, there were still improvements needed to ensure people received a good service in all areas of their care. We rated the key questions of Effective and Well led as Requires Improvement. The overall rating is Requires Improvement.

Enforcement

We have identified a breach in relation to ensuring directors are fit and proper persons at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.