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Kara House Residential Care Home Requires improvement

We are carrying out checks at Kara House Residential Care Home. We will publish a report when our check is complete.

Inspection Summary

Overall summary & rating

Requires improvement

Updated 8 June 2017

This inspection took place on the 18 and 19 April 2017 and was unannounced. The service was last inspected in February 2016 when it was rated as Requires Improvement.

Kara House is a care home registered to provide personal care and accommodation to 35 older people. At the time of our inspection there were 32 people living at the service. The home has two shared rooms, one of which two people shared.

One of the directors of the provider (Trinity Merchants Ltd) was managing the service after the registered manager had left in November 2016. They were in the process of being registered with the Care Quality Commission (CQC). 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. The manager had previous experience of managing care homes registered with the CQC.

Since January 2017 a senior carer had been given additional responsibilities at the service. They were supernumerary to the shift and completed audits and updated care plans.

People received their tablets as prescribed and the medicines administration records were fully completed. However, we noted two people had been prescribed two creams, one to be applied twice per day and one three times a day, the cream charts indicated they had been both applied three times a day. Guidelines for creams that had been prescribed ‘as required’ were not in place. These were immediately changed and implemented following our inspection.

We found improvements had been made since our last inspection. An activities officer had been employed who organised regular group activities and worked with some people on a 1:1 basis. The home had been re-decorated and was now more homely, with new pictures on the walls and notice boards with reminiscence items in the hallway. Record keeping was more thorough, with the food and fluid charts now being fully completed.

A comprehensive range of audits and monitoring was in place, completed by the senior with extra responsibilities and reviewed by the manager. However these had not identified the issues we found with the cream charts and ‘as required’ guidelines. We saw issues that had been identified in the audits had been recorded and actions put in place.

All the people we spoke with said they felt safe living at Kara House and that the staff were kind, respectful and knew their needs well. We heard and saw positive interactions between people and staff members throughout the inspection.

There were sufficient staff on duty to meet people’s needs, however some people said they had to wait longer for staff to support them at a weekend.

A safe system of recruitment was in place, although the gaps in employment for one new staff member had not been explained. After the inspection the manager told us they had obtained this information. An induction process was in place where new staff shadowed experienced staff so they could get to know people and their needs. Training was arranged and staff who were new to care were enrolled on the Care Certificate. Refresher training was up to date for existing staff. 90% of staff had obtained a recognised qualification in health and social care. The manager completed staff supervisions and regular staff meetings were held. This meant staff had the training and support to undertake their roles.

Care plans and risk assessments were in place for each person. These recorded their health and social care needs and provided staff with guidance on how to support people and mitigate any risks that had been identified. Care plans and risk assessments were evaluated each month by the senior care staff and updated for any changes in people’s needs.

Handovers were held between each shift to update the staff on any changes in people’s needs or health. This meant staff had the information to support people and meet their needs.

Staff had a good understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards procedures. Capacity assessments and best interest decisions had been completed and applications for a DoLS made to the local authority where required. People confirmed the staff gave them choices over day to day decisions and supported them to complete the tasks they could do for themselves so that they maintained their independence.

Incidents and accidents were recorded and analysed to identify any patterns; for example falls. We saw referrals to the falls team or dementia crisis team were made where required.

Systems were in place to meet people’s health and nutritional needs. People were regularly weighed in line with the assessed risk and referrals made to the Speech and Language Team (SALT), district nurses and other medical professionals as needed. Medical professionals told us the service made appropriate referrals and followed any advice they were given.

People’s end of life wishes were currently sought as they became unwell, with the person’s family being involved. Additional training in the ‘Six Steps’ for end of life care had been arranged for two staff. They would lead on developing care plans with people and their families before they became unwell so their wishes for their care at the end of their lives was known.

A medical professional told us the end of life care provided at Kara House was good, with some people’s health improving so they were able to come off the end of life pathway.

All areas of the home were clean. Procedures were in place to prevent and control the spread of infection.

Systems were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and gas supply. Regular checks were in place of the fire systems and equipment.

Regular resident meetings were held where people were asked for their feedback on the service. Relatives told us the staff and manager were approachable and they would raise any concerns they had directly with the staff. They said their concerns were acted upon by the staff team. Relatives also told us the service kept them fully informed about any changes in their loved ones health or wellbeing.

Inspection areas


Requires improvement

Updated 8 June 2017

The service was not always safe.

Oral medication was administered as prescribed. However guidelines for ‘as required’ medicines and creams were not always in place and the records showed some creams had been applied more frequently than prescribed. New guidelines and cream charts were written immediately after our inspection.

A safe system of staff recruitment was in place. However, one of the three files we looked at did not contain details of a gap in the staff member’s employment history. This information was obtained following our inspection.

Staff had received training in safeguarding vulnerable adults and knew the correct action to take if they witness or suspect abuse. We saw referrals to the local authority safeguarding team had been made appropriately

Care records included information about the risks people may face and guidelines for staff in how to minimise or eliminate the risks.



Updated 8 June 2017

The service was effective.

Staff received the training and support through supervisions to undertake their role.

The home worked within the principles of the Mental Capacity Act (MCA). Staff had a good understanding of the MCA and Deprivation of Liberty Safeguards so that people’s right were protected when they lacked capacity to consent to their care and treatment.

People’s nutrition and health needs were identified and referrals to other medical professionals were made when required. Food and fluid charts had been improved since the last inspection.

Improvements had been made to the environment to support people living with dementia.



Updated 8 June 2017

The service was caring.

People who used the service and their relatives all said that the staff were kind and caring and knew their needs well.

End of life care plans were implemented when people were approaching the end of their lives. Additional staff training had been planned to improve the recording of people’s wishes and their care at the end of their lives.



Updated 8 June 2017

The service was responsive.

An activities organiser had been recruited and they provided regular activities for people to join in with if they wanted which would help maintain people’s wellbeing.

Care plans were person centred and included details of people’s support needs and guidelines for staff in how to support people to meet these needs.

Daily records, including details of any behaviours that challenged the service were detailed and fully completed. However we found the personal care charts were not always fully completed.


Requires improvement

Updated 8 June 2017

The service was not always well led.

A director of the provider organisation was managing the service and was in the process of registering with the Care Quality Commission.

A senior with extra responsibilities had been introduced. They completed a comprehensive system of audits; however issues we found with the medicines had not been identified through the audits.

Regular staff meetings were held, which had noted an improvement in staff morale since the manager took over in November 2016.