Archived: Kenmore - Care Home with Nursing Physical Disabilities

Kenmore is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Kenmore is registered to provide nursing and residential care for up to 26 people. At the time of the inspection 16 people were living at the home.

At the time of the inspection the home did not have a registered manager in place. The registered manager had left the organisation in March 2018, an acting manager had been in post since then. A new manager had been recruited, they had commenced employment on 17 September 2018, they had not yet commenced their application to register with the Care Quality Commission. 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 told us they felt safe. Risk assessments were in place and people received appropriate care and support where a risk was identified. Many of the previous concerns regarding medicines had been addressed although further work was required to ensure records provided sufficient detail.

Previous concerns regarding the risk of Legionella had been addressed. Equipment was serviced and maintained. Work was still to be done to meet the recommendations of a recent fire risk assessment.

Improvements had been made to staff recruitment. Staff efficiency had been improved by the introduction of walkie talkies.

New staff received an induction when they commenced employment. Most staff were up to date with their training requirements. Although some topics were listed as being ‘one off’, this meant staff did not receive refresher training in that subject. Staff were now being supported through regular supervision.

People spoke positively about the meals at Kenmore. Staff supported people to eat and drink, patiently and with discretion. We identified one person who had recently lost weight, however, their records had not been updated to reflect this.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, records did not always evidence the requirements of the Mental Capacity Act 2005 had been consistently met. We have made a recommendation about meeting the requirements of Mental Capacity Act.

People and relatives told us staff were caring and kind. Staff treated people with kindness, respect and compassion. People told us staff respected their choices and staff encouraged people to retain their independence and life skills.

Staff and a number of volunteers supported people to engage in a range of activities both in the home and in the community.

Peoples care records had been updated and reviewed to ensure they were person centred and reflective of their care and support needs. Although no one at the home was receiving palliative care, the home was due to re-commence its work towards achieving accreditation for end of life care

Many of the issues raised at our previous inspection about a lack of effective governance had been addressed. The acting manager had ensured the registered providers programme of audits was implemented. These helped track the progress of the service in addressing the failing identified at our previous inspection. The acting manager had ensured regular meetings were held with staff, residents and relatives, improving communication between people, relatives, staff and management. Feedback about the acting managers conduct and approach was consistently positive.

The service is no longer in Special Measures. This is the first time the service has been rated Requires Improvement.

Kenmore is registered to provide nursing and residential care for up to 26 people. When we inspected, 20 people were using the service. The building is a converted older house with a more modern annex attached. Most people’s rooms were in the ground floor annex, although some people’s rooms were on the first floor of the older part of the building; rooms there were accessed via a lift. People’s rooms had sinks and were located near communal bathrooms and toilets. The home had a large dining room, two sitting rooms and an activity room.

Kenmore is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At the last inspection we rated the home as ‘Requires Improvement’ in all five of the five key questions and identified breaches of Regulation 9 (person-centred care), Regulation 12 (safe care and treatment), Regulation 18 (staffing), and Regulation 17 (good governance). We asked the registered provider to send us an action plan to include when and how improvements would be made. The action plan we received stated all concerns would be addressed by February 2017.

At this inspection we found little improvement had been made, and identified breaches of Regulation 12 (safe care and treatment), Regulation 17 (good governance), Regulation 18 (staffing), Regulation 19 (the employment of fit and proper people), and Regulation 11 (consent). The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.”

The home had a registered manager. A registered manager is a person who has registered with CQC 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.

We found some issues with medicines management identified at the last inspection had not been addressed. The application of people’s topical creams was not always recorded. Records could not evidence how medicines errors at the home had been learned from to prevent them happening again in the future.

Risk assessments were not always updated regularly. This was a finding at the last inspection. The quality of people’s moving and handling care plans varied. We observed an agency care worker put a person at risk of choking by not supporting them to eat in accordance with their care plan.

People and relatives told us there was not enough staff deployed to meet people’s needs at Kenmore. There was a reliance on agency nurses and care workers due to staff sickness and long term leave.

Recruitment records could not evidence fit and proper persons had been employed.

Staff told us they received training, however, training records could not evidence staff had received the training they needed to meet people’s needs. Staff had received appraisals, but their access to supervision had not improved since the last inspection.

As at the last inspection, records could not evidence the registered provider was compliant with the Mental Capacity Act 2005. One person’s liberty was being restricted and records failed to show why this was being done and how the person had been involved in decision-making.

Feedback about meals at the home was mixed. The catering supervisor was responsive to feedback and people had been asked for alternative meal ideas.

We identified issues with communication of people’s needs between the staff team. Relatives gave examples of when important information had not been passed to them. Feedback from visiting healthcare professionals was generally positive. People were supported to meet their holistic health needs.

Feedback about care staff from people and their relatives was not all positive. Some people told us care staff did not always respect their privacy and were not all kind and caring. Relatives told us staff were caring but did not always promote people’s dignity.

People’s care plans contained information about their personal histories and preferences. Staff knew people well as individuals and could describe their likes and dislikes. People and their relatives were involved in planning and reviewing their care.

The service supported people to meet their equality and diversity needs although this was not well documented.

As at the last inspection, the quality of people’s care plans varied. Some were individualised, detailed and up to date; others consisted of a list of tasks and were over two years old. We identified inconsistencies in people’s care plans and aspects which needed to be updated.

Formal complaints had been investigated and resolved but this was not always documented. Two people and one relative told us they had complained about a specific issue but there was no record of this in the complaints folder.

Some people told us they enjoyed the activities on offer at Kenmore, whereas others did not. We saw people engaging in activities during the inspection. Most people told us they wanted to go on more outings. We recommended the service involve people in a review of activities provision.

People, relatives and staff told us the registered manager spent most of the time in her office. Not all people and relatives thought the home was well-managed.

An action plan submitted after the last inspection had not been implemented. Audit systems and oversight by the registered provider and registered manager had failed to resolve and prevent new and continuous breaches of regulation.

People and staff raised concerns about a lack of communication and involvement in decision-making at the home.

We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

The home had a 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.

Kenmore provides both accommodation and nursing care for up to 26 people who have physical disabilities. People who use the service are usually between the ages of 18 and 65. People aged over 65 are not routinely admitted to the service but there may be cases dependent on the person’s medical condition or needs when this would be appropriate. Kenmore is considered a home for life so people may stay as long as their needs can be met. The home is a detached Victorian house set in its own grounds extended to provide single room accommodation on the ground and first floor. At the time of the inspection there were 26 people who used the service.

The service did not have systems in place to make sure people received their medicines as prescribed. Written guidance for ‘as required’ medicines was not available and staff did not always take the daily temperature of the room and fridge where medicines were stored. The registered manager told us any medicine errors were fully investigated, however records were not available during the inspection to confirm this.

One person and a relative told us dignity had been compromised on occasions with staff arriving too late to provide personal care. We pointed this out to the

registered manager at the time of the visit who told us they would discuss our concerns with staff immediately to make a positive difference.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. However, the testing of water temperatures was not planned to make sure baths, showers and sinks were tested at the same frequency.

Risk to people’s safety had been assessed by staff and these included risks with moving and handling, nutrition, falls, the use of specialist equipment and risks associated with personal care. Some risk assessments were better than others and detailed preventative measures to keep people safe. However, some risk assessments contained limited information. This meant staff did not always have detailed written guidance to help keep the person safe. We noted that there were some gaps in the reviewing of risk assessments.

The registered manager told us that staffing levels were reviewed on a regular basis to ensure people's needs were met. We didn’t see any examples during the inspection of people being kept waiting and call bells were generally answered within three to four minutes.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met. People subject to DoLS had this recorded in their care records. However, mental capacity assessments were not decision specific. Best interest decisions were not recorded in care plans.

Staff had not received regular supervision or an annual appraisal. Staff were aware of their roles and responsibilities and had the skills, knowledge and experience to support people who used the service. Staff told us they received mandatory training and other training specific to their role. Training records were held centrally by the registered providers learning and development department. There was an online HUB where staff training was recorded but we were told that updates to this take many weeks and sometimes months which always makes training statistics appear low. Reports of training we were provided with showed training was out of date for many staff, however the registered manager provided reassurance that all staff were up to date with their training it was the training statistics that were inaccurate.

Care records were insufficiently detailed to enable staff to provide safe care and treatment. Care records had not been reviewed and updated on a regular basis. Care records contained some information about the person's likes, dislikes and personal choices, however some were task orientated and did not contain sufficient detail to be person centred.

Quality monitoring was ineffective and did not pick up on the issues we found at this inspection. Staff meetings were infrequent.

People were protected by the services approach to safeguarding and whistle blowing. People who used the service told us they felt safe and could tell staff if they were unhappy. People who used the service told us that staff treated them well and they were happy with the care and service received. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and said that management acted appropriately to any concerns brought to their attention.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

We saw that people were provided with a choice of healthy food and drinks, which helped to ensure that their nutritional needs were met. The service had achieved Kirklees Healthy Choice Award from Kirklees Council (gold standard) which acknowledges good standards of hygiene and places that offer healthy eating options.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

There were positive interactions between people and staff. Staff were attentive and interacted well with people. Observation of the staff showed that they knew the people very well and could anticipate their needs. People told us that they were happy and felt very well cared for.

People’s independence was encouraged. Activities, outings and social occasions were organised for people who used the service.

The registered provider had a system in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident that staff would respond and take action to support them.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of the full version of this report.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with the manager and other staff and looking at records.

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

Is the service safe?

We found that the service was safe because people were protected against the risks associated with use and management of medicines.

People received their medicines at the times they needed them and in a safe way. Medicines were administered appropriately and kept safely.

Is the service effective?

We found that care plans for managing medicines were up to date and care workers had clear information to follow to ensure that people were supported to take their medicines safely and in a way that met their individual needs and preferences.

Is the service well led?

We saw that the service's managers had acted quickly in exceptional circumstances to secure a continued supply of medicines for people living in the home. We saw that audits (checks) of medicines were carried out regularly to assess the way medicines were managed and to ensure that people continued to receive the support they needed.

We saw that areas were clean and tidy, and there were cleaning schedules in place for all rooms which were up to date. We also saw checks were being completed by the manager and action plans put in place which identified areas of improvement.

We walked around the building and found that the building had large communal rooms and space for wheelchairs to pass. There was a lift in the building for service users to travel between floors.

Some of the comments included:

'It's pretty good, each of us gets our own distinctive room, set up correctly.'

'Staff are good, home is O.K, no problems.'

'Brilliant, very good. Staff are good and understand his needs. They try and encourage him to be involved in activities. The food is nice and we are on first name terms with staff and manager.'

"I am extremely happy with the service. She is safe and well cared for. Staff are fantastic."

We found staff respected people and ensured consent was gained before they helped with care or treatment.

We found appropriate arrangements were in place to ensure the safety and welfare of people who used the service.

However, we found appropriate arrangements were not in place in relation to medicine management. There were discrepancies between the recorded and actual stock levels of some medicines. Documentation was not always completed consistently.

We found robust recruitment processes were in place to ensure staff employed by the service were suitable for the role.

Effective procedures were in place to ensure people's comments, suggestions and complaints were recorded and acted on.