Archived: Kyffin Taylor

Kyffin Taylor is a residential care home that was providing personal care and accommodation to 26 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

Following the last inspection, we met with the provider to confirm what they would do and by when to improve the key questions Safe and Well Led to at least good. We asked the provider to take action to make improvements to monitoring people’s weight, and this action has now been completed.

We received positive feedback about the quality of care people received and the overall management of the service.

People told us that they felt safe living at the service. Care records provided detailed information around people's individual risks in order for staff to keep them safe from avoidable harm. Person centred care was delivered, giving people choice over their daily routines in line with their preferences.

Staffing levels were appropriately managed and people received care from consistent, regular staff. Enough staff were employed each day to meet people's needs and keep them safe. People and their relatives told us that care was provided in a safe and timely manner.

Recruitment processes were robust. The necessary pre-employment checks were completed and people received care from staff who were suitable to work in adult social care environments.

Processes and systems were in place to ensure people received their medicines on time from trained and competent staff.

People's overall health and well-being was effectively assessed and managed. Referrals were made to external healthcare professionals accordingly.

People received their medicines when they needed them from trained staff.

People made positive comments about the quality and standard of food they received. Menus offered a variety of home-made and fresh meals each day. People received support to eat their meals when required.

People were supported in a kind, caring and compassionate manner. Staff were familiar with the support needs of the people they were supporting.

The registered provider had a complaints policy in place. People and relatives knew how to make a complaint if they needed to. A recent complaint had been investigated in line with the provider’s procedures.

People were encouraged to participate in a programme of activities. Some people received support to attend church regularly.

The home was clean and hygienic. Health and safety measures were in place to ensure people lived in a safe, well-maintained environment.

More information is in Detailed Findings below

Rating at last inspection:

Requires Improvement (Report published 12 May 2018). At this inspection we found the overall rating had improved.

Why we inspected:

This was a planned comprehensive inspection based on the ratings at the last inspection. It is CQC methodology to re-inspect Requires Improvement providers within a 12 month timescale.

At the last inspection on 9 April 2018 we asked the provider to take action to make improvements for monitoring people’s weight loss and this action has been completed.

Follow up:

No concerns were raised within this inspection. We will therefore aim to re-inspect this service within 30 months. We will continue to monitor the service through the information we receive. If any concerning information is received we may inspect sooner.

Kyffin Taylor 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.

Kyffin Taylor accommodates up to 29 people, the majority of whom have dementia in one adapted building. The building has 21 rooms on the ground floor and eight on the first floor. There is a car park at the front of the home and secure, well maintained gardens at the rear.

There was no registered manager in post at the home. The previous registered manager had left in October 2017. However the current manager had submitted their application to be registered manager with the 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 living at Kyffin Taylor. Relatives said they had no concerns. People were weighed regularly but weight loss was not always identified and responded to promptly. We found a person had lost significant weight. Despite being weighed each month the weight loss had not been reported to the manager or deputy manager so action could be taken. Nutritional screening risk assessments, like a Malnutrition Universal Screening Tool (MUST) tool, were not used by the registered provider. 'MUST' is a five-step screening tool to identify adults, who are malnourished, at risk of malnutrition (under-nutrition), or obese. The manager took immediate remedial action and referred the person to health care services.

We saw there was enough staff on duty to provide care and support to people living in the home. Staff responded to people’s needs when they needed them; call bells were answered quickly.

Staff had been checked when they were recruited to ensure they were suitable to work with vulnerable adults.

Medicines were administered safely to people and stored safely and securely when not in use. Staff who administered medicines had received medicine training and had undergone competency assessments to ensure they had the skills and knowledge to administer medicines safely to people.

People's needs were assessed and care plans were completed to demonstrate the support required. Support plans were completed for all aspects of care, including personal care, mobility, falls and nutrition and were regularly updated.

The environment and equipment was well maintained and subject to service contracts and safety checks. All areas seen were clean and kept hygienic.

Staff sought advice from external health and social care professionals at the appropriate time. This ensured people's health was monitored effectively.

Staff sought the consent of people before providing care and support. The home followed the principles of the Mental Capacity Act (2005) for people who lacked mental capacity to make their own decisions.

Staff understood people's care needs and how they liked their care delivered. Staff could give examples of people's likes and dislikes and the support people required.

The environment was suitable for people living with dementia. Large signs for key areas such as, toilets and bathrooms were displayed. Bedroom doors were brightly coloured. Personalised identification outside each bedroom varied. There was a secure and well-kept garden for people to sit in.

Staff received regular support, supervision and training. Staff had received annual appraisals and had received regular supervision throughout the year. Most of the care staff had achieved an NVQ or Diploma qualification in health and social care at level two and three. New staff had completed the Care Certificate as required.

A three week menu was in place and we saw people offered choice of well balanced meals and snacks. People told us the food was good. People's nutritional needs were assessed and recorded.

We saw good standards of privacy and dignity for people receiving care in the home. Staff were kind and friendly in their approach to people. When supporting people to move from one place to another staff took time and were gentle and reassuring.

Care records showed people's plan of care was written in a way that reflected their wishes, preferences, needs and choices in areas such as people's routine, preferred foods and social activities.

Social activities were arranged including musical events, exercise and crafts.

Complaints received by the home were recorded and investigated appropriately.

End of life care was provided and the correct documentation had been completed. Staff had completed a recognised training course to support people to have a comfortable and dignified death.

Since the last inspection the provider had introduced a ‘Challenging Behaviour risk assessment which identified any known triggers, any de-escalation technique and identified any safeguarding risk. This document was now in use and had been completed for people displaying behaviour that challenged, because they had a diagnosis of dementia.

A number of audits were completed to monitor quality and drive improvement of the service provided. However an audit of care records on 31 January 2018 had not identified the issue we identified during this inspection.

Staff were supported by the manager and deputy manager through supervision and by attending regular staff meetings.

Feedback on inspection from people in the home and relatives was very positive regarding the care and support provided at Kyffin Taylor. People were able to provide formal feedback each year through questionnaires.

The rating from the last inspection was clearly displayed within the home as required.

You can see what action we told the provider to take at the back of the full version of the report.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our on-going monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Kyffin Taylor 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 home accommodates up to 29 people, the majority of whom were living with dementia in one adapted building. The building has 21 rooms on the ground floor and eight on the first floor. There is a passenger lift to the upper floor and an enclosed garden at the rear. There were 28 people living in the home at the time of our inspection.

There had been recent changes to the management at Kyffin Taylor. The last registered manager left in October 2017. The provider had begun the process to find a replacement. The deputy manager was the ‘acting 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.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, Is the service Safe? And Is the service Well Led? to at least good.

In April 2017 we found that care records did not reflect current risk and people’s care needs. They also lacked the detail required to inform staff how to meet people’s needs. At this inspection we found that care records were regularly reviewed and support plans and risk assessments were updated to ensure the information reflected people’s current care needs.

At the last inspection we found that regular quality assurance audits of care records had not identified the omissions, lack of detail and updates in care records or the failure to refer people to the relevant health care professionals in relation to falls. At this inspection we found that the audit was more robust and issues identified were highlighted to staff and the necessary action taken.

Care plans and risk assessments provided information to inform staff about people's support needs, routines and preferences. They had been reviewed regularly and reflected people's care needs accurately.

Medicines were managed safely in the home.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported.

Safety checks of the environment and equipment were completed regularly.

There were enough staff on duty to provide care and support in a safe manner to people living in the home.

The provider had robust recruitment procedures in place to ensure staff were suitable to work with vulnerable adults.

People living in the home and relatives were able to share their views and were able to provide feedback about the service. Feedback we received from people, relatives and staff was complimentary regarding the manager’s leadership and management of the home.

Systems and processes were in place to assess, monitor and improve the safety and quality of the service.

We have made a recommendation about the completion of some risk assessments.

Kyffin Taylor is a residential care home located in Maghull. The home provides accommodation and personal care for up to 29 people, the majority of whom were living with dementia. The building has 21 rooms on the ground floor and eight on the first floor. There is a car park at the front of the home and secure, well maintained gardens at the rear. There were 28 people living in the home at the time of our inspection.

There was a registered manager in post. 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.

Prior to the inspection we had concerns regarding the monitoring of people who may be at risk of falls. We found assessments and care planning was not always updated to support safe care.

Systems and processes were in place to assess, monitor and improve the safety and quality of the service. We found these had not fully identified the issues we reported on regarding people’s safety.

Medicines were managed safely in the home.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported.

Safety checks of the environment and equipment were completed regularly.

Adaptations were in place to promote a dementia friendly environment. This was to ensure the comfort and wellbeing of people who lived at the home.

There were enough staff on duty to provide care and support to people living in the home. The provider told us they were increasing staff numbers to further assure safe care.

The provider had robust recruitment procedures in place to ensure staff were suitable to work with vulnerable adults.

Staff worked in partnership with health and social care professionals to make sure people received the care and support they needed.

Staff were trained to ensure that they had the appropriate skills and knowledge to meet people's needs. They were well supported by the registered manager.

Staff sought the consent of people before providing care and support. The home followed the principles of the Mental Capacity Act (2005) for people who lacked mental capacity to make their own decisions.

People liked the food and were able to choose what they wanted to eat.

We found that staff had a good understanding of people’s care and individual needs.

People at the home were listened to and their views were taken into account when deciding how to spend their day.

Care plans provided information to inform staff about people's support needs, routines and preferences. They had been reviewed regularly and most reflected people’s care needs accurately.

People told us staff were kind, polite and maintained their privacy and dignity. We observed positive interaction between the staff and people they supported.

A programme of activities was available for people living at the home to participate in.

A process for managing complaints was in place. People we spoke with knew how to raise a concern or make a complaint.

People living in the home and relatives were able to share their views and were able to provide feedback about the service.

Feedback we received from people, relatives and staff was complimentary regarding the managers' leadership and management of the home.

You can see what action we told the provider to take at the back of the full version of this report.

This inspection was ‘focussed’ in that we only looked at the three breaches of regulations to see if the home had improved and the breaches were now met. This report only covers our findings in relation to these specific areas / breaches of regulations. They cover only three of the domains we normally inspect; whether the service is 'Safe' ‘Responsive’ and ' Well led'. The domains ‘Effective’ ‘Caring’ were not assessed at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Kyffin Taylor' on our website at www.cqc.org.uk.

On this inspection, we found improvements had been made and the home had taken action to address the issues identified with regards to medications. There was also action taken to ensure more person centred information was included in peoples care plans. Quality assurance systems were in place to monitor and improve standards in the home had also been improved. The two breaches of regulation were now met.

There was a registered manager in post. 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.

We spent time looking at the medication processes in the home to check if the areas identified in our last report had been improved, and if the warning notice had been met. We saw there were systems in place to monitor and check medications, which were more robust, including additional training for staff.

The provider was able to evidence a series of quality assurance processes and audits carried out internally by staff, the registered manager and the area manager. We found these had been developed to meet the needs of the service.

While improvements had been made we have not revised the overall quality rating for the home. To improve the rating to ‘Good’ would require a longer term track record of consistent good practice. We will review the quality rating at the next comprehensive inspection.

Kyffin Taylor is a residential care home located in Maghull. The home provides accommodation and personal care for up to 29 people, the majority of whom have dementia. The building has 21 rooms on the ground floor and eight on the first floor. There is a car park at the front of the home and secure, well maintained gardens at the rear. On the day of inspection there were 28 people living in the home.

A registered manager was in post. 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.

Medicines were not always managed safely within the home. For instance, there were gaps observed in the recording of administered medicines and room temperatures where medicines were stored were not monitored; however fridge temperatures were monitored and recorded but were not within safe ranges. Medicines were not always administered in line with safe administration guidance.

All people we spoke with told us they felt safe living at Kyffin Taylor and relatives agreed. One person told us, “I feel very safe here” and another person told us, “They are all kind to us, I feel very safe.”

We found that there was an effective procedure in place to recruit staff and there were adequate numbers of staff on duty to meet people’s needs.

Care files showed staff had completed risk assessments to assess and monitor people’s health and safety. We saw risk assessments in areas such as falls, nutrition, mobility and pressure relief. Staff had completed training in relation to safeguarding and had a good understanding of how to report concerns. A small number of safeguarding incidents had not been reported.

We looked at accident and incident reporting within the home and found that accidents were reported appropriately. Measures were in place to ensure the environment was safe and well maintained, including equipment used within the home.

We found that people’s consent was usually sought in line with the principles of the Mental Capacity Act 2005 and deprivation of liberty safeguards (DoLS) were applied for appropriately.

Staff received an induction into their role and completed regular training to help ensure they had the knowledge and skills to meet people’s needs. Not all staff had received supervision in the last few months, however staff told us they felt well supported.

When asked about the food we received mixed feedback. People told us the food was nice but that they did not always get a choice in what they ate, but that alternatives were available should they not like the meal offered.

Some adaptations had been made to the environment to assist people with orientation and safety, such as pictoral signs. This meant that people’s independence and safety was promoted within the home.

People living at the home told us staff were kind and caring and treated them with respect and relatives we spoke with agreed. Staff knew the people they were caring for well, including their needs and preferences. Interactions between staff and people living in the home were warm and caring.

People we spoke with told us their relatives visited frequently and relatives we spoke with were happy with the visiting arrangements. People were happy with the care they received and relatives were involved in the care planning process. Care plans were in place which offered guidance on how to support people, but some lacked sufficient detail.

Preadmission assessments were completed to ensure people’s needs could be met as soon as they moved into the home.

Activities were available for people to participate in, such as quizzes, games and singing.

People were able to share their views through quality assurance surveys and regular meetings and had access to a complaints procedure. A process was in place to manage complaints, forms were available for people to use and relatives we spoke with were aware how to raise concerns should they need to.

Systems were in place to monitor the quality and safety of the service, however they did not pick up on all of the issues highlighted during the inspection. We also found gaps in the recording of some care provision, such as repositioning records and dietary charts were not always completed accurately.

We asked people their views of how the home was managed and feedback was positive. All people we spoke with felt able to raise concerns should they need to and were confident that they would be listened to.

Although the registered manager had notified CQC of some events and incidents within the home in accordance with our statutory notifications, they had not notified us of all safeguarding referrals that had been made.

You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found appropriate care plans and risk assessments in place. These were sufficiently detailed, individualised to each person and reviewed regularly. Records we saw showed evidence of involving people in planning their care and establishing consent. We observed staff providing care and found they were warm, polite and respectful in their interactions. Staff had a good understanding of the needs of the people that used the service. This view was shared by the relatives we consulted, who also told us they felt their relative was safe living at the service. As part of our inspection we asked for infromation regarding any Deprivation of Liberty Safeguards (DoLS) applications that had been made. The manager informed us there were no DoLs in place at the service at this time. During our visit we noted that the service was clean and hygienic and all equipment and appliances within the home were checked and serviced regularly, this prevented putting people at unnecessary risk of harm or injury.

Is the service effective?

We found that staff members were knowledgeable about the needs and wishes of people living at the service and support was delivered in a way that met those needs. Records we reviewed confirmed that appropriate checks had been undertaken before staff started work, to ensure the suitability of people working at the home.

Is the service caring?

Relatives of people who lived at the Kyffin Taylor told us staff were caring and responsive to the needs of the people who used the service. Staff told us they were clear about their roles and responsibilities and told us how they promoted people's independence and respected their privacy and dignity. People we spoke to commented; 'All the staff are really nice, nothing is too much trouble for them.'

Is the service responsive?

People who lived at the home were listened to and their views were acted upon. People were asked to give feedback on their experience of the service. The registered manager did this, through the use of surveys and meetings. People's feedback was then used to make improvements to the service.

Is the service well-led?

During our inspection we looked at the quality assurance systems currently in place at Kyffin Taylor. We found that the provider had put in place both internal and external audits. We saw records which confirmed that the provider had an effective system in place to take account of comments or complaints relating to the service.

During our inspection, we found the home to be warm and welcoming with a pleasant atmosphere. All the relatives we spoke with were very satisfied with the care being provided. One relative said, 'She always appears well presented and cared for.' They went on to tell us they visited every day and felt the staff were caring and attentive.

We reviewed two people's care records and found they contained the majority of information staff required to provide care in a way which met people's individual needs. However, we found the way the home had supported a person who had behaviour that challenged the service had not been monitored and reviewed appropriately.

We were shown around the building and checked maintenance records for fire, water, gas and electrical safety. The building had been well maintained and this meant people were protected against the risks of unsafe or unsuitable premises. The staffing levels in place were satisfactory at the time of the inspection. An effective complaints system was in place within the home.

Two people said they would like more things to do during the day. One of the relatives we spoke with, when asked whether any improvements could be made, said they would like to see more activities in the day for the people living there.

We spoke with six people who were visiting their relatives who live in the home. One person said 'It is an excellent place. I could not praise it enough. I come everyday and it is always spotlessly clean.' Another visitor said, 'Staff go out of their way to respond to people when they need assistance.' The relative of a person who had recently moved into the home told us the manager and care workers had been really supportive to their family during their relative's admission.